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What can you tell me about the new drug for fibromyalgia? I've been using amitriptyline but wonder if I should switch.

In June of 2007, the Food and Drug Administration (FDA) approved the first drug for the treatment of fibromyalgia syndrome (FMS). Pregabalin (Lyrica) is an anti-seizure medication that has been shown to reduce the painful symptoms of FMS by as much as 50 per cent.

Off-label use of pregabalin was first approved for the management of diabetic neuropathy and neuralgia (nerve pain) from shingles. It appears to work by reducing the release of substance P and glutamate. These are neurotransmitters or nerve messengers that play an important role in signaling pain to the brain.

Amitriptyline is a tricyclic antidepressant (TCA). It provides pain relief, sleep, and an overall sense of well-being in patients with FMS. Amitriptyline and other TCAs seem to work well for many people with FMS. But studies have shown that over time, their effectiveness may decrease.

If your symptoms are under control with amitriptyline, there may be no need to switch medications. But if you find that your symptoms are less well-managed over time, then it may be a good idea to consider something else.

Discuss this and all other options with your primary care physician or specialist who is helping you manage your FMS. Drug therapy should always be combined with a wide range of other nondrug treatment.

Yoga, meditation, and other forms of relaxation have been shown to help. Exercise has some of the same benefits of the anti-depressants used to treat FMS. Proper nutrition and stress management are key elements in the management of FMS.

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