End Fatigue

Minalcipran for Fibromyalgia Pain

The FDA has recently (and for the first time) begun to approve medications for treating fibromyalgia pain. In the last year, the FDA has approved Lyrica, Cymbalta, and now Minalcipran. Although these medications can be helpful, and you will hear about them (each company will spend ~ $70 million/year advertising them), it is critical to remember that the key to pain relief is to use the "SHINE Protocol" to eliminate the underlying causes of the pain. Pain is like the "oil light on your dashboard" telling you that something urgently needs attention. By treating SHINE:

Sleep
Hormonal support (despite normal lab tests)
Infections
Nutritional support, and
Exercise as able

Most of you will find that your pain will go away, or at least markedly decrease. In the interim, or even long term in cases where we can't get to the root cause of the pain, pain medications can offer a lot of relief.

Minalcipran is a medication that is related to Cymbalta and Effexor, and increases levels of serotonin and norepinephrine. Both of these neurotransmitters have been shown to lower pain. Minalcipran may work when these others have not, as it more effectively raises norepinephrine (a cousin to adrenaline). The research showed that Minalcipran dropped pain scores by an average of ~ 1/3, with relief beginning at ~ 1 week and being maximal at 9 weeks.

Using the 100 mg dose was every bit as effective as the higher 200 mg dose — but caused a lot more side effects. The main side effect was nausea, which interestingly goes away after ~ 6-10 days (so simply lower the dose if this is a problem, and then raise it gradually).

Minalcipran, though approved, has not yet been released for use in the U.S., but likely will be soon (no release date yet). It is available in Europe. It will be marketed in the U.S. as "Savella."

For a detailed program on eliminating pain, see Eliminating Fibromyalgia Pain.

Reference

Mease PJ, et al. J Rheumatol 2009; 36:398-409 The Efficacy and Safety of Minalcipran for Treatment of Fibromyalgia

(Note — All of the study authors were on the payroll of the companies making Minalcipran.)