I came across the website of a pain treatment clinic here in Los Angeles. Below is what they advise for the treatment of fibro. Some of these drugs I have never heard of such as Anzemet and Zofran. This doctor seems to have quite a protocol for fibro treatment. Just thought this is interesting. (So many regular doctors are reluctant to prescribe pain meds). Improving the quality of sleep is a priority. Your doctor may prescribe medications such as Xanax, Klonopin, Elavil and Trazodone to do just that. Your doctor may also prescribe strong painkillers such as Vicodin ES, MS Contin or Oxycontin. One of the ways these medications give you pain relief is by decreasing the level of Substance P in your tissues, joints and spinal fluid. In some recent studies, injection or oral administration of the serotonin-3 antagonist medication Tropisetron significantly reduced pain symptoms in patients with fibromyalgia. Medications in the same family as Tropisetron such as Dolasetron (Anzemet) and Ondansetron (Zofran) are normally used for treatment of chemotherapy induced nausea and vomiting. These medications bind to serotonin receptors and diminish serotonin induced release of substance P from nerve fibers. In other studies, injection of steroid (methyl prednisolone acetate) in the spinal fluid reduced the levels of a pain transmitter called interleukin-8 and produced dramatic and long lasting pain relief in patients with nerve pain from shingles. It is not yet known if this type of treatment may also help patients with fibromyalgia. Anti- inflammatory drugs such as Tolmetin may be helpful by reducing pain and inflammation but sometimes can irritate the stomach and cause heartburn or ulcers. Celebrex and Vioxx are a new type of anti-inflammatory drugs called COX- 2 inhibitors. These drugs are effective and will not irritate the stomach. A new technique of injection of Botulinum toxin in the painful muscles may relieve muscle pain. Botulinum toxin is produced by the bacteria Clostridium botulinum, which causes botulism food poisoning. The toxin allows muscles that are in spasm to relax. The injection is very safe but not widely known and only performed by a few doctors. An alternative therapy that has helped some patients is Guaifenesin, which is an ingredient in many over-the-counter cough medications. However do not use Guaifenesin in combination with the other ingredients that are found in cough mixtures, as these can produce side effects. Guaifenesin must be used as a 200 mg pure tablet, which is available over the counter or a 600 mg tablet available by prescription. Alternative therapy practitioners believe that Guaifenesin may help by increasing body levels of serotonin and decreasing body levels of phosphate. Excess phosphate results in cellular overactivity followed by fatigue. There is reported to be an initial worsening of symptoms with the onset of Guaifenesin treatment and it may take a few months to see an improvement. When you have a flare- up, use common sense and do not fight the pain. Put ice or heat on your painful joints and muscles and wear your brace if you have one. You may rub over-the-counter ointments, rubs and sprays such as Eucalypta Mint, Ben-Gay or Flex-all 454. A new ointment called Zostrix (Capsaicin) may also help painful joints by decreasing the amount of substance P, which sends pain signals to the brain. Zostrix is the burning ingredient in red-hot chili peppers. The ointment itself may give you a funny burning sensation that lasts the initial couple of days. Wear rubber gloves when you apply it and keep it out of your eyes. Rest is important because fatigue can make the pain worse. Your doctor may sometimes recommend injections of steroid into the painful joints. Pantothenic acid (also called Vitamin B5) has been found to decrease inflammation and relieve pain in some people. Take 1000 mg daily for one month and then reduce to 500 mg daily. Your doctor may use biofeedback or meditation to help you learn to relax. If you are depressed you may need a higher dose of antidepressant medication and counseling. Call your Doctor if you experience constipation or any side effects from your medications. Inform your doctor that you have a right to obtain adequate pain relief. National Organization: The Fibromyalgia Network Phone: 1- 800-853-2929). You may request educational brochures and information on classes, clubs, support groups and physician referrals.. Note: All medications mentioned on this site--including, specialty compounded ointments such as Capsaicin, Gabapentin, Ketamine, Vitamin E--may be ordered directly from L.A. Pain Clinic.