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LETTERS TO THE EDITOR

Lithium for Fibromyalgia

Department of Anesthesiology, Wake Forest University Medical Center, Winston-Salem, NC

To the Editor:

I feel ethically obligated to write this letter. I am an anesthesiologist and have been disabled by fibromyalgia for over 10 years. During this time, my husband, John Lewis, also an anesthesiologist, and I have been studying the disease.

After excess activity, a major component of my pain can become debilitating, affecting all aspects of life and preventing sleep. This pain is not responsive to opioids, NSAIDs, or gabapentin. However, a dose of 300 mg of lithium carbonate will decrease the pain by 70–80% within 40 minutes. The effect lasts 4–5 hours. It is dramatic. It is reproducible. There is precedent for its use (1,2).

Dr. Lewis and I believe that fibromyalgia may be related to a calcium-parathyroid axis dysfunction. Lithium causes a brief rise in parathyroid hormone. Perhaps this is the reason for the drug’s efficacy (3).

Lithium has a long history of safe use. It is inexpensive and readily available. Side effects are usually well tolerated. If large doses are needed, blood levels should be monitored. It is worth a try.

References

1. Tyber MA. Lithium carbonate augmentation therapy in fibromyalgia. Can Med Assoc J 1990; 143: 902–4.[Medline]
2. Teasell RW. Lithium therapy for fibromyalgia [letter]. Can Med Assoc J 1991; 144: 122–3.
3. Lewis JM, Fontrier T. Lithium and fibromyalgia. J Musculoskeletal Pain 2003; 11: 69–70.

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