Although there is no cure for fibromyalgia (FM) or chronic fatigue syndrome, also called chronic fatigue and immune dysfunction syndrome (CFIDS), prescription medications can improve symptoms and help the patient work toward recovery. In general those with CFIDS and fibromyalgia are sensitive to medications and require very small dosages to achieve the desired effects. They also may not be able to tolerate even small dosages of some medications and these should be avoided or replaced with other ones.
The most important prescription treatments are those that improve the quality of sleep. The majority of CFIDS/FM patients do not experience deep, refreshing sleep and may need medications to help improve the quality of their sleep. The most prescribed of these medications are the tricyclic anti-depressants especially Doxepin and Evavil. These medications in addition to their anti-depressant effects also exhibit sedating properties and help to improve sleep quality. The dosages used for CFIDS and fibromyalgia are much less than those used for depression usually 5- 50 mg. Another class of drugs used for sleep is the benzodiazepines such as Klonopin and Ativan. These medications also help reduce anxiety and help protect the brain from the effects of over stimulation which is common in CFIDS and fibromyalgia. Other medications used for sleep include Desyrel, Ambien, Soma and Flexeril.
As the quality of sleep improves, symptoms will also improve including fatigue, cognitive problems and pain. Non-prescription sleep treatments such as valerian root plus lemon balm and melatonin can also be helpful and are sometimes used in place of medications.
Another class of medications taken for CFIDS/FM is the selective serotonin reuptake inhibitors (SSRIs) which include Prozac, Zoloft and Paxil. The dosages used for CFIDS and fibromyalgia are generally lower than those used for depression. These drugs can help ease depression and anxiety, improve sleep and increase energy. Recently there has been some controversy involving these medications especially their long-term use. This has caused many CFIDS doctors to avoid using them except in cases of major depression. Natural alternatives can be effective substitutes and are usually without side effects. These include 5-HTP, St. John's Wort and Sam-e.
Fibromyalgia patients and less frequently CFIDS patients may require prescription medications to manage pain. As sleep disturbances are corrected and other areas are addressed such as nutritional issues, pain will usually improve; however, pain medications are sometimes necessary. A new medication that is being used effectively to control fibromyalgia pain is Celebrex. It is a newer class of the non-steroidal anti-inflammatory drugs (NSAIDS). Traditional NSAIDS, such as aspirin and ibuprofen, aren't as effective as Celebrex, and these medications can cause stomach bleeding, and can worsen food sensitivities and leaky gut. They should be used with care. For those with Sulfa allergies, Celebrex should be avoided and Vioxx is often used instead.
Narcotics are the strongest of the pain relievers and carry a risk of physical and psychological addiction. They are sometimes necessary in cases of severe pain. Muscle relaxers such as Soma and Flexeril can help with fibromyalgia pain in addition to improving sleep quality. Ultram is a cousin to the narcotic family. It is a strong pain reliever, but with less potential for addiction.
Another drug that is being used effectively in managing fibromyalgia pain and other symptoms is Neurotonin. It is approved for use in epilepsy, yet some doctors find it helpful in fibromyalgia and CFIDS.
Natural pain treatments can be effective in managing pain without side effects and the potential for addiction. These include the combination of magnesium and malic acid, MSM, Sam-e, glucosamine sulfate and chondroitin sulfates and essential fatty acids.
Prescription drugs are also used in CFIDS/FM to correct hormonal imbalances. Hypothyroidism or under-active thyroid is common in these conditions and is treated with natural or synthetic thyroid hormones. Also DHEA, an adrenal hormone, is often low and can be an effective treatment. Another adrenal hormone that can be low is cortisol. There is a lot of controversy among doctors over whether to administer corticosteroids in these instances. Some will use low-dose hydrocortisone (Cortef) to try to bring cortisol levels back to normal and to support the adrenal gland while others argue that this causes the body to shut down normal cortisol production and causes other dangerous side effects. In CFIDS patients with neurally mediated hypotension (NMH), another corticosteroid called Fludrocortisone (Florinef), is often prescribed to help normalize blood pressure regulation. The use of growth hormone has
shown good results in CFIDS patients who are deficient. The dosages used in CFIDS patients are a fraction of the dosages used for those with GH deficiency who do not have CFIDS.
Because the immune system of CFIDS/FM patients is not functioning optimally, they are susceptible to opportunistic infections. Prescription drugs may be useful in their treatment. These include anti-fungals such as diflucan, sporonox and nystatin which are used to treat candida and yeast infections, antibiotics which are used to treat mycoplasmal or bacterial infections, anti-virals such as Famvir and Valtrex which are used to treat active viral infections. Antibiotics should be used with care as they can cause yeast overgrowth. Olive leaf extract is powerful, natural antibiotic and anti-viral agent.
It is important to find a physician who is knowledgeable in the field of CFIDS and fibromyalgia who can work with you to determine what medications are appropriate for you. When used correctly, prescription drugs can be valuable tools in the treatment of these conditions.