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Pharmacologic Therapy in Fibromyalgia (FM) and Chronic
Fatigue Syndrome (CFS)
Pharmacologic Therapy in Fibromyalgia (FM) and Chronic
Fatigue Syndrome (CFS)
Daniel J. Clauw M.D.Daniel J. Clauw M.D.
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SymptomsSymptoms
Psychological and Behavioral
Consequences
• Decreased activity
• Poor sleep
• Increased distress
• Maladaptive illness behaviors
Psychological and Behavioral
Consequences
• Decreased activity
• Poor sleep
• Increased distress
• Maladaptive illness behaviors
Dually Focused TreatmentDually Focused Treatment
“STRESS”“STRESS”
POOR ENVIRONMENTPOOR ENVIRONMENT
BAD GENESBAD
GENES
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Some BenefitSome Benefit• Tricyclic compounds
• Amitriptyline (Elavil) and Cyclobenzaprine (Flexeril) best studied
• Tolerability improved by giving single dose several hours before bedtime
• Start low, go slow. Begin with 5 or 10 mg and increase to 30 - 40 of cyclobenzaprine or 50 – 70 mg amitriptyline
• Of most benefit in treating pain, insomnia; less improvement in fatigue
• Tricyclic compounds• Amitriptyline (Elavil) and Cyclobenzaprine
(Flexeril) best studied• Tolerability improved by giving single dose
several hours before bedtime• Start low, go slow. Begin with 5 or 10 mg and
increase to 30 - 40 of cyclobenzaprine or 50 – 70 mg amitriptyline
• Of most benefit in treating pain, insomnia; less improvement in fatigue
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Some BenefitSome Benefit
• Other classes of neuroactive compounds– MAO inhibitors– Mixed serotinergic / noradrenergic compounds– SSRI generally ineffective– Gabapentin (Neurontin) for pain– Tramadol (Ultram) for pain
• Other classes of neuroactive compounds– MAO inhibitors– Mixed serotinergic / noradrenergic compounds– SSRI generally ineffective– Gabapentin (Neurontin) for pain– Tramadol (Ultram) for pain
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No benefit / possible harmNo benefit / possible harm
• Corticosteroids• Immune-based therapies• Anti-infective therapies• Anti-allergy therapies• Fludrocortisone (Florinef)• Nutritional supplements
– Mg, NADH, essential fatty acids
• Corticosteroids• Immune-based therapies• Anti-infective therapies• Anti-allergy therapies• Fludrocortisone (Florinef)• Nutritional supplements
– Mg, NADH, essential fatty acids