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Charles B. Alpert, MD has provided some strategies for physicians treating Fibromyalgia patients.  If you are a physician and you would like to add your strategies, please send e-mail to 

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Proper management of fibromyalgia is challenging. Many patients seek frequent medical attention. Despite expended time and resources, symptoms continue to exacerbate and vary. Frustration seems to be the rule.  This condition is not well understood and patients are frequently mismanaged. Many physicians still believe that FMS doesn't really exist.  People commonly go through 5 years of a run-around before the diagnosis is made.

Treatment should include restoration of a normal sleep/wake cycle, aerobic exercise, stress reduction, education, support and symptomatic relief


Many medications are utilized and are helpful on an individual basis. NSAIDS are usually first line, but often provide little relief and may be deleterious. Anti-inflammatories may interfere with stage 4 sleep. The only drugs with proven clinical benefit are two tricyclics (Elavil and Flexeril), although follow-up studies report no lasting effect. Other antidepressants, anxiolytics and anticonvulsants may be beneficial. Side effects of drugs are frequently limiting.

The positive effects of medications seem to wear off over time. Drug regimens should be modified frequently. Modifications are best made one at a time to prevent confusion. One must be careful to avoid using too many drugs. If new meds are added, old ones should be tapered. Opiates should be avoided, due to dependency and the fact that they seem to catalyze chronic pain syndromes. It is helpful for the patient to keep a journal documenting the effects of medications.

Sleep is one of the most important issues in FMS. Non-narcotic drugs that promote sleep are the most appropriate. These may include Benadryl, Norflex, Flexeril, Elavil, Pamelor, Desyrel, Soma, Kava-kava and/or Valerian Root. Ambien, Klonopin, other benzodiazipines, Risperdal or Zanaflex can be used with caution if all else fails. Drugs should only be used short term. Once the sleep cycle is restored, sleepers may no longer needed and should be tapered.

Non-narcotic AM stimulants may be helpful, especially for fibro fog. Ginkgo Biloba, ginseng, SSRIs (i.e. Prozac), caffeine and pseudofed have been used.  Special caution needs to be taken with SSRIs due to the possibility of sleep disruption and agitation.

Other herbs, dietary supplements/restrictions and melatonin have been recommended and have been successful for some.  Magnesium and malic acid seem to be helpful.  Melatonin has not proven to be all that effective with most people.  The question about whether guafenicin helps has not been answered as of yet- reports are conflicting

Hypnosis, stress reduction techniques, moist heat, pain creams, aquatherapy and massage are helpful for symptomatic relief. Some patients benefit from trigger point injections, biofeedback, acupuncture, manipulation and/or TENS. Cognitive-behavioral therapy has been found to be of lasting benefit.

Education needs to be stressed.  Coping strategies should be reviewed at length. Vocational issues need to be addressed. The family should be involved in the care plan and treatment. Creating daily planners and weekly routines reduce stress and are helpful.

Devin Starlanyl, MD and fibromyalgia patient, has provided useful information for physicians.  Please visit Devin's Diagnostic

She also provides information for every member of the healthcare team.  Please visit 



Additional resources for Physicians



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