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Proper management is challenging (but not impossible)

Despite expended time and resources, symptoms continue to exacerbate and vary.

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

Many medications are utilized and can be helpful on an individual basis. NSAIDs often provide little relief. Elavil and Flexeril, both tricyclics, have been proven beneficial, but only on a short-term basis. Recently, Ambien has been noted to help.

Antidepressants, anxiolytics, muscle relaxants, antiparkinsonians, hypnotics and anticonvulsants may be utilized. Drug regimens require continual monitoring and modification. Side effects are frequently limiting. Stimulants such as an SSRI, pseudoephedrine or caffeine can be helpful, but should be taken in the morning and combined with a bedtime sleep inducing agent.

Opiates should be avoided, but a short course may be necessary for acute flares. 

Numerous supplements, herbs and other substances are being tried, and do help some patients. Studies have indicated that the combination of magnesium and malic acid helps reduce symptoms. Some promising results have been found with thyroid supplements, human growth hormone and guafenicin.

Physical Therapy should concentrate on aerobics, low resistance/high repetition exercises, stretching and aquatics.

Massage is almost always helpful. Moist heat, pain creams, electrical stimulation and hypnotherapy can be helpful. Some patients benefit from trigger point injections, acupuncture and/or manipulation.

Chiropractic adjustments are most beneficial after massage or moist heat when the muscles are relaxed.

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Support, education along with cognitive-behavioral therapy is necessary.

Maintaining a positive attitude and finding a good doctor may be difficult but are essential.

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