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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