Monday, July 15, 2013

Proven Treatments for CFS and Fibromyalgia

Proven Treatments for Fibromyalgia and Chronic Fatigue Syndrome
July 12, 2013

At the 2012 meeting of the Collegium Internationale
Neuro-Psychopharmacologicum (CINP), a symposium was held to discuss
fibromyalgia and chronic fatigue syndrome, two illnesses that remain


Fibromyalgia is more common in women than in men and is characterized
by aching all over, decreased sleep, stiffness upon waking, and most
prominently, being tired all day, as well as a host of other symptoms
including headache, dizziness, and gastrointestinal upset. Researcher
Siegried Kasper suggested that treating fibromyalgia requires more
than just medication. His approach is known as MESS, which stands for
medication, exercise, sleep management, and stress management.

Medications to treat the illness include milnacipran (not available in
the US), duloxetine (Cymbalta, a serotonin-norepinephrine reuptake
inhibitor or SNRI), or pregabalin (Lyrica), and if tolerated, low
doses of the tricyclic amitriptyline (Elavil).

According to Kasper, SSRIs and anti-inflammatory drugs don't work, and
benzodiazepines decrease the deepest phase of sleep (stage 4) and can
exacerbate the syndrome.

Recommended exercise is moderate, graded (to a pulse of about 120, or
at a level where the patient can still talk, but can't sing), and
should be done in the early morning rather than the late afternoon
where it might interfere with sleep.

Good sleep hygiene is recommended, such as keeping the same sleep
schedule every day and abstaining from caffeine (even in the morning).

Working on developing active coping strategies for stressors that are
likely to occur is a good idea. Mindfulness and other meditative
techniques may also be helpful. Joining a support group (that
encourages exercise rather than discouraging it) was also recommended.

Chronic Fatigue Syndrome

At the CINP meeting researcher Simon Wessely discussed chronic fatigue
syndrome (CFS), which has many overlaps with fibromyalgia. He reported
that careful controlled study of more than 15,000 individuals has
indicated that the illness is not associated with a viral infection.
Just as many people with and without chronic fatigue syndrome were
found to be infected with a virus.

However, like the myth that vaccines cause autism, the myth that
chronic fatigue is associated with a virus remains popular despite the
lack of evidence. A large randomized study validated Wessely's
treatment techniques, but he has continued to be vilified for the
position that the illness is not virally based. The study showed that
patients who participated in cognitive behavior therapy and graded
exercise improved more than those who received conventional medical

Wessely thought the most important cognitive change to make was
accepting that exercise is not harmful for patients with chronic
fatigue syndrome, and is in fact helpful and therapeutic. Many older
treatment approaches had advocated rest, rest, and more rest, or even
"intensive rest." However, Wessely indicated that this would be
counter-productive, as the patient would lose muscle mass and
cardiovascular conditioning, and would become even more tired and
chronically fatigued.


Although the editors of have made every effort to
report accurate information, much of the work referenced here is in
abstract or pre-publication form, and may not have received proper
review by the scientific community at this time. Patients should
consult with their physicians about any treatment decisions.
Physicians should consult the peer-reviewed literature.

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