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 Effective Treatment Approaches for CFS, Fibromyalgia and Myofascial Pain 
 
The following is one in an ongoing series of columns entitled From Fatigued to Fantastic by . View all columns in series

Four main categories of problems need to be treated.
A half-century of work by Dr. Janet Travell, the White House physician for Presidents Kennedy and Johnson and author of the Trigger Point Manual showed that the same problems caused by hypothalamic suppression resulted in muscles getting stuck in the shortened position. Chronic muscle shortening then causes myofascial and fibromyalgia pain. As she laid the groundwork for effective treatments these processes, our research team dedicated our published study to her memory. These are the four key areas that need to be treated for Chronic Fatigue syndrome, fibromyalgia and muscle pain to resolve:

1--Disordered sleep. Most patients with these illnesses find that they are unable to get 7-8 hours of deep sleep a night without taking medications. In part, this occurs because hypothalamic function is critical to deep sleep. Unfortunately, many of the most common sleep medications actually aggravate the sleep problems by decreasing the amount of time spent in deep sleep. For patients to get well, it is critical that they take enough of the correct sleep medications to get 8 to 9 hours sleep at night! These medications include Ambien, Desyrel, Klonopin, Xanax, Soma and, if you don't have Restless Leg Syndrome, Flexeril and/or Elavil. In addition, natural remedies can help sleep. An excellent one (which I developed -Revitalizing Sleep Formula by Enzymatic Therapy -- 100 percent of my royalty for all products I develop is donated to charity) includes theanine, Jamaican Dogwood, wild lettuce, valerian, passionflower, and hops. Other natural sleep aids include Calcium, Magnesium, 5-HTP (100-300mg), and melatonin (3/10-1mg). Some patients find that over-the-counter antihistamines such as doxylamine (Unisom for sleep) or Benadryl can also help. In the first six months of treatment, it is not uncommon to sometimes need to take even six to eight different products simultaneously to get 8 hours of sleep at night. After 6-18 months of feeling well, most people can come off of most sleep (and other) medications. I'm starting to believe that, to offer a margin for safety during periods of stress, it may be wise to stay on 1/2 to 1 tablet of a sleep medication for the rest of your life. Your doctor may initially be uncomfortable with this. Nonetheless, our experience with over 2000 patients and 2 research studies have found this approach to be safe and critical to people getting well. When one recognizes that CFS/FMS is a hypothalamic sleep disorder -- not poor sleep hygiene -- this approach makes sense. Otherwise, it is as if your doctor would immediately try to stop blood pressure or diabetes medicines every time the patient was doing better!

2--Hormonal deficiencies. The hypothalamus is the main control center for most of the glands in your body. Most of the normal ranges for our blood tests were not developed in the context of hypothalamic suppression or these syndromes. Because of this (and for a number of other reasons) it is usually necessary, albeit controversial, to treat with thyroid, adrenal (very low dose cortef; DHEA), and ovarian and testicular hormones -- despite normal blood tests! These hormones have been found to be reasonably safe when used in low doses. Growth hormone has also been shown to be helpful in fibromyalgia. We don't use it because, unfortunately, it can cost over $15,000 a year and is given by injection. Fortunately, there may be a cheaper way to raise your low growth hormone. Most growth hormone is made during deep sleep. This may be another reason why getting 8 to 9 hours of deep-sleep a night can be critical!

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 About The Author
Jacob Teitelbaum MD is author of the popular free iPhone application "Cures A-Z" and author of the best-selling book From Fatigued to Fantastic! (3rd revised edition, Avery/Penguin Group) and Pain Free 1-2-3-A......moreJacob Teitelbaum MD
 
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