Amitryptoline - Elavil

- 12.5-75 mg -low doses help reduce symptoms and minimize side effects.  If it is going to work it will do so in the first two weeks. (N=23)  Jaeschke, et al, Clinical usefulness of Amitryptoline in Fibromyalgia, results of 23 randomized control trials.  Journal of Rheumatology 18(3) 447-51, 3/91

Paxil and Trazadone

- serotonin re-uptake inhibitors - anecdotally useful - I couldn't find papers on it.

Ibuprofen and Xanax (Alprazolam)

are useful when used together. N=78, 4 groups - I, A, IA, Placebo. IA group responded well, N=52 8 weeks - same results.  McBroom, Hester, Treatment of Primary FMS with Ibuprofen and Alprazolam, double blind, placebo controlled study.  Arthritis and Rheumatism 34(5) 552-60, 1991 May

Hypnotics: Halcion, Restoril, Dalmane

- 14 pts, 10 of 14 had complete resolution of symptoms in one to 4 weeks (mean = 3 weeks), 2 had reduction of symptoms, 2 unresponsive patient responded to electro-acupuncture. Side effects can be a problem. Rothschild, B, Retrospective assessment of Fibromyalgia therapeusis.  Comprehensive Therapy, 20(10): 545-9, 1994

Clomipramine (Anafranil)

- a serotonergic anti-depressant better at relieving pain than depression,

Amitriptyline

is effective at doses lower than those used in major depression. Goodrich, PJ, Sandoval, R. Psychotropic treatment of CFS and related disorders (review); J of Clinical Psychiatry 54(1): 13-20, 1993, Jan.

Cyclobenzaprine (Flexaril)

10 mg at night works as well as 30 mg (10 TID) in reducing symptoms and 30 mg significantly increases side effects. Santandrea et al, "A double blind cross over study of two Cyclobenzaprine regimens in primary FMS."  J of International Medical Research 21(2), 74-86, 1993, April

Cyclobenzaprine (Flexaril) and Ibuprofen

- N=32, 15 pts - 10 mg Flexural, 17 pts 10 mg Flexaril and 600 mg Ibuprofen. C+I better for morning stiffness, all symptoms improved to the same extent

S-Adenosylmethionine

is helpful with pain, fatigue, morning stiffness.  It is an anti-inflammatory, analgesic, antidepressant.  N=44 Jacobsen, S; "Oral s-Adenosylmethionine in primary fibromyalgia", Scandinavian J of Rheumatology, 20(4) 294-302, 1991)

Thyroid- Cytomel-T-3

-The hypothesis is that T3 receptors are resistant to T3 hormone.  Increased cortisol levels, as seen after an accident or surgery or during emotional trauma, lead to a decrease in TSH and a shift from beta-receptors to alpha-receptors. Patients resistant to T4 and desiccated thyroid responded to T3 with elimination of their FMS symptoms.  Euthyroid patients (patients with normal thyroid function blood tests) treated with T3 experienced relief of their FMS symptoms. Supraphysiologic doses (150-250mcg) were sometimes required and patients experienced no stimulation side effects at this dosage. Lowe, DC, Eichelberger, MD, et al; Improvement in Euthyroid Fibromyalgia Patients treated with T3; Journal of Myofascial Therapy, Vol1, No2 July1994.

Unpublished- Oxytocin and DHEA in Fibromyalgia and Chronic Fatigue

Oxytocin is produced in the retina, pineal, ovary, adrenals, thymus, and pancreas as well as the posterior pituitary.  DHEA -dehydroepiandosterone is produced by the adrenals.  The adrenals produce 30-50 mg of DHEA a day, and 2-3 mg of Cortisone per day.  DHEA helps stimulate production of muscle and muscle repair.  Dr. Jon Russell showed that fibromyalgia patients have a lower level of DHEA sulfate.  Oxytocin is active in cell membranes and activates cyclic AMP, and the inositol triphosphate system, which is DHEA dependent.  DHEA sulfate levels are measured and DHEA and Oxytocin supplemented.  Dr.Stodinger in Spokane has 200 patients on this protocol.  66% of patients have had complete remission of symptoms. Dr.Flechas, who did the work on Malic acid and magnesium, developed this protocol, is looking for someone to do a large controlled trial on it, as it appears promising.  Side effects include water retention and weight gain.

RX that don't work:

Zopiclone

- helps with fatigue but not pain - 33 pts, double blind

Fluoxetine (Prozac)

has no effect, N=42, double blind (anecdotally useful)

Chlormezanone (Trancopal)

- double blind - no beneficial effect

Benzodiazapines - Valium, etc.

- contraindicated - they interfere with stage 4 sleep.

Imipramine (Tofranil)

steroids, non-steroidal anti-inflammatories don't help

Steroids and Narcotics are contraindicated