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Treatment of Chronic Fatigue Syndrome and Fibromyalgia is still controversial. Please read Disclaimer before proceeding.
STEPS TO RECOVERY:
EDUCATION: Know that this is a recognized disorder. It's not in your head, it's not Cancer and you're not crazy.
ACTIVITY / EXERCISE: The more you exert the sicker you get. On the other-hand, if you stay in bed you get deconditioned. Balance light activity with bed-rest with common sense as a guideline. Posture in CFS/FM characterized by spasm, shortening, and pain in muscles. These lead to: nuchal or temporal headaches, neck/shoulder tension, apical breathing. Learn to keep posture and concentrate on breathing and you'll do much better. Simple stretches, Yoga, Tai Chi may help.
PHYSICAL MODALITIES: Cool to hot pack in the neck and shoulders causes much more blood flow. Massage may help tenderness and for aches and pains. Acupuncture can help with pain, but you must find a qualified person. Hydrotherapy - Vertical flotation, tepid water (approximately 84 degrees) CFS and FMS patients need to be careful of hot temperature water because it lowers blood pressure and upregulates the immune system. (Makes Cytokies which cause flu-like symtoms). Low Level Interval Exercise -- 4-8 minutes then rest for 4-8 minutes, 3-4 times.
NUTRITION: Prudent Diet -- carbohydrate based, rice, potato, pasta, fresh fruits, vegetables, light meals. (chicken, turkey, fish) Stay away from red-meat. AVOID: Sugar, Caffeine, Alcohol, Nutrasweet and Tobacco. This is referred to as S.C.A.N.T. (possibly dairy and wheat too - especially if you have stomach problems)
VITAMINS AND SUPPLEMENTS: To help get your body in the best possible shape so you can recover. Many patients has subtle defficiencies. Multi-Vitamin, that has minerals. High dose of cobalamin (B12). Many CFS patients don't absorb B12 very well into the cell not the blood. CoEnzyme Q10 100-120mg per day can bring a 10 percent global improvement. (everything seems to get just a little bit better) Omega-3 fatty acids (evening primrose oil) and Omega-6 (fish oil) fatty acids interfere with inflamatory pathways so as to reduce aches and pain. (may take the edge off of arthritis and muscle pain)
SYMPTOMATIC THERAPY: Sleep management. -- Klonopin and Doxepin has helped. (low doses) Tylenol PM has shown some success. Melatonin is a good drug for phase shifting sleep. If your sleep clock is off and you find yourself falling asleep later than you used to. Desyrel (Trazadone) @ 50mg nightly. Central activation. -- SSRIs: Prozac, Zoloft, Paxil, Effexor, Luvox. Dopamine Agonists: Wellbutrin. Headache control. -- different from typical headache. (behind eyes or back of neck. Pressure-like or squeezing quality to it. Migraine or throbbing also) Diamox shrinks fluid in brain, to take pressure off. Calcium channel blockers can increase blood flow to brain which can reduce swelling in the brain. If headach is Migraine, (one-sided, throbbing) Midrin and Imitrex can be used. Relief from myalgias and arthralgias. -- NSAIDS, (Naprosin). Narcotic agonist (Ultram). Narcotic analgesics (avoid if possible).
FIBROPAIN: Vague, flue like-aching, burning muscle pain seen in Fibromyalgia. Magnesium sulfate injections. 2cc @ 50% Magnesium sulfate, once or twice a week have shown 80% of some improvement. Magnesium burns which is a drawback. (this is investigational at this time) Anticonvulsants, such as Neurontin for bad headaches as well as nerve-type pain. (it has very few side effects) Also used are Tegretol, Depakote, Mexill. (consult physician). Oxytocin a hormone, increase blood flow to eye, brain and muscles. You may think and see more clearly. (doesn't work for everyone). IV Lidocaine, can reduce severe fibro pain as a last resort.
NEURALLY MEDIATED HYPOTENSION: Volume Expansion. 70-90% OF CFS/FM have Neurally Mediated Hypotension. Salt and water can be a major help with low blood pressure and low heart rate. 64 ounces of water a day. 2-6 grams of salt a day. If this doesn't do it, Florinef can be added, as well as a beta blocker such as Atenolol. Blood pressure needs to be checked. If you stand in the shower and you get weak and feel like you may faint-- may be NMH.
REPLETION: Certain chemicals & hormones in CFS patients can be low.
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