So how do I treat the underlying problems causing the pain?
There are usually five key areas that need to be treated to eliminate muscle/myofascial pain. It helps to remember the acronym “S.H.I.N.E.,” which stands for:
1. Sleep: Get adequate sleep, preferably eight to nine hours a night. Sleep replenishes the body’s energy and heals its muscles. Inadequate sleep will leave you exhausted and in pain.
2. Hormonal support: Get tested for hormone deficiency and treated if needed. Hormone deficiencies can contribute to fibromyalgia and chronic fatigue syndrome.
3. Infections: Get treatment when symptoms of infections occur. The lack of restorative sleep in CFS/fibromyalgia leads to dysfunctional immune systems. Underlying viral, bacterial, bowel, sinus and yeast infections are common and can be a contributing cause or result of CFS/fibromyalgia.
4. Nutritional Support: Optimal nutritional supplementation is essential. Many nutrients can be depleted as a result of CFS/fibromyalgia. B-12, magnesium, acetyl L-carnitine and glutathione, as well as your basic A, B, C and D vitamins need to be supplemented at a level that your average over the counter multivitamin cannot provide.
5. Exercise: Exercise as able. After 10 weeks on the four steps above, you will be able to slowly increase your exercise without being wiped out the next day!
6. Pain Therapies from Comprehensive Medicine
Comprehensive (or integrative) medicine combines the best of holistic and pharmaceutical treatments to create a therapy plan. The wonderful thing it is that it gives you a full tool kit to deal with your problems. Using comprehensive medicine, almost everyone can find a “shoe that fits” so you can get your life and health back!
Many natural therapies can be very helpful for pain. My three favorite pain-relieving herbals are willow bark, Boswellia, and cherry. While going after and eliminating the underlying causes of the pain, it is also perfectly reasonable to use pain medications for temporary relief. The toxicity of chronic pain is far greater than the toxicity of these medications. The main problem is that these medications can cause side effects, especially when started at high dose. It is reasonable to start with a higher dose if needed to get pain free quickly, but if the side effects become problematic, immediately lower the dose to the level that is comfortable (even if this is simply one-half tablet daily at bedtime). As your body adapts to the side effects over a week or two, the dose can then be raised. Starting at too high a dose, without stopping and retrying at a lower dose in the face of side effects, is the major reason why people do not tolerate medications for pain that otherwise would be very helpful.
Three new medications have been FDA approved for fibromyalgia pain: Lyrica, Cymbalta and Minalcipran. However these are not the most effective pain medications for fibromyalgia — simply the most expensive. Below I have listed the medications I recommend be tried for fibromyalgia pain in the order that I find them to be the most effective. Medications can often be combined, and it is reasonable to use a non-sedating medication like Cymbalta (antidepressant) or Skelaxin during the day in combination with a sedating medication like Neurontin or Lyrica at bedtime.