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Fibromyalgia Management

Part 1 – Fibromyalgia Symptoms
This was a talk a did a little while ago on Fibromyalgia symptoms and medications for the New Zealand College of Pharmacists. In this talk (which I’ve divided into parts for easier listening) I go over how to recognise this syndrome, and then the many options of treatment.

In this segment:

  • Statistics and prevalence of this condition
  • Diagnosis of fibromyalgia
  • Comparison to widespread muscular pain and chronic regional pain
  • Definition of pain & how the syndrome affects your body


Part 2 – Fibromyalgia Syndrome Defined
In this segment:

  • How pain works
  • Physical damage vs perceived pain
  • How Fibromyalgia Syndrome causes pain amplification, disruption of the limbic system and other symptoms
  • More symptoms of fibromyalgia ie. the ‘fibro fog’


Part 3 – Fibromyalgia Diagnosis Criteria
In this segment:

  • Functional MRI’s of the brain
  • Sleep disruption
  • Interrelation of fibromyalgia, depression and chronic fatigue
  • Fibromyalgia diagnosis criteria
  • Stress response in the body
  • The therapeutic domain and how this relates
  • Neurosensory disorder – abnormal handling of pain messages


Part 4- Fibromyalgia Medication and Management
In this segment:

  • Fibromyalgia Management and regaining quality of life
  • Core muscle strength and fitness –  regular incremental aerobic exercise
  • Endorphin production and pain relief
  • Fibromyalgia diet – low inflammation foods
  • Fibromyalgia Medication – Phenergan and getting better sleep
  • Amitriptyline for pain relief
  • Tramadol and SSRI’s as medication
  • Tricyclic antidepressants
  • Mirapex for fibromyalgia
  • SAMe for fibromyalgia
  • No evidence for opioids – ie. methadone being effective for pain relief. In some cases they can make the situation worse
  • No evidence for NSAIDs – Non-steroidal anti-inflammatories – being useful
  • Guaifenesin – inconclusive


Part 5 – Fibromyalgia Medication List
In this segment – the Fibromyalgia Medication List :

  • Paradex treatment
  • Codine – risks and benefits and dosage
  • Tramadol – varied results
  • Morphine, Fentanyl Patches and Oxycodone – large risks and little benefit. Not suitable for fibromyalgia pain relief, and carry the risk of hyperalgesia
  • Gabapentin, Amitriptyline and Nortriptyline – some good evidence
  • Cymbalta – some good evidence of pain reduction and quality of life, restorative sleep
  • The importance of choosing the right dose – this is crucial
  • Non-evidenced based / alternative treatments: Ayervedic, Bowen, Reflexology, Colostrum


Part 6 – Evidence Based Fibromyalgia Treatment
In this segment:

  • Importance of evidence based review of ‘miracle’ cures – how effective are they really?
  • Genetic profiling
  • The Marshall Protocol
  • Managing Fibromylgia – giving patients control over their self-medication with a stepped plan and dosage range
  • Lifestyle changes that improve quality of life
  • Not all pain is fibromyalgia – how to tell the difference between fibro pain and pain caused by other conditions
  • Other more wide ranging possible causes of fibromyalgia
  • Stress, cortisol and circadian rhythm as an underlying cause
  • Phantom limb pain





Dr Teitelbaum: Re-energising even if you have been diagnosed with Fibromyalgia


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