Chronic Fatigue & Fibromyalgia

Dr David Richardson


Chronic Fatigue Syndrome & Fibromyalgia

A Practical & Achievable Team Based Protocol for Treatment

In my opinion Fibromyalgia is very closely related to Chronic Fatigue syndrome, the main difference being that in Fibromyalgia the pain predominates while in CFS the fatigue dominates

 Protocol for treatment

1. Diagnostic.

Rule out other active treatable diseases  especially thyroid, iron VitaminB12 or folate deficiencies, plus chronic infections such as chlamydia, mycoplasma, Ross River Fever, Lyme disease, Epstein Barr and Cytomegalovirus, Barma Forest Disease , also rule out Coeliac disease, milk and wheat intolerances, and systemic candida. Treat these diseases if you have them. Once you have done all you can reasonably do for these conditions and fatigue persists you may have CFS. Fatigue needs to have lasted more than 6 months to be called Chronic Fatigue

2. Lifestyle/routines

  1. Re-establish sleep/wake cycle Using the strategies in the Beyond Blue Fact Sheet.  I find Melatonin & Phosphatidylserine are  very useful  taken at bedtime. You will NOT get better if you stay up half the night and sleep through most of the day!

  2. Establish ROUTINES - regular bedtime and getting up time are a good start.

  3. Maintain balance of rest and activity.

  4. Break tasks down into components and do in bite size pieces. Continue to set goals, but little achievable ones

  5.  Graded Exercise Program preferably supervised by an Exercise Physiologist, especially as improvement takes hold. This can be  funded by Medicare in Australia. The Graded Exercise Program should start slow and slowly increase using a Home Exercise Program and weekly assessment and gym program.

3 Psychological Interventions

  1. Cognitive Behavioural Therapy ( CBT) from a qualified psychologist is vital (this is funded by Medicare in Australia). CBT   may  identify and dispel any psychological factors that may unwittingly be adding to the syndrome or preventing recovery.

  2. CFS/Fibro in my experience seems particularly common in the driven, high achieving, perfectionist personality type who tend to give themselves little credit for their achievements and have a never ending To Do List. The psychologist can help you with this.

  3. Focus on BEING rather than forever DOING. Meditation or other relaxation helps here as does CBT.

  4. Treat depression - If you have lived with Fibro or CFS for some time you are likely to be depressed!Cognitive Behavioural Therapy from a qualified psychologist (this is funded by Medicare in Australia) often with Lovan, Efexor, Zoloft or Lexapro. SamE, 5 hydroxy tryptophan and St John's Wort may also be used.

  5. Ensure  your habitat is peaceful and relatively stress free - again the psychologist can help with strategies with this. Avoiding bright lights including strong sunlight and loud sounds seems to help some people.

  6.  Relaxant Herbal supplements or  occasionally low dose Endep (10-25mg taken in the early evening) may be of benefit, as well as meditation and relaxation strategies.

  7. Set recovery goals and reinforce success in meeting these goals. Non success is a setback not a failure.

4. Monitor Improvements

Recovery from CFS/Fibro is slow -  sometimes so slow it seems you are not getting better. This is very dispiriting and depressing. I suggest  you  compare how you are now with how you were 1, 3 or 6 months ago, not with how you were before CFS/fibromyalgia.

5. Supplements

I almost always use an adrenal gland boosting mixture ( I use Metagenics Adrenotone and Brahmitone just 1 each per day) plus a magnesium supplement.

Using too many supplements gets very expensive (further adding to stress) and confusing so I advocate minimum. However some of the following may help.

Consider Vitamin supplements especially Vitamins A, C, E and Multi B, plus minerals especially Zinc, and Selenium plus Fish Oil.

  1. Magnesium - is an essential supplement for most people with CFS/Fibro in my view.

  2. Consider Melatonin 3mg plus Phosphatidylserine at night to help improve sleep and sleep wake cycle.

Less often I may use:

  1.  Ginseng,  CoQ10, SaME or Acetyl L Carnitine may boost energy levels

  2.  DHEA  5-20mg for females and 25-100mg for males daily if your levels are low.

  3. Pregnenalone up to 200mg/day may decrease muscle and joint pains.

  4.  Bio-identical HRT, especially in over 40 yr olds consider to get hormone levels back to a 25 -35yr old level.

6. Specific Therapies that may help some people, but are complex and need great commitment and up to three years to complete.

  1. 1.Marshall Protocol - links CFS/Fibro with Vitamin D metabolism imbalance

 © Dr David Richardson Royston Clinic 2008