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For this reason, we frequently recommend a trial of a low dose stimulating-type antidepressant -- not so much for anxiety or depression as to replace those necessary brain chemicals! Bupropion has the fewest side effects and is most activating; but duloxetine is very effective when both depression and pain are problems together.
If you are sleepy during the day (that is, you fall asleep reading, watching TV or riding in the car), then a stimulant medication might be in order.
Short of anesthesia, there is no drug that will totally alleviate the pain of CFS/ME or FM, so the first step in pain management is the recognition that you will probably always have some pain.
The second step is to employ non-pharmacological therapies such as cool packs, hot packs, liniments (such as over-the-counter Deep Heat, Icy Hot, Aspercream, etc.), warm tub or shower soaks, massage, a vibrating massager, perhaps chiropractic treatment or even acupuncture.
If you are not able to access a provider who is expert on CFS/ME, your next best bet is to find a doctor who is empathetic and willing to help.
Your doctor will need to be sure you don't use too much, and he/she will need to check liver and kidney function regularly if you use these medications.
Doses of up to 100 mg four times daily can be used (although an overdose condition called "serotonin syndrome" can occur if you are taking certain antidepressants or other drugs).
Narcotic medications are generally not recommended for chronic pain unless absolutely necessary.
The first principle for improving sleep is to practice good "sleep hygiene." This includes: (1) using your bed for sleeping only; (2) avoiding stimulant foods and beverages at night; (3) keeping a regular sleep schedule by getting up every morning at the same time; (4) avoiding daytime naps (although short rest periods are fine); (5) not watching TV or using a computer in the bed at night (instead, try reading, soft music, or relaxation tapes); and (6) hiding the clock from view.
Another practice that is often very helpful is to have a "wind-down period" before going to bed.
This person may be your existing primary care doctor or someone else you find who either knows about CFS/ME or is willing to learn about it.