The Aword

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Medications effective in the treatment of FMS appear to work mainly through an effect on deep sleep (Goldenberg 1986).

They should be started at the lowest possible dose and increased every few days to a week to maximum relief of daytime FMS symptoms without unacceptable side effects.

These include: trazodone (50mg starting dose); cyclobenzaprine (10-60mg taken an hour before bedtime); alprazolam (0.5-4mg taken half to one hour before bedtime) and diphenhydramine (50-300mg half to one hour before bedtime); amitriptyline (10-150mg taken 2 hours before bedtime).

Treatment of problems such as insomnia and anxiety should be regarded as secondary to pain relief because pain is most likely to be the source of the problem. Use of hypnotics and anxiolytics is thus inappropriate if pain relief remains suboptimal.