Jacob Teitelbaum .
Background: Hypothalamic dysfunction has been suggested in Fibromyalgia (FMS) and Chronic Fatigue Syndrome (CFS). This dysfunction may result in disordered sleep, subclinical hormonal deficiencies, and immunologic changes. Our previously published open trial showed that patients usually improve by using a protocol which treats all the above processes simultaneously. The current study examines this protocol using a randomized, double-blind design with an intent-to- treat analysis. Methods: Seventy-two FMS patients (38 active: 34 placebo; 69 also met CFS criteria) received all active or all placebo therapies as a unified intervention. Patients were treated, as indicated by symptoms and/or lab testing, for: (1) subclinical thyroid, gonadal, and/or adrenal insufficiency, (2) disordered sleep, (3) suspected Neurally Mediated Hypotension (NMH), (4) opportunistic infections, and (5) suspected nutritional deficiencies. Results: At the final visit, 16 active patients were “much better,” 14 “better,” 2 “same,” 0 “worse,” and I “much worse” vs. 3, 9,11, 6, and 4 in the placebo group (p Conclusions: Significantly greater benefits were seen in the active group than in the placebo group for all primary outcomes. Using an integrated treatment approach, effective treatment is now available for FMS/CFS. Introduction Effective treatment of chronic fatigue syndrome (CFS) and fibromyalgia (FMS) is, in many ways, fairly straightforward, although the lab testing needs to be interpreted somewhat differently than for other conditions. Detailed information is available in the fully updated edition of From Fatigued to Fantastic! (Avery/Penguin-Putnam August 2001), but the core principles can be learned in this article and by reading our two published studies. The full text of both can be seen at www.endfatigue.com. This will help you understand the rationale behind my approach and will give you a good overview of what occurs in CFS/Fibromyalgia. To aid in caring for these complex CFS/FMS patients in the time you have available, patients can also complete an educational program on our website (www.endfatigue.com). This program will analyze their history and labs and print out a complete medical record for that patient (except, of course, for the physical exam) with a treatment protocol and information sheets tailored to that pati ent’s case. For those who cannot prescribe, most of our protocol can be done naturally and patients can obtain a free prescription to take to their lab for the tests they need on our web site. If you are willing to use a significant part of this protocol, we will also be happy to add your name to the free referral list on our website. We also have workshops for health care practitioners. Why Have These Diseases Been so Confusing? CFIDS/FMS represents a syndrome — a spectrum of processes with a common end point. Because it affects major “control systems” in the body, there are myriad symptoms that initially do not seem to be related. Recent research has implicated hypothalamic and mitochondrial dysfunction. (3) These explain the large number of symptoms and why most patients have a similar set of complaints. How to Make the Diagnosis The clinical and research criteria for diagnosing CFIDS and…