Clinicians need to excercise a lot of patience with these patients. One of the key elements to non pharmacological approach is to encourage the patients to become SELF MANAGERS through counselling and training. Patient education is focussed on improving pain, sleep, fatigue and function. Out of the non- pharmacological approaches excercise and psychoeducational approaches have shown be highly beneficial in curbing the symptoms of FM. High intensity aerobic excercises And Aquatherapy are very helpful in some patients.[11,12]] Other tools which might have a positive impact on the quality of life are meditation, stress management and relaxation techniques.

Pharmacological Intervention
Antidepressants:Tricyclic Antidepressants in low doses of 25-50mg/d have been found to be effective for bringing about improvement of fatigue, sleep, pain and depressive symptoms of fibromyalgia.
Amitryptyline has found itself as the first line drug in the management of fibromyalgia in many practices. It has to be carefully monitored as patients on it will have a tendency towards weight gain and developing tolerance.
Serotonin Noradrenaline Reuptake Inhibitors are also used in treating FM as levels of serotonin and noradrenaline has been found to be lower in certain subgroups.
Duloxetine at 60mg dosage has been tried but with only marginal effects on patients with FM.
Milnacipran which inhibits the reuptake of serotonin and noradrenaline (norepinephrine), has found itself approved in Australia for the treatment of FM. It is generally administered with a dosage of 100 mg which is given daily in divided doses.

Antiepileptic drugs- The neurotransmitters Substance P and glutamate are found in increased levels in patients suffering with Fibromyalgia. These constitute the targets of pregabalin and gabapentin, which help in promoting sleep, alleviating anxiety and modulate pain.

Antiepileptic drugs- The neurotransmitters Substance P and glutamate are found in increased levels in patients suffering with Fibromyalgia. These constitute the targets of pregabalin and gabapentin, which help in promoting sleep, alleviating anxiety and
modulate pain. Other drugs that are commonly used in the management of fibromyalgia areTramadol, Pramipexole and Memantine. There is weak supporting evidence for use of anti inflammatory medications and hardly any so for paracetamol. Opioid induced hyperalgesia and poor clinical response have put drugs like codeine, fentanyl and oxycodone as contraindications

Intravenous Infusions- Myer’s Cocktail, named after John Myers MD is a well known form of infusion treatment in the medical circles attending to FM. It’s constituents are as follows

• 5 milliliters (mL) magnesium chloride hexahydrate
• 3 mL calcium gluconate
• 1 mL hydroxocobalamin
• 1 mL pyridoxine hydrochloride
• 1 mL dexpanthenol
• 1 mL B-complex (thiamine, riboflavin, niacinamide) vitamins
• 5 mL vitamin C

Think a cocktail might help you better manage your fibromyalgia symptoms? We’re not talking about a fruity drink with a cherry and an umbrella. Many people who are living with fibromyalgia swear by the Myers cocktail, an intensive vitamin and mineral dose delivered once a week intravenously. Both patients and practitioners report that this infusion – named for John Myers, MD, the Baltimore doctor who first experimented with a vitamin and mineral mix of magnesium, calcium, B vitamins, and vitamin C – helps ease fibromyalgia pain and other symptoms, such as profound fatigue.

According to fibromyalgia researcher David Katz, MD, founding director of the Prevention Research Center at Yale University in Derby, Conn, about 12,000 people across the United States are treated with the Myers cocktail, and about four out of five say the treatment helps ease fibromyalgia symptoms. The treatment is considered to be a form of complementary and alternative medicine (CAM), not traditional treatment, which includes prescribed medications. However, people often are willing to try novel approaches because living with fibromyalgia is often challenging and fibromyalgia symptoms can be so persistent. Myers Cocktail 101

The Myers cocktail contains a variety of nutrients:

• milliliters (mL) magnesium chloride hexahydrate
• 3 mL calcium gluconate
• 1 mL hydroxocobalamin
• 1 mL pyridoxine hydrochloride
• 1 mL dexpanthenol
• 1 mL B-complex (thiamine, riboflavin, niacinamide) vitamins
• 5 mL vitamin C

Proposed Mechanism of action- Proposed Mechanism of action- Though the exact mechanism of action remains unclear, groups of patients receiving Myer’s Cocktails have experienced reduction in pain and fatigue.B Vitamins are essential for maintaining the health of nerve cells and hence probably stabilisation of the nerve cells by the influx of B Vitamins maybe helpful in reducing the pain. The fatigue of FM has been compared to the fatigue experienced after rigorous excercise, which can build up lactic acid in the oxygen deprived muscles. The Magnesium and Calcium help in dilating the blood vessels so that they can carry more oxygen and help muscles relax.

Lidocaine Infusions- Lidocaine infusions are becoming pretty popular amongst some patients and practitioners alike. Some patients have reported a significant reduction of the symptoms of FM.

Ketamine Infusions- Ketamine works by blocking the NMDA receptors. In doing so, it can reboot the pain receptors which have been altered in patients of FM. In the long term ketamine may also help in decreasing Neuro inflammation which might play a role in neuropathic pain.