We have known for a good while that there are many symptom overlaps between fibromyalgia and chronic fatigue syndrome. Many aspects of  Gulf War Illness seem to fit with aspects of CFS and FMS as well.

Interesting research just completed at Georgetown University reveals that there are proteins found in the CFS (cerebrospinal fluid) of patients with theses disorders that are unique to these illnesses and “overlap in these 3 “syndromes” as well.

Add to this recent research pinpointing around 20 genetic variations occurring in patients with FMS, CFS, and GWI  and what do we have….

Healthy Confusion!!!

What I mean by this is that when research creates more questions than it answers we know we are making progress! Researchers are digging deep, creating theories, wanting answers.

We know that these illnesses have genetic components and predispositions. We know that there are abnormal levels of neurotransmitters and other central nervous system proteins in those of us who have these “syndromes”.

These
overlaps make us wonder… “do these various ‘invisible illnesses’ perhaps have one, common and fundamental abnormality and, perhaps a basic…..cause?”

This is not unlike what has happened in physics in recent history. All kinds of related discoveries have been made and advances embraced. But disparate findings have led physicists to ask….

Is there just ONE theory, one basic underpinning, that explains all these findings? A…

Grand Unified Theory

Well, there is not one for physics at this point and there is not one for our “invisible illnesses”. Yet the fact that so much research is now being done is great news.

Perhaps we will find a “unified theory”- a commonly shared genetic or biochemical abnormality that will produce a focused, targeted treatment.

Until then we try new treatments as they become available and should be grateful that research continues to confirm that “invisible illnesses” should not be invisible after all!

“Pristiq” is the latest in the group of anti-depressants known as SNRIs, or serotonin and norepinephrine reuptake inhibitors. Also in this class is Cymbalta (duloxetine), which is the only anti-depressant that has an FDA approval for fibromyalgia. “Venlafaxine” (Effexor, Effexor XR) is another SNRI and is quite similar to Pristiq which is the trade name for “desvenlafaxine.
I suspect we will be hearing more about Pristiq because it is so similar to Effexor and Cymbalta. I began prescribing Effexor for FMS and pain patients several years ago because it seemed to work better on their depression/pain overlap than the SSRIs which are “selective serotonin reuptake inhibitors”. Examples of SSRIs are Paxil, Zoloft, Celexa, and many others.

This is called “off-label” prescribing by the FDA and simply means that the physician is prescribing a medication for something the FDA has not approved it for. It is entirely accepted and legal and is done with all kind of medications we know can help a particular problem but has not gone through the arduous FDA process.

We know that the neurotransmitters serotonin and norepinephrine seem to be involved in FMS (see “What causes Fibromyalgia”), CFS, and other chronic pain syndromes. Therefore a medication that boosts the levels of these could potentially be helpful.

My concern with Pristiq is that it is not very flexible in it’s dosing at this time. Those of us with FMS and related disorders can be unusually sensitive to medications. My axiom is to “start low and go slow.”
Start with a very low dose and gradually increase the dose if until there is a response.
On the other hand the fact that it is sustained-release is a plus. This allows for once/daily dosing and more constant drug levels.
This does not mean to try Pristiq if your physician recommends it. It may work great for you. I suspect, however, that a lower dosage form of Pristiq will be needed if it is to become helpful in our quest.

Yours, Dr. Don

P.S. If any of you have tried or are on Pristiq I would love to hear from you in the comments section or by email!!!