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From the Townsend Letter
November 2018

Effective Treatment of Pain and Sleep in Fibromyalgia:
A Comprehensive Clinical Approach
by Jacob Teitelbaum, MD
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Allodynia. This is when light touch on the skin is painful. This results from an increase in a brain neurotransmitter chemical called NMDA and can improve with compounded topical pain creams including ketamine and NMDA receptor antagonist medications such as Namenda.
Small fiber neuropathy. When chronic pain and central sensitization become prolonged, the small nerve fibers in the body may start to shrink back. This can also result in problems from low blood pressure and heart rate control called orthostatic intolerance and POTS. A simple one-minute quiz (you can request this from me at can effectively screen for these low blood pressure issues, and they are very treatable – although most physicians are not familiar with them. Interestingly, small fiber neuropathy seems to be associated with immune depletion and can respond well to intravenous gamma globulin as well as treating the underlying chronic infections and using the SHINE Protocol overall.
Fortunately, virtually all pain can be effectively treated using a mix of standard and holistic treatment options. The problem is not lack of effective treatment for pain, but rather inadequate physician education about the research.

BioDisruptOptimizing Sleep in Fibromyalgia
Sleep is when tissue repair and growth hormone release occur. A number of studies have confirmed that inadequate sleep results in pain simply not going away. So, helping the person to get seven to eight hours of good solid sleep at night despite their hypothalamic sleep center not working is critical.
No single treatment will be enough to achieve this. If you give a high enough dose of one treatment to keep them sleeping for eight hours, the person will be hung over into late afternoon. Instead, it is essential to use low doses of several treatments combined. The free practitioner treatment tools available from include a detailed treatment checklist on sleep (and over a dozen other areas) listing both natural and prescription options. Here are my favorites:

Natural Options

  1. The Revitalizing Sleep Formula (by Integrative Therapeutics). This mix of valerian, lemon balm, passionflower, hops, 5 HTP, and theanine is outstanding for sleep. Give 2 – 4 capsules at bed time
  2. Terrific ZZZZ (by EuroPharma). An excellent mix of essential oils
  3. Melatonin. Most have minimal effect here. An exception is Nature's Bounty Dual Spectrum 5 Mg Melatonin (Amazon or Walgreens). This has both immediate and sustained release
  4. Magnesium (If diarrhea I give the Jigsaw Sustained-Release Form) 150 – 200 mg at bedtime. Alternatively, a hot bath with 2 cups of Epsom salts (magnesium salts) an hour before bedtime can be very helpful for both pain and sleep


  1. Ambien or Lunesta to help people fall asleep. These can have significant side effects (including sleepwalking and eating) as well as rebound insomnia when stopped. Nonetheless they can be very helpful. To help people stay asleep, I add
  2. Trazodone (Desyrel) 25 – 50 mg
  3. Cyclobenzaprine (Flexeril) 2.5 – 5 mg
  4. Neurontin 100 – 600 mg
  5. Benadryl 12.5 – 50 mg

Although fibromyalgia requires a comprehensive protocol to see optimal results, the parts of the protocol above can result in dramatic improvement. The free Energy Analysis Program at (step three) is a 10 minute quiz which can analyze the person's symptoms, and even lab tests if available, to determine the main causes of their energy crisis and tailor a protocol to optimize their energy. By having the person fill out the symptom checklist that is part of the free treatment tools, your staff can enter the results into this program and generate a free detailed report that will make you look like a wizard! So, you now have all the tools you need to be a fibromyalgia expert – today!


SUPPORTThe Townsend Letter is dedicated to examining and reporting on functional and integrative medicine. Our editorial content depends on support from readers like you, and we would appreciate your help to keep this content forthcoming. Please take this opportunity to contribute $50, or choose one of the other amounts listed on the next page, and ensure that our independent voices keep up the good fight against the skeptics, who would like to silence us and eliminate your medical freedoms.

Jacob Teitelbaum, MD



Jacob Teitelbaum, MD, is the author of the best-selling From Fatigued to Fantastic!, Pain Free, 1,2,3!, and The Fatigue and Fibromyalgia Solution. He is the lead author of four studies on effective treatment for fibromyalgia and chronic fatigue syndrome.



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