A young woman with diffuse musculoskeletal pain and wide spread soft tissue tenderness consulted me recently, and I made a diagnosis of fibromyalgia. The visit was typical of many of the frustrations of dealing with fibromyalgia patients. I gave her my usual pep talk about the wonders of exercise and sleep hygiene. Her reply was pretty predictable, and she told me she didn’t see how she could bring herself to exercise until I made her feel better. It was obvious to her that exercise would only increase her pain. I gave her a prescription for pregabalin 75 mg b.i.d.. She returned 5 weeks later. The medication had worked beyond my wildest expectations and beyond even the promises of the drug representative. She told me it caused muscle twitching and made her wake up more often at night. In addition to dizziness and difficulty sleeping she had at least six headaches since her initial visit. She told me that she wanted to stop taking the medication. I think at this point in the narrative I may have blurted out something like, “Oh! You’re still taking it?!” In place of this wonder drug she wanted to start on a program of exercise and vitamins.
I was delighted to hear that she wanted to belatedly take my advice and start an exercise program, but I asked a bit warily: “What kind of vitamins did you have in mind?” She didn't have a very clear plan about which supplements she was hoping would take the place of the wonder drug that I had prescribed. Since she wanted to help herself, and clearly didn’t want another wonder drug, I felt that I should offer some advice, but I too was uncertain which supplements were best, or if there was any scientific evidence to support their efficacy.
While we were chatting, I googled “vitamins fibromyalgia” and quickly brought up a vast sea of websites that were selling vitamins and potions. None of them had the scientific gravitas that I was hoping for, but in a flash of inspiration I opened PubMed (http://www.ncbi.nlm.nih.gov/pubmed/) and using the same search phrase I found lots of references. None of them looked like scientific miracles waiting to happen, but at least PubMed is unbiased. I wrote down the phrase PubMed for my patient in lieu of a prescription. She seemed pleased with this. I told her to come back and see me if exercise and supplements weren't doing a good enough job and I'd try and find another wonder drug for her.