Fibromyalgia is a condition characterized by widespread pain, poor sleep, fatigue and often mood, cognitive problems. It is a difficult condition to treat and requires the use of more than anti-inflammatories and Tylenol with codeine. Evidence-based medications are available including Health Canada approved Pregabalin (Lyrica) and Duloxetine (Cymbalta). There is some evidence for medications such as tramadol (Tramacet, Tridural, Ralivia, Zytram) and pharmaceutical cannabinoids (marijuana pill known as Nabilone (Cesamet) or spray Sativex). Non-drug therapies such as Exercise (aerobic and strengthening), Cognitive-behavioural therapy (education and self-empowerment) and a multidisciplinary team approach are also strongly supported in clinical trials.

There is emerging evidence for bio-identical hormone replacement therapies (subclinical hypothyroidism, menopause and even use of human growth hormone in proven adult deficiency syndromes following head trauma); we have recently documented success with testosterone replacement (such as Androgel) as helpful for chronic pain and fatigue (besides libido) particularly after long-term opioid use causing hypogonadism.