TABLE 5-3 Summary of Treatments Recommended in Guidelines or Found to Be Effective in Systematic Reviews for Conditions Comorbid with and Related to Chronic Multisymptom Illness

Condition Pharmacologic Nonpharmacologic

•  SNRIs (duloxetine and milnacipram)

•  CBT


•  Tricyclic medication (amitriptyline)

•  Aerobic exercise


•  Pregabalin

•  Combination of exercise, CBT, education, and self-help books


•  Gabapentin

Chronic pain

•  Tricyclic medications

•  Radiofrequency ablation of medial branch nerves to facet joints for low back pain


•  SNRIs and SSRIs

•  Acupuncture for headaches and low back pain



•  Transcutaneous electric nerve stimulation for temporary relief of low back pain


•  Anticonvulsants

•  Epidural steroids for leg pain


•  Opioids

•  Physical or restorative therapy


•  Psychologic treatment (for example, CBT, biofeedback, relaxation training)


•  Botulinum-toxin injections for chronic migraines

Chronic fatigue syndrome

•  NSAIDs for pain symptoms

•  CBT


•  Melatonin for problems in sleeping

•  Graded exercise therapy


•  Antidepressants for depression and to improve sleep quality

•  Lifestyle changes (for example, regular sleeping schedule; avoidance of caffeine, alcohol, and tobacco; and dietary changes)


•  Alternative therapies (for example, yoga, Tai Chi, acupuncture, and massage)


•  CPAP for problems in sleeping

Somatic-symptom disorders

•  SNRI (venlafaxine) if anxiety and depression symptoms are present

•  CBT and other forms of psychotherapy


•  Biofeedback


•  Consultation letters to primary-care physicians

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