Question: I have been diagnosed with fibromyalgia and I’ve been tested for Epstein-Barr Virus. My levels of the virus were high. I know this is a difficult condition to treat. I am very fatigued. I’d like your suggestions on what treatments are appropriate.

Dr. Hibberd’s answer:

EBV infection may cause fatigue, but does not cause fibromyalgia. Fibromyalgia refers to a condition of inflammation of fibrous tissue and muscle with no known cause. It is unfortunately a diagnosis used when no cause is evident. Be sure you have consulted a rheumatologist to be sure you don’t have a disorder that could be addressed with specific treatment options.

Since many diseases and malignancies may have similar symptoms, you must be sure you have not only had a complete medical evaluation, but also maintain a regular follow-up schedule so that no underlying disease is overlooked. In the meantime, work closely with your primary care physician for the safest and most appropriate ways for you to manage your conditions.

Often combinations of small doses of multiple drugs — such as anti-inflammatory, anti-depressant, and sparing muscle cramp medications — are more effective than high doses of single agents. Avoid using any long term oral or injectable steroid medications.