The Curbsiders podcast

#7 Become a Fibromyalgia and Chronic Pain Master, Part 2

May 11, 2016 | By

This episode is a must listen if you’ve ever felt helpless in the face of fibromyalgia and chronic pain. Keep listening for part 2 of our â€œcurbside” with expert clinician and prominent researcher Dr. Daniel Clauw, from the University of Michigan’s Chronic Pain and Fatigue Research Center. The show is chock full of clinical pearls for the mastery of chronic pain syndromes.

Take Home Points:

  1. Recognize the symptom pattern of multifocal pain with fatigue, memory problems and sleep disturbances as fibromyalgia.
  2. Intervene early and you can prevent disability, development of narcotic addiction and a vicious cycle of comorbidity.
  3. Fibromyalgia can be present in addition to a chronic nociceptive conditions e.g. rheumatoid arthritis, lupus, sickle cell disease
  4. There are lots of evidence based nonpharmacologic and pharmacologic therapies for fibromyalgia and chronic pain. Read Dr. Clauw’s JAMA review and use them!

Clinical Pearls

  • Dr. Clauw’s YouTube video and website work better than meds.
  • Give Cyclobenzaprine 5-15 mg about three hours before bed to minimize next day grogginess.
  • Give two thirds of sedating meds like gabapentin, pregabalin in the evening and one third in the morning.
  • Drop the tender point exam. Instead use the new 2011 ACR Criteria to diagnose fibromyalgia.

Recommended Reading:
Claus, DJ. Fibromyalgia: a clinical review. JAMA. 2014 Apr 16;311(15):1547-55. doi: 10.1001/jama.2014.3266.

Clauw, Daniel J. Fibromyalgia and Related Conditions. Mayo Clin Proc. 2015; 90(5):680-692.

Resources for patients
Chronic Pain – Is it All in Their Head? – Daniel J. Clauw M.D.


  1. February 20, 2017, 2:35am Michaela Skelly MD writes:

    Going to definitely use the fibroguide and youtube video in my practice. Thanks!! Will add cyclobenzaprine to the duloxetine and gabapentin that I am already using. Never thought of cyclobenzaprine as a weak tricyclic:). I knew narcotics were not recommended but now I know they are REALLY not.

  2. March 30, 2017, 6:47am Guilherme Bächtold writes:

    Upon checking the comments on the youtube video, I recommend you to be very clear on what the title means, "is it all in their head". People seem to be very offended by the title, so you should give a thorough explanation, otherwise the patient might be unwelcoming to the information.

    • March 31, 2017, 1:18pm Matthew Watto, MD writes:

      Thank you for tuning-in and for taking the time to provide feedback. We really appreciate and enjoy all comments. Just to clarify the YouTube video you are referring to is not something we created rather something we just shared as a resource.

CME Partner


The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit and search for this episode to claim credit.

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