Table 7

 Medical management of symptoms

NSAIDs, non-steroidal anti-inflammatory drugs.
PainAmitriptylineCan be very effective for pain which does not respond to analgesics. Drowsy side effect can help with sleep problems (see below)
Poor sleep with painAmitriptylineAlthough most young people tolerate 20–30 mg once a day easily, some need to start at 5 mg and work upwards. If they do not have benefit after a six week trial at 30 mg once a day then stop treatment
Difficulty getting off to sleepMelatoninNot so helpful if the problem is a restless night, but can help if it is difficulty getting off to sleep. Adult practitioners suggest that the effect wears off if it is used every night and suggest using it on alternate nights
PainNSAIDsReported to be helpful by adult practitioners for pain