Relative to many of today's diseases and disorders, little is known about the etiology, the cause, and the long-term effects of Chronic Fatigue Syndrome (CFS) and Fibromyalgia Syndrome (FMS). The two disorders share a myriad of characteristics, however, which begs the question: Are they really two separate diseases? How does Myofascial Pain Syndrome fit in? What are the various pain expressions characteristic of each? How are symptoms the same or distinct from each other? Neck pain, back pain, and sciatica have been reported in all three conditions but in varying degrees of intensity and frequency. How are they the same and how are they different? We have already begun to explore the answers to these questions in previous articles, we will continue to do so in this and subsequent articles in this series.
There are many similarities between chronic fatigue syndrome and fibromyalgia. The course of both disorders is generally persistent and chronic, with symptoms arising steadily to a crescendo, often waxing and waning in cycles. Unfortunately, the prognosis is poor with little real understanding of the etiology or cause. Treatment strategies for both chronic fatigue and fibromyalgia are focused more on symptoms than on treating the perceived cause. Pain often varies from dull to acute, from fleeting to constant or chronic. Improvement is possible for those with the disorder(s), but complete recovery is rare. Most CFS and FMS sufferers continue to have symptoms for years, if not decades.
Sufferers of both CFS and FMS also seem to be susceptible to secondary psychological problems, such as depression, anxiety, and mood swings. The psychological and psychosomatic aspects of these conditions have not been lost on researchers, with much current research focusing on related psychological issues. It is also quite common for depression to become quite serious, as chronic fatigue symptoms and fibromyalgia pain take a heavy toll.
Treatment for both disorders, FMS and CFS, are often similar, if not the same. Increased occurrence has been demonstrated in blood relatives, suggesting a possible genetic component to the disorder. And, while certain segments of the population seem to be at greater risk, are more susceptible, both conditions are present in all demographic groups. However, the most susceptible demographic group, for both disorders, is women in their middle years, particularly women from 30 to 50 years of age. Symptoms of both fibromyalgia and chronic fatigue syndrome seem to worsen after exertion, demanding activity, and stress of all types (physical, cognitive or emotion).
When routine lab tests are conducted on patients with suspected CFS or FMS, the results quite often appear normal. Both disorders are extremely difficult to diagnose. CFS and FMS often overlap or are found jointly with other disorders and/or diseases such as allergies, tension headaches, migraines, irritable bladder, irritable bowel and autoimmune disorders.
Chronic fatigue and fibromyalgia also share numerous abnormalities not commonly linked to other disorders. Some of the abnormalities or characteristics peculiar to CFS and FMS include central nervous system abnormalities (CNS), perhaps a reason for the various pain expressions and mood disorders, and lowered levels of the neurotransmitters norepinephrine and serotonin, also with an impact on mood and pain, to include neck pain, back pain, deep hip and pelvis pain, and sciatica. Fibromyalgia sufferers in particular experience a decreased threshold for pain overall, at times localized and at other times diffuse and acute. Chronic fatigue patients will also suffer from idiosyncratic pain, diffuse and varied in its expression. Abnormalities also arise in each of the nervous system's two branches, the sympathetic and parasympathetic nervous systems.
FMS and CFS patients may also exhibit disorders affecting multiple body systems, the nervous system, as noted above, the circulatory system, particularly hypertension and heart-related problems (also a possible stress link) and digestive, as in ulcers and acid reflux (stress again) and endocrine (hormones also impacted by stress). Sleep abnormalities are considerable and widespread. Interestingly, brain imaging seems to indicate that blood flow wanes to some areas of the brain. Symptoms also appear to arise in patients' sensory processing, generating a higher sensitivity to sensory input (light, sound, chemicals) and, again, pain stimuli. To summarize, chronic fatigue syndrome and fibromyalgia share a host of symptoms, ranging from neurological to gastrointestinal.
There are symptoms characteristic of each disease or disorder, chronic fatigue and fibromyalgia. For example, CFS presents a more powerful association or link with intolerance to exercise, greater fatigue, flu-like symptoms and vision changes. Symptoms found to be more prevalent in fibromyalgia include the presence of the particularly painful trigger and tender points and the presence of allodynia. Allodynia is the powerful triggering of pain responses for things that wouldn't be painful to an unaffected person. Physicians refer to a certain pain expression from movement or motion as "motion allodynia." Pain specialists refer to pain at a comfortable or normal temperature, temperature not uncomfortable to the most people, as "cold allodynia." Allodynia is often used by physicians to refer to neuropathic or "bizarre" pain, which presents as the result of any non-noxious stimuli, often "jumping around from affected to unaffected parts of the body.
Of the two disorders, CFS is being reported to be nearing or at epidemic levels, affecting many persons at the same time across a wide range of demographic groups. CFS symptoms wax and wane more frequently than symptoms of FMS, and the rate of disability is greater in chronic fatigue syndrome patients. Currently, we don't know what the direct (or indirect) connection is between chronic fatigue syndrome and fibromyalgia. Early research and speculation has suggested that they could possibly be distinct, meaning the two disorders are not related, identical, the same disorder, but with different names, overlapping, two diverse expressions of a similar disorder or possibly the result of different causes or triggers leading to a common pathway, two subtypes of a larger illness and part of a spectrum of illnesses, including both...and possibly Myofascial Pain Syndrome. Until further research is done, it is difficult to say with any degree of certainty.
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John P. Zajaros, Sr., The Bad Back Guy