July 19, 2010

Fibromyalgia and chronic fatigue syndrome / myalgic encephalomyelitis (CFS/ME) are both illnesses characterized by extreme amounts of fatigue. In fact, the conditions seem to be so intertwined that the medical community continues to debate whether fibromyalgia fatigue is simply a different expression of the same disorder that causes CFS/ME.

Statistically, fibromyalgia fatigue occurs in more Americans than chronic fatigue syndrome. The U.S. Centers for Disease Control and Prevention believes there are about 5 million people in the United States with fibromyalgia, compared with a little over 1 million people with chronic fatigue syndrome.

Still, research has found that the line between fibromyalgia fatigue and chronic fatigue syndrome is a very thin one. The Arthritis Foundation estimates that 50 to 70 percent of people with fibromyalgia also fit the criteria of chronic fatigue syndrome.

Does this mean that some people could be suffering from both conditions? Possibly, but it would be difficult for most physicians to diagnose this with certainty. Nonetheless, there are important differences in the ways fibromyalgia fatigue and chronic fatigue syndrome present themselves. The recommended treatments for each syndrome also feature some notable differences.

Links Between Fibromyalgia Fatigue and Chronic Fatigue Syndrome

Research into each disease grew out of different medical fields. Fibromyalgia researchers are primarily rheumatologists and arthritis experts. Chronic fatigue syndrome researchers most often are immunologists and virus experts. Because of this, fibromyalgia has been thought of as a muscle disorder while chronic fatigue syndrome has been linked to viral infections - despite their similarities.

Similarities Between Fibromyalgia Fatigue and CFS/ME

Beyond the common symptoms, researchers have found that fibromyalgia and chronic fatigue syndrome primarily occur in middle-aged people.

Also, both disorders appear to target women more often than men. About 80 to 90 percent of people with fibromyalgia fatigue are female. Chronic fatigue syndrome is four times more likely to occur in women than in men.

• Pain
• Fatigue
• Sleep disorders
• Irritable bowel syndrome symptoms
• Chronic headaches
• Association with Temporomandibular Joint Syndrome (TMJ)
• Cognitive or memory impairment
• Dizziness
• Impaired coordination

However, those are largely surface similarities. When we talk about pain, most of us (including health-care workers) don't have a good vocabulary for different types of pain. When you look deeper, you discover that FM is linked to pain states such as hyperalgesia (pain amplification) and allodynia (pain from a typically non-painful source). CFS/ME, meanwhile, is associated with muscle aches like what you get with the flu. Also, not everyone with CFS/ME has pain.

Differences Between Fibromyalgia Fatigue and Chronic Fatigue Syndrome

Chronic pain and fatigue are common symptoms of both fibromyalgia and chronic fatigue syndrome. The difference is that, in fibromyalgia, fatigue often takes a backseat to debilitating muscle pain. In chronic fatigue syndrome, people have an overwhelming lack of energy, but also can experience some pain.

Some more important differences between the two include:

• What prompted the condition. Many people diagnosed with fibromyalgia fatigue report that their symptoms followed some sort of trauma - a physical injury or an emotional shock. On the other hand, chronic fatigue syndrome appears to spring from a viral infection like mononucleosis or influenza.


• Distinct pain sites. People are diagnosed with fibromyalgia fatigue if they feel tenderness or pain in at least 11 of 18 distinct locations on their bodies. People with chronic fatigue syndrome do not have these pain sites.


• Inflammation. People with chronic fatigue syndrome often complain of fever, swollen glands, and other signs of inflammation. Doctors find no evidence of inflammatory response in patients with fibromyalgia fatigue.


• One key difference, when it comes to a diagnosis, is which symptom is worst, pain or fatigue. The diagnosis could also be influenced by whether your doctor is more familiar with the American College of Rheumatology's criteria for FM or the CDC's guidelines for CFS/ME.


• Greater immune dysfunction in CFS/ME


• Abnormal nerve response in FM


• Stress-system (HPA axis) abnormalities predominantly from the adrenal glands in CFS/ME and the hypothalamus in FM


• FM patients have abnormal levels of a cellular chemical called substance P (which transmits pain signals), this level appears to be normal in CFS/ME patients.


• CFS/ME patients often have high levels of a cellular antiviral enzyme called RNase L, while the level is normal in FM patients.


• CFS/ME diagnostic criteria include low-grade fever and sore throat, FM criteria do not.


• The onset of FM frequently is traced to a physical or emotional trauma. The pain of FM usually gets better with heat and massage, while CFS/ME pain doesn't.


• Elevated pro-inflammatory cytokines in CFS/ME, and sometimes elevated anti-inflammatory cytokines in FM.


• FM has generally not been connected with viral and bacterial infections (with a few exceptions, such as mycoplasma and parvovirus B19)


• CFS/ME has occurred in epidemics, but none have been reported for FM


• FM is not thought to ever be progressive or life-threatening (as CFS/ME can be in rare cases)


• FM does not usually cause severe immune dysfunction, neurological symptoms and exercise intolerance


• CFS/ME usually does not cause allodynia (exaggerated response to pain: non-painful stimuli experienced as painful)


• Diagnosis of FM requires tender points (painful areas in the muscle that occur in certain places)


• CFS/ME tends to begin after flu-like symptoms and may be linked to a virus


• CFS/ME patients often have high levels of a cellular antiviral enzyme called RNase L, while the level is normal in FM patients


• CFS/ME diagnostic criteria include low-grade fever and sore throat, while FM criteria do not


• People with FM have tender points and abnormal levels of a cellular chemical called substance P (which transmits pain signals), and this level appears to be normal in those with CFS/ME

Treating Fibromyalgia Fatigue and Chronic Fatigue Syndrome

Given the similarities between the two syndromes, it's no surprise that there's much overlap regarding the recommended treatments for fibromyalgia fatigue and chronic fatigue syndrome. Common treatments between the two include:

• Sleep. Getting plenty of sleep is key to managing the symptoms of both syndromes. Both sets of patients often experience disrupted sleep, so it is important that they maintain good sleep habits and avoid caffeine, alcohol, and tobacco. If necessary, talk to your doctor about using medication to aid in falling asleep.


• Cognitive behavioral therapy. Patients with chronic fibromyalgia or chronic fatigue syndrome have been found to benefit from cognitive behavioral therapy, which teaches people how to recognize symptoms and self-treat using a variety of coping strategies such as relaxation therapy, cognitive pain management, and rest.

However, treatments do differ in a couple of important areas. While exercise has been found to be very beneficial to fibromyalgia patients - aerobic exercise in particular has been shown to relieve symptoms - chronic fatigue symptom patients are told to moderate any exercise, as their symptoms often grow worse following exertion.

People with chronic fatigue syndrome who have muscle aches often are prescribed non-steroidal anti-inflammation drugs (NSAIDs), like aspirin or ibuprofen for their pain. But NSAIDs have been found to have no effect on muscle pain involved with fibromyalgia. Patients with fibromyalgia most often find pain relief through the use of antidepressants.

The good news is that both syndromes can improve with careful diagnosis and thoughtful treatment - and don't forget the importance of a good night's sleep for both CFS/ME and fibromyalgia.