The Facts About Fibromyalgia and Chronic Fatigue Syndrome
by Alan Kronhaus, M.D., Health and Welllness Editor

Fibromyalgia is a “condition” not a disease. You can also call it a “clinical syndrome” defined by chronic widespread muscular pain, tenderness and fatigue. It’s the “fraternal twin” of another condition called chronic fatigue syndrome or “CFS.” The two entities share a number of symptoms, and the names are often used interchangeably. They are probably both variants of the same pain and fatigue syndrome.

Fibromyalgia is fraught with problems for doctors and patients. It is a problem for physicians in part because we can barely agree on what it is, let alone what causes it or how to diagnose it. There is no “objective marker” or diagnostic test for the condition, which means physicians must rely on a patient’s symptoms, which are by definition subjective, and to a lesser degree their findings on physical exam, to make the diagnosis.

The American College of Rheumatology (ACR) has issued guidelines for diagnosing fibromyalgia. It says that to be diagnosed with the condition, you must have experienced widespread pain for at least three months and have a minimum of 11 locations on your body – called “trigger points” – that are tender under relatively mild, firm pressure.

While widespread pain and tenderness are the key symptoms of fibromyalgia, fatigue and sleep disturbances are an integral part of the problem for most patients. People with fibromyalgia often wake up tired and unrefreshed, even when they seem to get plenty of sleep – as if they miss the deep, restorative stage of sleep. Nighttime muscle spasms and restless leg syndrome may also be associated with fibromyalgia, and may contribute to the sleep disturbances.

Other kinds of pain problems are common in patients with fibromyalgia. Many have headaches and facial pain, including temporomandibular joint (TMJ) dysfunction. Abdominal pain and full-blown irritable bowel syndrome (IBS) (see pg. 22 in the April issue of Boom!) are also common in folks with fibromyalgia.

Fibromyalgia is seven times more common in women than in men. It tends to occur in early or middle adulthood, but certainly can occur later in life. Diagnosing fibromyalgia is difficult because there isn’t a single, specific diagnostic test. It is a diagnosis of exclusion, which means that medical providers must “rule out” diseases that can mimic fibromyalgia, such as polymyalgia rheumatica and hypothyroidism, when making the diagnosis.

Many researchers believe that the underlying pathology of fibromyalgia has something to do with the way the brain processes information about pain. Interestingly, some people with fibromyalgia have abnormal levels of Substance P, a chemical that helps transmit and amplify pain signals to and from the brain. For people with fibromyalgia, it’s as though the “volume control” is turned up too high in the brain’s pain processing areas. This may explain the “hypersensitivity” experienced by so many fibromyalgia patients – hypersensitivity not only to pain, but also to odors, noises, bright lights and touch as well.

Considering the absence of objective tests or markers for fibromyalgia, and the protean nature of the symptoms, many doctors doubt that fibromyalgia is a bona fide medical entity. Some consider it a “fad” diagnosis, like hypoglycemia was a decade or so ago, employed merely to give a “name” to otherwise unrelated symptoms, many of which are psychological or psychosomatic. Worse, some medical professionals believe that fibromyalgia is a favorite diagnosis of malingerers – people who are feigning symptoms to avoid work or other responsibilities. That sort of skepticism only contributes to the depression and frustration experienced by so many fibromyalgia patients.

Although fibromyalgia isn’t progressive and generally doesn’t lead to other conditions or diseases, the problems of pain, fatigue and depression associated with the condition often interfere with the patient’s ability to work at home or on the job, or maintain close family or personal relationships. The frustration of dealing with an often-misunderstood condition can itself be a debilitating complication of the condition.

Treatment – Self-care and lifestyle adjustments are keys to success!

Fibromyalgia is even more difficult to treat than it is to diagnose; nonetheless, the right combination of medication, self-care and lifestyle adjustments can prove beneficial. Increasing physical activity and decreasing stress at home, at work and in relationships, may be the keys to success.

•  Reduce Stress.  To the extent possible, try to apply the “Four S’s” to all activities and relationships in your life: simple, slow, serene, and supportive. Find ways to reduce stress that work for you. Learn to say no without guilt.

•  Exercise regularly. At first, exercise may increase your pain, but often it reduces pain and fatigue if you start slow, increase your activity level at a comfortable pace, and exercise regularly. Choose activities that fit into your daily routine, like taking the stairs instead of the elevator, delivering a message personally instead of sending an email, or parking further away from your destination. Then add low-impact activities such as taking long walks in pleasant surroundings, or swimming, or pedaling a stationary bike while reading the newspaper or watching television. “Slow and steady” wins the race…and reduces the symptoms of fibromyalgia.

•  Get enough sleep. Sleep allows the body to repair itself, physically and psychologically. Practice good “sleep hygiene,” which includes the following: Establish a regular pattern of going to bed and waking up; go to bed only when sleepy; don’t nap; if you can’t fall asleep within 20 minutes, don’t toss and turn – get up and do something boring until you feel sleepy; avoid caffeinated beverages later in the day; develop rituals to give your body cues that it’s bedtime, like turning down the lights and reading or listening to something soothing; make sure your bed is comfortable and your bedroom is cool, dark and quiet.

•  Educate yourself. Organizations like the Arthritis Foundation and the National Fibromyalgia Association are excellent resources for information that you can share with those close to you. Joining a support group can help with coping strategies, and relieve isolation and frustration.

•  Use medication judiciously. Medications can help if used appropriately. Prescribing the right medication in this condition is more of an art than a science, and requires a close, cooperative relationship between doctor and patient. Some observers feel that Tylenol and Ultram are the most useful analgesics for the pain of fibromyalgia. The muscle relaxant Flexeril may help at bedtime. The use of prescription sleeping medication may also prove useful for some patients. Certain types of antidepressants can be quite beneficial, but their effects can vary widely in fibromyalgia patients, so your physician may have to try different options before finding one, or a combination, that works well.

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