Unfortunately the causes for fatigue are so varied that often it takes many visits before a definitive cause for fatigue is found.
If after significant testing no cause is identified, and your fatigue is of greater than six months in duration, you may have met one of the criteria for being diagnosed with Chronic Fatigue Syndrome. Diagnosis of either Fibromyalgia or chronic fatigue and immune dysfunction syndrome (CFIDS — also known as chronic fatigue syndrome or CFS) has only been possible in recent times. Although the diagnosis is made more frequently now, diagnosing these conditions can still be difficult. The signs and symptoms are common to both conditions and to other medical conditions and specific definitive testing is not available.
What Is Chronic Fatigue Syndrome and Fibromyalgia?
Fibromyalgia is commonly mistaken for arthritis because of the dispersed pain in multiple regions of the body. It is a widespread pain and tenderness at specific body sites along with muscular stiffness, fatigue, and sleep disturbances. The outstanding symptom of CFIDS is extreme, even disabling fatigue lasting at least six months. Muscular pains, flu-like symptoms, and mood changes are also common and overlap with the signs and symptoms of fibromyalgia. In fact, up to 75% of patients diagnosed with fibromyalgia have signs and symptoms matching a diagnosis of CFIDS. The cause of Fibromyalgia is unknown. It affects 5% of the American population, with women being 10 times more susceptible than men. The peak age is approximately 35 years old but the onset can present between the ages of 20 to 60.
Currently there is research being conducted in the area of Chronic Fatigue Syndrome & Fibromyalgia. In general some theories include: Viral infections, abnormal immune response, brain dysfunction, abnormal hypothalamo-pituatary-adrenal function, disrupted sleep and stress, exposure to pesticides (toxins), muscle abnormalities and others. Current research is also looking at the nervous system, particularly abnormal levels of neurotransmitters. Neurotransmitters are the hormones that regulate the central nervous system. Fibromyalgia patients tend to have high levels of substance P, a neurotransmitter found in spinal fluid which transmits pain signals. Should you or a family member suspect they have CFS and or fibromyalgia we would recommend first consulting your family practitioner. There are lists of tests your doctor can perform to rule out more common causes for fatigue.
Investigators from the Multicenter Fibromyalgia Criteria Study have developed a case definition for fibromyalgia as follows:
- Diffuse musculoskeletal pain greater than 3 months.
- When pressure is applied to specific regions at the neck, shoulder, elbow, upper back, lower back, hip, and knee (a total of 18 point locations) the tender point criterion are met if pain occurs at least eleven sites.
- Alternate criteria: 8 to 10 tender points plus 3 additional symptoms. Additional symptoms are present in approximately 50% of patients and include:
- Morning Stiffness
- Sleep Disturbance
- Paresthesias (numbness)
Source: Adapted from Wolfe F. Smythe HA, Yunus MB, et al.
There is no known cure for either fibromyalgia or CFS. Doctors therefore focus on relieving the symptoms of the disease. Treatment may include the following:
- Medication – Non-steroidal anti-inflammatory agents (NSAIDs), such as ibuprofen, are often used to relieve muscle pain and stiffness. Antidepressant medications are often helpful not only for relieving symptoms of depression but also for establishing good sleeping patterns and controlling chronic pain. Medications that fight viral infections have not proved helpful.
- Physical activity - Moderate exercise is often beneficial, particularly for people with fibromyalgia. A structured exercise program, particularly with the assistance of a physical therapist, may greatly reduce symptoms.
- Counseling – These can be difficult illnesses to live with. Psychological or psychiatric counseling may be particularly helpful in relieving depression and improving coping skills.
- Dietary supplements and herbs – Because of the difficulties and uncertainties surrounding treatment of fibromyalgia and CFIDS, many dietary and herbal treatments have been proposed disease.
- Non-drug therapies - Some fibromyalgia and CFIDS patients find relief in therapies such as acupuncture, aquatic therapy, chiropractic adjustments, massage, self-hypnosis, tai chi, stretching, yoga, or therapeutic touch.