Fibromyalgia and Chronic Fatigue Syndrome are poorly understood conditions for both doctors and for the public, their potential patients. There is not one clear symptom or test that makes the diagnosis of either Chronic Fatigue Syndrome or Fibromyalgia .The list of associated possible symptoms are long and varied and there is a great overlap between the two. Many people clearly would satisfy the criteria for both diagnoses and can be said to have Fibromyalgia/ Chronic Fatigue Syndrome.
To be diagnosed with Chronic Fatigue syndrome a person is said to have severe fatigue for at least 6 months or longer that is not relieved by rest and not due to medical or psychiatric conditions associated with fatigue. Suffering from this unexplained fatigue means that the patients who seek medical care are often told by their doctors that they can find nothing wrong with them, and that their tests are normal. When a doctor is presented with a patient who complains of fatigue they check for a host of medical problems that are known to cause fatigue. Two of the most common are anemia, and hypothyroidism (underactive thyroid gland). The problem arises for both the patient and the doctor, when the doctor runs a series of tests and does not find that anything is abnormal. The doctor doesn’t have a treatment plan, and the patient is left without an understanding of what might be wrong, and often that results in the patient seeking yet another doctor’s opinion. But there is no test that defines chronic fatigue syndrome, and so a common scenario is that a person seeks care from a variety of different healthcare providers only to wind up just where they started…being told that nothing can be found.
Very often these patients are told that they must have an underlying depression which can be manifested as fatigue. The patient will be offered antidepressant medication even if they insist that they are not depressed. Many people are caught up in a cycle of testing and retesting, and even trying other antidepressant medications when the first one does not have any beneficial effect, all without benefit.
To further establish a diagnosis of Chronic Fatigue syndrome, the patient is said to suffer from a number of the following symptoms: unrefreshing sleep, fatigue present before the day’s activities, impairment in short-term memory or concentration, post-exertional malaise (prolonged exhaustion following physical activity that lasts more than 24 hours), muscle pain, multi-joint pain without swelling or redness, headaches, recurring sore throats, tender cervical or axillary lymph nodes.
As pain is among the symptoms listed from chronic fatigue syndrome, one may logically ask, what is it that distinguishes someone as having fibromyalgia? There are two particular characteristics of fibromyalgia pain that make the diagnosis as laid out by the American College of Rheumatology in 1990. Fibromyalgia sufferers have a history of widespread pain for at least three months. Widespread pain means that there is pain on both sides of the body, and also above and below the waist. And they have tender “trigger points.”
A doctor can perform an exam showing that there are at least 11 of 18 identified specific locations around the body that patients tend to feel tenderness at. This would clinch the formal diagnosis, but in the real world, if a patient has the characteristic type of pain and associated symptoms of fibromyalgia, the clinical diagnosis is made without strict adherence to the number of eleven tender spots to use the diagnosis, as defined in the diagnostic criteria.
Now consider what one may find doing research on symptoms associated with fibromyalgia besides their pain: anxiety and depression, chronic headaches, dryness in mouth, nose, and eyes, sensitivity to cold and/or heat, inability to concentrate, irritable bowel syndrome, numbness or tingling in the fingers and feet, poor circulation in hands and feet (Reynaud’s phenomenon), restless legs syndrome, stiffness. There is quite an overlap.
So how does one decide whether their condition is Chronic Fatigue syndrome, or Fibromyalgia? For some patients with fatigue there is little pain, but for most with fibromyalgia pain, fatigue is also a large problem. So for many, it would seem that the most appropriate label would seem to be “Fibromyalgia/ Chronic Fatigue Syndrome.”
Getting past the definitions we are left with suffers who have a whole host of problems for which there is no clear cure .There are two medications that have been approved by the FDA for fibromyalgia pain, Cymbalta and Savella. Both have the chemical characteristics of antidepressants. A variable effect has been found in patients, and although helpful for some, these are not the real answer to this problem. There is also no clearly known single cause and there cannot be one cure to the variety of problems that are associated, and the symptoms that are manifest with Chronic Fatigue or Fibromyalgia. No wonder that these patients have a difficult condition to bear, and the doctor’s a difficult condition to try and treat.
If there is no clear treatment then what can be done?
FIBROMYALGIA/ CHRONIC FATIGUE SYNDROME
Where Integrative Medicine is Essential
Doctors treating this need to think “out of the box “with regard to natural therapies including dietary approaches that provide so much more than simply using medications for symptom relief. To even attempt to heal the person’s system as a whole, a holistic approach taking into account mind- body connection, dietary and lifestyle influences and the like, provide the best hope for sufferers.
Attending to underlying food and other environmental sensitivities is crucial for many people who suffer from Fibromyalgia/ Chronic Fatigue. Dietary control by temporary elimination of problem foods and immunotherapy for sensitivities to foods, mold, dust and other allergens can make a dramatic difference for some.
A complete evaluation of Chronic Fatigue/ Fibromyalgia sufferers requires a thorough investigation of hormonal balance. Many people without an overt proven medical condition such as hypothyroidism are still found to have suboptimal levels leading to the patient being untreated. Striving for optimized levels and consideration of adrenal stress and borderline dysfunction, is not emphasized in most medical offices which do not routinely care for Chronic Fatigue / Fibromyalgia patients.
Getting adequate rest for the body through restful sleep is an essential element in caring for these patients. There are a number of methods to enhance sleep before resorting to medications as a last resort. The first and simplest, but unfortunately the least used practice, is deep breathing techniques or some form of meditation to reduce stress and help insomnia. A nutritional supplement approach is successful for many with disturbed sleep using amino acids like 5- HTP, GABA, l-glycine and theanine. There are many helpful herbal compounds that can be safely tried. These could include valerian root, passion flower, hops, chamomile, and skullcap. Melatonin a hormone, is a well known sleep aid, and hormonal balancing may help sleep not only for menopausal women but in younger women and for men as well.
A safe technology of note is called CES (Cranial electrical Stimulation.) It allows the user of a small home device to create a more relaxed pattern of brain waves which promotes sleep in insomnia sufferers, and also provides general daytime relief of stress. A related technology provides pain relief through electrical stimulation of affected body parts, and both modalities can be used for those who suffer from the pain of fibromyalgia, and the insomnia and stress which inevitably accompanies their pain.
Infections may play a role in others and needs to be considered by physicians. In the northeast particularly, the possibility of underlying Lyme disease should be evaluated. In that case labs specializing in infectious disease testing should be consulted, as the known percentage of “false negative “tests are too high. Unfortunately a “false negative test, meaning that the person tests negative despite having the problem being tested for, has been proven to commonly occur in Lyme disease.
Other infections such as Epstein Barr Virus and other viruses, or Candida yeast are common associated factors in Chronic Fatigue/ Fibromyalgia syndromes. The integrative approach to infections involves not only specific measures which can be taken against the infectious agent, but enhancement and monitoring the status of immune functioning of the patient.
In summary the causes, of Fibromyalgia/ Chronic Fatigue Syndrome are many and the applied therapies can be many as well. Whichever may be the most prominent factor; hormonal imbalance, infections , food intolerances or stress and sleep problems, the best approach is to address everything in an interrelated treatment program, individually tailored to address the needs of the variety of people who suffer from these common and often debilitating conditions. With this approach there is hope and effective treatment.
Henry C. Sobo, M.D. practices Integrative Medicine in Stanford, CT. For more information see his website at www.drsobo.com or call the office at 203-348-8805. 111 High Ridge Road, Stamford, CT. [email protected]