Chronic Fatigue - Fibromyalgia

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Chronic Fatigue Syndrome and Fibromyalgia Symptoms and Treatments

By Jacob A. Teitelbaum, MD

This is a fast paced world. We are all busy; living our full lives, burning the candle at both ends. all get tired. We all get sick from time to time and maybe even depressed. But the illness called chronic fatigue syndrome is not like the normal ups and downs that we experience in everyday life. People with chronic fatigue syndrome feel overwhelming fatigue, and often pain as well. This is an illness that does not go away with a few good night’s sleep. It drags on and on and doesn’t resolve itself. It steals vigor and energy over months, and sometimes even years.

In this article we'll talk about powerful vitamins, minerals, amino acids, and herbs combined in scientifically validated formulas that people with chronic fatigue syndrome or fibromyalgia can use every day. These nutrients can help address some root problems of chronic fatigue syndrome and fibromyalgia by restoring energy and health to sufferers.

What is chronic fatigue syndrome?

Chronic fatigue syndrome (CFS) also known as chronic fatigue and immune dysfunction syndrome (CFIDS), or myalgic encephalomyelitis (ME).1,2 is a group of symptoms associated with unrelenting and debilitating fatigue.1,2 The profound weakness of CFS causes a persistent and substantial reduction in activity level. You feel too tired to do normal activities or are easily exhausted for no apparent reason.1,3

Beside extreme fatigue, symptoms of CFS include general pain, mental fogginess, flu-like symptoms, and gastrointestinal problems. A list of symptoms includes: 2-4

• Headache
• Frequent infections, such as sinus or respiratory infections, swollen glands, bladder infection or yeast infections
• Muscle and joint aches
• Inability to concentrate or “brain fog”
• Allergies to foods and medications
• Anxiety and depression
• Decreased sex drive The number of symptoms and the severity of these symptoms can vary among people. The symptoms of CFS hang on or reoccur frequently for more than six months.3

Are chronic fatigue syndrome and fibromyalgia considered to be the same illness?

Fibromyalgia syndrome (FMS) is a painful shortening of muscles throughout the body.5 FMS is basically a sleep disorder characterized by many tender knots in the muscles. These tender knots, called tender or trigger points,are a major cause of the achiness that people with fibromyalgia and CFS feel.6

Approximately 80 percent of chronic fatigue syndrome patients have received an overlapping diagnosis of fibromyalgia syndrome. For most people, fibromyalgia and chronic fatigue syndrome are the same illness.6,7

What causes chronic fatigue syndrome?

There are many causes that can trigger CFS. Current research is looking at the roles of neuroendocrine dysfunction, viruses, environmental toxins, genetic predisposition, food sensitivities, yeast overgrowth, faulty digestion, or a combination of these factors.2

For many people, CFS is triggered by a bout with a viral illness (like a cold or the flu), or even a stressful event.2,3 CFS is usually a mix of underlying causes. It is like a domino effect in that each problem can trigger another problem, and so on. For example, fatigue and poor sleep can trigger a weakened immune system, which can, in turn, trigger yeast or bacterial infections.8

Who gets chronic fatigue syndrome?

CFS is more common than you might expect. It strikes people of all ages, racial, ethnic, and socioeconomic groups. Approximately 800,000 people nationwide have CFS and over six million have fibromyalgia at any given time.9,10

It is important to stress that CFS is a real illness; it is not “just in your head.” Unfortunately, sufferers of CFS may find that many healthcare practitioners discount the symptoms of this illness or misdiagnose it as another disease. This can lead to additional emotional suffering.

How long does chronic fatigue syndrome last?

The illness varies greatly in its duration. Some people recover after a year or two. More often, those who recover are more likely to do so three to five years after onset. Yet for some people, the illness seems to simply persist. There are rare cases of spontaneous improvement after five years without undergoing any treatment. However, this is very unusual.2

What are the complications of chronic fatigue syndrome?

The patterns of CFS vary from individual to individual. However, many common patterns of symptoms are seen in CFS suffers. These symptoms and problems interact and create new symptoms and problems. For example, infections and disrupted sleep can lead to digestive, hormone, and immune problems.11

Infections

The most notorious pattern seen in CFS states is the one in which a person suddenly comes down with a flu-like illness that doesn’t go away. These viral or bacterial infections can suppress the body’s master gland, the hypothalamus. Since the hypothalamus controls the other glands, including the adrenals, ovaries, testes, and thyroid, suppression of this gland will lead to a subtle but debilitating decrease in the functioning of all glands and their hormones. Suppressed hypothalamic function from chronic infections can then trigger sleep dysfunction.12

Disrupted Sleep

The suppression of the hypothalamus gland can lead to poor sleep because the body confuses its day/night cycles. Because of this, people with CFS have trouble staying in the deep, restorative stages of sleep that “recharge their batteries.”13

Poor sleep can cause immune suppression, which may lead to secondary bowel infections. The bowel infections seen in people with CFS can cause decreased absorption of nutrients, which can lead to chronic vitamin and mineral deficiencies.13

Is there a cure for chronic fatigue syndrome?

Treating chronic fatigue syndrome presents a significant challenge to people with CFS and their healthcare practitioners. Recently, a published placebo-controlled study (of which I was the lead investigator) showed that when using an integrated treatment approach, over 85 percent of CFS and fibromyalgia patients can improve—often dramatically. The full text of this study can be seen at ‘www.endfatigue.com’. An editorial in the April 2002 issue of the Journal of the American Academy of Pain Management noted that this treatment, which I developed, is now a highly effective and excellent part of the standard of practice for treatment of fibromyalgi Since this treatment addresses many different problems associated with CFS/FMS, it needs to be individualized to each patient.15

Medical Treatments

Medications that provide symptom relief are frequently the first line of treatment chosen by healthcare practitioners for the person with CFS. These include medications for pain, sleep disturbances; digestive problems such as nausea, depression and anxiety, and flu-like symptoms.16

However, medications have not been universally successful because they tend to put a bandage on symptoms instead of addressing the root problems. Because of this, medications may need to be supplemented by the other supportive therapies that can address the root problems.

Supportive Treatments

People with CFS/FMS may be depressed, given the catastrophic lifestyle disruption this disease may cause. They may also feel guilt and frustration because their symptoms were not taken seriously for such a long time. Fear can be a factor as employment and family relationships may be jeopardized by this illness.

Therapies that help people to relax and improve coping skills may be helpful and include counseling for emotional and mental health, cognitive behavioral therapy, sleep management therapy, and massage.16

Lifestyle Treatments

Altered digestion, food intolerances, decreased energy, fatigue, cognitive problems, and sleeplessness create the need for changes in daily living routines. These can include alterations in diet; exercise modifications; alterations in activities of daily living according to one's energy level; and sleep/rest management. All may require the assistance of professional clinicians, such as a nutrition specialist, physical and/or occupational therapists, mental health professionals, and sleep therapists.16

Other Treatments

Many persons find complementary therapies such as acupuncture, tai chi, special diets, and herbal supplements to be helpful. Since treatments for CFS/FMS work best when tailored to the individual’s needs, it is beneficial to work with an experienced healthcare practitioner to coordinate these interventions.

What steps do I need to take to get well?

Since the causes and symptoms of chronic fatigue syndrome and fibromyalgia are complex, the interventions to improve health and energy are somewhat involved. The multitiered regimen to get on the road to recovery is outlined below.

The Road to Recovery Adequate Sleep

Disordered sleep is the underlying process that drives many of the symptoms of CFS/ FMS. The most effective way to eliminate pain in CFS/FMS is to get seven to nine hours of deep sleep each night.17

However, getting adequate sleep is easier said than done for CFS sufferers with underlying fibromyalgia symptoms. The muscle knots of fibromyalgia make it uncomfortable to lie in one position for extended time, causing difficulty in returning to deep sleep. Because of this, people with CFS/FMS do not stay in deep stages of sleep to recharge their “batteries.” In addition, poor sleep can cause and be caused by the suppression of the hypothalamus gland, which causes the brain to think it is daytime instead of night.18

It may be helpful to use herbal products to promote good quality sleep. There are many natural supplements that are marketed as sleep formulas. To get the best results, it is very important that the right ingredients are in the sleep formula you buy. (See chart below)

Herbal Ingredient Effect on Sleep Wild Lettuce Hops Jamaica Dogwood L-Theanine Valerian Passion Flower Has been found to have sedative effects.19 Acts as a mild sedative and has a sleep inducing effect.20,21 Has been found to be mildly sedative and is often used for anxiousness.22 Causes significant increases of neurotransmitter concentrations in brain, which promotes muscle relaxation and improves sleep.23,24 This herb has been clinically studied for its ability to improve sleep quality.25-33 This herb eases nervousness and insomni34,35

Therefore, it is important to look for an herbal sleep formula that is especially formulated for people with CFS/FMS. The combination of herbs is important as each herb addresses a different aspect of sleeplessness and muscle tension.

Daily Nutritional Supplementation for Energy

Good overall nutrition is important for everyone, of course. However, there are several vitamins, minerals, and amino acids that can have powerful nutritional effects for a person with CFS. The chart below lists the most critical ingredients. You can see that almost all of the vitamins and minerals in a chronic fatigue/fibromyalgia formula should work together synergistically to help improve energy levels and overall health.

Vitamins and Minerals

Vitamin E: Helps to relieve pain in CFS patients. Can also improve night leg cramps, which interferes with sleep.36

Vitamin C: Enhances immune function by increasing natural killer cells, B and T cells. Can prevent chronic bladder infections by acidifying urine.37-44

Vitamin D: Regulates immune functions of monocytes and neutrophils.45-47

Magnesium: Involved with immune support. Working with malic acid, enhances immune function by increasing natural killer cells. Magnesium is also critical for the relief of muscle pain.48,49

Inositol: Enhances immune function by increasing natural killer cells.50

Malic Acid: Working with magnesium, improves energy levels by improving cellular functions. Especially important in muscle metabolism.49

Amino Acids: Glycine, Serine, Taurine, Tyrosine are essential for the production of energy in the body. Also essential for brain function.51

Zinc: Supports the immune system by enhancing neutrophil activity and supporting healthy antigen-antibody binding.52,53

Selenium: Supports immune function by enhancing antibody production.54,55

Fructooligosaccharides: Provides nutrition for good bacteria in the intestinal tract, improving digestion and healthy microflor56

All of the vitamins, minerals, and other nutritional supplements on the list are important to ensure recovery from chronic fatigue syndrome. To ensure that your nutritional supplement regimen contains all of these ingredients, look for a powdered supplement formulated specifically for CFS/FMS sufferers that can be reconstituted in a beverage of your choice. A powdered drink mix is a pleasant, easy way to ensure that you are taking all of the needed vitamins, minerals, and amino acids that will give you the needed energy to recover from your illness.

B Vitamin Complex for Energy

In addition to the powdered energy drink mix, it is important that you also take a vitamin B-complex supplement specifically formulated for people with CFS/FMS. The B vitamin formula, which should include niacinamide, thiamin, riboflavin, vitamin B6, vitamin B12, pantothenic acid, and choline, is especially important to restore the energy production needs of your body, as well as for mental function. It is also important to make sure that the dosages are high enough for CFS/FM needs.57,58 The chart below lists the B vitamins that are critical for people suffering from CFS.

B Vitamins Effect on Chronic Fatigue Syndrome

B Vitamins Effect on CFS Niacinamide Thiamine Vitamin B6 Pantothenic Acid Folic Acid Vitamin B12 Essential vitamin that is a component of the body's energy furnace, helping to improve fatigue and "brain fog".59 Essential in the process of energy production. This vitamin also removes lactic acid from muscles, which causes them to be sore in fibromyalgia patients.59 Working along with thiamine, this vitamin is critical in the process of energy production.59 This vitaminan improves adrenal gland function, which will boost energy levels. It can also aid in weight loss by decreasing appetite.60 Aids in strengthening the immune system, and aids in mental clarity and concentration.61 Important for brain function and nerve repair. Aids in relieving fatigue symptoms in CFS patients.57

Studies have demonstrated that people with CFS/FMS are often deficient in many of the B vitamins, which tend to worsen their symptoms of fatigue and mental “fogginess” and ultimately lead to a weakened immune system.57,58,61,62

How often should I take chronic fatigue syndrome/fibromyalgia formula supplements?

Because good quality sleep is so important to the recovery process, it is very important to take an herbal sleep formula that is specially formulated to help maintain deep restorative sleep in people with CFS/FMS. This should be taken every evening, about 30-60 minutes before bedtime to ensure that you get seven to nine hours of deep sleep each night.

After a good night’s rest, a powdered energy drink mix formulated for people with CFS/FMS should be drunk along with a well-balanced breakfast. In addition to the nutritional beverage mix, a vitamin B complex supplement designed specifically for CFS sufferers, containing niacinamide, thiamin, riboflavin, vitamin B6, vitamin B12, pantothenic acid, and choline, should be taken every morning.

The nutritional drink mix and the vitamin B complex supplement will ensure that your body has all the vitamins, minerals, and amino acids to combat your overwhelming fatigue, pain, and “brain fog”.

Together, these three interventions–sleep formula, morning energy drink mix, and energy B complex supplement–can make an incredible difference that you should begin to notice within 1 month of starting this program.

Conclusion

Chronic fatigue syndrome and fibromyalgia are complex physical processes with physical causes. The unrelenting symptoms of fatigue, pain, and mental fogginess can be overwhelming and frightening. Partnering with a healthcare practitioner specializing in CFS and utilizing different medical treatments, supportive therapies, and lifestyle changes are healthy ways to combat chronic fatigue syndrome. And taking nutritional supplements formulated specifically for people with CMS/ FM that help boost energy or help you get a good night’s sleep can give you critical control over the outcome of your illness and set you on the road to recovery.

References

1. Teitelbaum J. From Fatigued to Fantastic. New York: Penguin Putnam Inc.; 2001:1.

2. Chronic Fatigue Syndrome. Chronic Fatigue Syndrome News Website. Available at: http://www.cfsnews.org/fahtm. Accessed on May 3, 2002.

3. Chronic Fatigue Syndrome Fact Sheet. National Institute of Allergy and Infectious Diseases Website. Available at: http//www.niaid.nih.gov/
factsheets/cfs.htm. Accessed on May 3, 2002.

4. Teitelbaum J. From Fatigued to Fantastic. New York: Penguin Putnam Inc.; 2001: 9-11.

5. Chronic Fatigue Symptoms. Wisconsin Chronic Fatigue Syndrome and Myalgic Encephalomyelitis Association Website. Available at: http//www.wicfs-me.org/common.htm. Accessed on May 3, 2002.

6. Teitelbaum J. From Fatigued to Fantastic. New York: Penguin Putnam Inc.; 2001: 14.

7. Ibid., pp. 2-3.

8. Ibid., p. 11.

9. Ibid., p. 2.

10. Chronic Fatigue Prevalence Study. Chronic Fatigue and Immune Dysfunction Syndrome Association of America Website. Available at: http//www.cfids.org/
about-cfids/prevalence-
study.asp. Accessed on May 3, 2002.

11. Teitelbaum J. From Fatigued to Fantastic. New York: Penguin Putnam Inc.; 2001: 5.

12. Ibid., pp. 5-6.

13. Ibid., pp. 7-8.

14. Chronic Fatigue Syndrome. Center for Disease Control Website. Available at: http//www.cdc.gov/
ncidod/diseases/cfs/
demographics.htm. Accessed on May 3, 2002.

15. Teitelbaum J, Bird B, Greenfield R, Weiss A, Muenz L, Gould L. Effective treatment of chronic fatigue syndrome (CFIDS) and fibromyalgia (FMS)- a randomized, double-blind, placebo-controlled, intent to treat study. Journal of Chronic Fatigue Syndrome. 2001;8.

16. Treatments for Chronic Fatigue Syndrome. Chronic Fatigue and Immune Dysfunction Syndrome Association of America Website. Available at: http//www.cfids.org/
about-cfids/
treatment.asp. Accessed on May 3, 2002.

17. Teitelbaum J. From Fatigued to Fantastic. New York: Penguin Putnam Inc.; 2001:105-6.

18. Ibid., pp. 98-100.

19. Lactucarium. In: Fleming T., ed. PDR® for Herbal Medicines. Montvale, NJ: Medical Economics Company; 1998: 453-4.

20. Hops. In: Blumenthal M., ed. The Complete German Commission E Monographs. Austin, Tex: American Botanical Council; Integrative Medicine Communications; 1998: 147.

21. Hops. In: Fleming T., ed. PDR® for Herbal Medicines. Montvale, NJ: Medical Economics Company; 1998: 400-1.

22. Jamaica Dogwood. In: Fleming T., ed. PDR® for Herbal Medicines. Montvale, NJ: Medical Economics Company; 1998: 428-9.

23. Yofogoshi H, Kobayashi M, Mochizuki M, Terahima T. Effect on theanine, r-glutamylethylamide, on brain monoamines and striatal dopamine release in conscious rats. Neurochemical Research. 1998;23: 667-73.

24. Juneja L, Chu D, Okubo T, Nagato Y, Yokogoshi H. L-theanine: a unique amino acid of green tea and its relaxation effect in humans. Trends in Food Science & Technology. 1999; 10: 199-204.

25. Atelle AS, Xie JT, Yuan CS. Treatment of insomnia: an alternative approach. Altern Med Rev. 2000;5:249-259.

26. Leathwood PD, Chauffard F, Heck E, Munoz-Box R. Aqueous extract of valerian root (Valeriana officinalis L.) improves sleep quality in man. Pharmacol Biochem Behav. 1982;17:65-71.

27. Leathwood PD, Chauffard F. Aqueous extract of valerian reduces latency to fall asleep in man. Planta Med. 1985;51:144-148.

28. Lindahl O, Lindwall L. Double blind study of a valerian preparation. Pharmacol Biochem Behav. 1989;32:1065-1066.

29. Balderer G, Borbely A Effect of valerian on human sleep. Psycho-Pharmacol. 1985;87:406-409.

30. Schulz H, Stolz C, Muller J. The effect of valerian extract on sleep polygraphy in poor sleepers: a pilot study. Pharmacopsychiatry. 1994;27:147-151.

31. Robbers JE, Tyler VE. Tyler's Herbs of Choice. New York, NY: The Haworth Herbal Press;1999:154.

32. Valerian. In: Blumenthal M, Goldberg A, Brinckmann J., ed. Herbal Medicine. Expanded Commission E Monographs. Austin, Tex: American Botanical Council; Integrative Medicine Communications; 2000:397.

33. Valerian radix. In: WHO Monographs on Selected Medicinal Plants, Vol. 1. Geneva: World Health Organization; 1999:267-276.

34. Passion Flower. In: Fleming T., ed. PDR® for Herbal Medicines. Montvale, NJ: Medical Economics Company; 1998: 573-5.

35. Passion Flower. In: Blumenthal M., ed. The Complete German Commission E Monographs. Austin, Tex: American Botanical Council; Integrative Medicine Communications; 1998: 179-80.

36. Teitelbaum J. In: From Fatigued to Fantastic. New York: Penguin Putnam Inc.; 2001: 128, 146.

37. Dyke GW, Craven JL, Hall R, Garner RC. Effect of vitamin C supplementation on gastric mucosal DNA damage. Carcinogenesis. 1994;15:291-295.

38. Tuovinen V, Vaananen M, Kullaa A, Karinpaa A, Markkanen H, Kumpusalo E. Oral mucosal changes related to plasma ascorbic acid levels. Proc Finn Dent Soc. 1992;88:117-122.

39. Fernandez MD, Correa R, Del Rio M, De la Fuente M. Effects in vitro of several antioxidants on the natural killer function of aging mice. Exp Gerontol. 1999;34:675-685.

40. de la Fuente M, Ferrandez MD, Burgos MS, Soler A, Prieto A, Miquel J. Immune function in aged women is improved by ingestion of vitamins C and E. Can J Physiol Pharmacol. 1998;76:373-380.

41. Heuser G, Vojdani Enhancement of natural killer cell activity and T and B cell function by buffered vitamin C in patients exposed to toxic chemicals: the role of protein kinase-C. Immunopharmacol Immunotoxicol. 1997;19:291-312.

42. Nockels CF. The role of vitamins in modulating disease resistance. Vet Clin North Am Food Anim Pract. 1988;4:531-542.

43. Tajima S, Pinnell SR. Ascorbic acid preferentially enhances type I and III collagen gene transcription in human skin fibroblasts. J Dermatol Sci. 1996;11:250-253.

44. Teitelbaum J. From Fatigued to Fantastic. New York: Penguin Putnam Inc.; 2001: 68-9.

45. Cantorna MT, Humpal-Winter J, DeLuca HF. In vivo up regulation of interleukin-4 is one mechanism underlying the immunoregulatory effects of 1,25-dihydroxyvitamin D(3). Arch Biochem Biophys. 2000;377:135-8.

46. Tokuda N, Kano M, Meiri H, Nomoto K, Naito S. Calcitriol therapy modulates the cellular immune responses in hemodialysis patients. Am J Nephrol. 2000;20:129-37.

47. Saini A, Cohen DJ, Ooi BS. Regulation of macrophage growth responses to colony-stimulating factor-1 by 1,25-dihydroxyvitamin D3. J Am Soc Nephrol. 1995;5:2091-3.

48. Doan L, Handa B, Roberts NA, Klumpp K. Metal ion catalysis of RNA cleavage by the influenza virus endonuclease. Biochemistry. 1999;38:5612-9.

49. Teitelbaum J. From Fatigued to Fantastic. New York: Penguin Putnam Inc.; 2001: 148-9.

50. Ibid., p.83.

51. Ibid., p. 154.

52. Wellinghausen N, Kern WV, Jochle W, Kern P. Zinc serum levels in immunodeficiency virus-infected patients in relation to immunologic status. Biol Trace Elem Res. 2000;73:139-149.

53. Hasegawa H, Suzuki K, Suzuki K, Nakaji S, Sugawara K. Effects of zinc on the reactive oxygen species generating capacity of human neutrophils and the serum opsonic activity in vitro. Luminescence. 2000;15:321-327.

54. Girodon F, Galan P, Monget AL, et al. Impact of trace elements and vitamin supplementation on immunity and infections in institutionalized elderly patients: a randomized controlled trial. Arch Intern Med. 1999;159:748-54.

55. Johnson MA, Porter KH. Micronutrient supplementation and infection in institutionalized elders. Nutr Rev. 1997;55:400-4.

56. Gibson GR, Beatty ER, Wang X, Cummings JH. Selective stimulation of bifidobacteria in the human colon by oligofructose and inulin. Gastroenterology. 1995 Apr;108(4):975-82.

57. Teitelbaum J. From Fatigued to Fantastic. New York: Penguin Putnam Inc.; 2001: 19-20.

58. Regland B, Andersson M, Abrahamsson L, et al. Increased concentrations in the cerebrospinal fluid in patients with fibromyalgia and chronic fatigue syndrome. Scand J Rhematol. 1997; 26: 301-7.

59. Teitelbaum J. From Fatigued to Fantastic. New York: Penguin Putnam Inc.; 2001: 152-3.

60. Ibid., p. 154.

61. Jacobson W, Saich T, Borysiewicz L, et al. Serum folate and chronic fatigue syndrome. Neurology. 1993; 43:2645-7.

62. Heap L, Peters T, Wesseley S. Vitamin B status in patients with chronic fatigue syndrome. JR Soc Med. 1999; 92:1183-5.

Fibromyalgia Symptoms and Treatments

By the National Institute of Health

Use your browser's back button to navigate this Fibromyalgia menu.

• What Is Fibromyalgia?
• How Many People Have Fibromyalgia?
• What Causes Fibromyalgia?
• How Is Fibromyalgia Diagnosed?
• How Is Fibromyalgia Treated?
• What Research Is Being Conducted on Fibromyalgia?
• Where Can People Get More Information About Fibromyalgia?
• Keywords

What Is Fibromyalgia?

Fibromyalgia is a chronic disorder characterized by widespread musculoskeletal pain, fatigue, and multiple tender points. "Tender points" refers to tenderness that occurs in precise, localized areas, particularly in the neck, spine, shoulders, and hips. People with this syndrome may also experience sleep disturbances, morning stiffness, irritable bowel syndrome, anxiety, and other symptoms.

How Many People Have Fibromyalgia?

According to the American College of Rheumatology, fibromyalgia affects 3 to 6 million Americans. It primarily occurs in women of childbearing age, but children, the elderly, and men can also be affected.

What Causes Fibromyalgia?

Although the cause of fibromyalgia is unknown, researchers have several theories about causes or triggers of the disorder. Some scientists believe that the syndrome may be caused by an injury or trauma. This injury may affect the central nervous system. Fibromyalgia may be associated with changes in muscle metabolism, such as decreased blood flow, causing fatigue and decreased strength. Others believe the syndrome may be triggered by an infectious agent such as a virus in susceptible people, but no such agent has been identified.

How Is Fibromyalgia Diagnosed?

Fibromyalgia is difficult to diagnose because many of the symptoms mimic those of other disorders. The physician reviews the patient's medical history and makes a diagnosis of fibromyalgia based on a history of chronic widespread pain that persists for more than 3 months. The American College of Rheumatology (ACR) has developed criteria for fibromyalgia that physicians can use in diagnosing the disorder. According to ACR criteria, a person is considered to have fibromyalgia if he or she has widespread pain in combination with tenderness in at least 11 of 18 specific tender point sites.

How Is Fibromyalgia Treated?

Treatment of fibromyalgia requires a comprehensive approach. The physician, physical therapist, and patient may all play an active role in the management of fibromyalgia. Studies have shown that aerobic exercise, such as swimming and walking, improves muscle fitness and reduces muscle pain and tenderness. Heat and massage may also give short-term relief. Antidepressant medications may help elevate mood, improve quality of sleep, and relax muscles. Patients with fibromyalgia may benefit from a combination of exercise, medication, physical therapy, and relaxation.

What Research Is Being Conducted on Fibromyalgia?

The NIAMS is sponsoring research that will increase understanding of the specific abnormalities that cause and accompany fibromyalgia with the hope of developing better ways to diagnose, treat, and prevent this disorder.

Recent NIAMS studies show that abnormally low levels of the hormone cortisol may be associated with fibromyalgia. At Brigham and Women's Hospital in Boston, Massachusetts, and at the University of Michigan Medical Center in Ann Arbor, researchers are studying regulation of the function of the adrenal gland (which makes cortisol) in fibromyalgia. People whose bodies make inadequate amounts of cortisol experience many of the same symptoms as people with fibromyalgia. It is hoped that these studies will increase understanding about fibromyalgia and may suggest new ways to treat the disorder.

NIAMS research studies are looking at different aspects of the disorder. At the University of Alabama in Birmingham, researchers are concentrating on how specific brain structures are involved in the painful symptoms of fibromyalgia. At George Washington University in Washington, DC, scientists are investigating the causes of a post-Lyme disease syndrome as a model for fibromyalgia. Some patients develop a fibromyalgia-like condition following Lyme disease, an infectious disorder associated with arthritis and other symptoms.

NIAMS-supported research on fibromyalgia also includes several projects at the Institute's Multipurpose Arthritis and Musculoskeletal Diseases Centers. Researchers at these centers are studying individuals who do not seek medical care, but who meet the criteria for fibromyalgia. (Potential subjects are located through advertisements in local newspapers asking for volunteers with widespread pain or aching.) Other studies at the Centers are attempting to uncover better ways to manage the pain associated with the disorder through behavioral interventions such as relaxation training.

In March 1998, NIAMS and several other NIH institutes and offices issued a Request for Proposals to promote research studies of fibromyalgia. As a result of this request, NIAMS and its partners recently funded 15 new fibromyalgia projects totaling more than $3.6 million.

The NIAMS supports and encourages outstanding basic and clinical research that increases the understanding of fibromyalgia. However, much more research needs to be done before fibromyalgia can be successfully treated or prevented.

The Federal Government, in collaboration with researchers, physicians, and private voluntary health organizations, is committed to research efforts that are directed at significantly improving the health of all Americans afflicted with fibromyalgia.

Where Can People Get More Information About Fibromyalgia?

Arthritis Foundation
1330 West Peachtree Street
Atlanta, GA 30309
404/872-7100
800/283-7800 or call your local chapter (listed in the telephone directory)
World Wide Web address: http://www.arthritis.org

This is the main voluntary organization devoted to all forms of arthritis. The Foundation publishes a pamphlet on fibrositis. Single copies are free with a self-addressed stamped envelope. The Foundation also can provide physician referrals.

Fibromyalgia Network
P.O. Box 31750
Tucson, AZ 85751-1750
800/853-2929
Contact: Ms. Kristin Thorson

Fibromyalgia Partnership (formerly Fibromyalgia Association of Greater Washington)
P.O. Box 160
Linden, VA 22642-0160
(toll free) 866/725-4404
Fax: 866-666-2727
World Wide Web address: http://www.fmpartnership.org

National Fibromyalgia Association
2200 N. Glassell Street, Suite A
Orange, CA 92865
714/921-0150
E-mail: fna@fmaware.org
Web site: fmaware.org

These are the main organizations devoted to fibromyalgia. They publish newsletters and provide pamphlets on the disease.

The National Institute of Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse is a public service sponsored by the NIAMS that provides health information and information sources. The NIAMS, a component of the National Institutes of Health, leads and coordinates the Federal medical effort in arthritis, musculoskeletal, bone, muscle, and skin diseases by conducting and supporting research projects, research training, clinical trials, and epidemiological studies, and by disseminating information on research initiatives and research results.

Keywords

Fibromyalgia

What is Fibromyalgia?
Who is affected?
What are the symptoms?
How is it diagnosed?
What causes FM?
How is FM treated?
What is the prognosis?
An Overview of Fibromyalgia for the Newly Diagnosed Patients
Newsweek Article on Fibromyalgia, May 19, 2003

What is Fibromyalgia?

Fibromyalgia (FM) is an increasingly recognized chronic pain illness which is characterized by widespread musculoskeletal aches, pain and stiffness, soft tissue tenderness, general fatigue and sleep disturbances.  The most common sites of pain include the neck, back, shoulders, pelvic girdle and hands, but any body part can be involved.  Fibromyalgia patients experience a range of symptoms of varying intensities that wax and wane over time.

Who is affected?

It is estimated that approximately 3-6% of the U.S. population has FM.  Although a higher percentage of women are affected, it does strike men, women and children of all ages and races.  Because of its debilitating nature, Fibromyalgia has a serious impact on patients' family, friends, and employers, as well as society at large.

What are the symptoms?

FM is characterized by the presence of multiple tender points and a constellation of symptoms.

Pain  The pain of FM is profound, widespread and chronic.  It knows no boundaries, migrating to all parts of the body and varying in intensity.  FM pain has been described as deep muscular aching, throbbing, twitching, stabbing and shooting pain that defines the very existence of the Fibromyalgia patient.  Neurological complaints such as numbness, tingling and burning are often present and add to the discomfort of the patient.  The severity of the pain and stiffness is often worse in the morning.  Aggravating factors which affect pain include cold/humid weather, non-restorative sleep, physical and mental fatigue, excessive physical activity, physical inactivity, anxiety and stress.

Fatigue  In today's world many people complain of fatigue; however, the fatigue of FM is much more than being tired.  It is an all-encompassing exhaustion that interferes with even the simplest daily activities.  It feels like every drop of energy has been drained from the body, which at times can leave the patient with a limited ability to function both mentally and physically.

Sleep Problems  Many Fibromyalgia patients have an associated sleep disorder which prevents them from getting deep, restful, restorative sleep.  Medical researchers have documented specific and distinctive abnormalities in the stage 4 deep sleep of FM patients.  During sleep, individuals with FM are constantly interrupted by bursts of awake-like brain activity, limiting the amount of time they spend in deep sleep.

Other symptoms  Additional symptoms may include:  irritable bowel and bladder, headaches and migraines, restless legs syndrome (periodic limb movement disorder), impaired memory and concentration, skin sensitivities and rashes, dry eyes and mouth, anxiety, depression, ringing in the ears, dizziness, vision problems, raynaud's syndrome, neurological symptoms and impaired coordination.

How is it diagnosed?

Currently there are no laboratory tests available for diagnosing Fibromyalgia.  Doctors must rely on patient histories, self-reported symptoms, a physical examination and an accurate manual tender point examination.  This exam is based on the standardized ACR criteria.  Proper implementation of the exam determines the presence of multiple tender points at characteristic locations.

It is estimated that it takes an average of five years for a FM patient to get an accurate diagnosis.  Many doctors are still not adequately informed or educated about FM.   Laboratory tests often prove negative and many FM symptoms overlap with the symptoms of other conditions, thus leading to extensive investigative costs and frustration for both the doctor and patient.  Another essential point that must be considered is that the presence of other diseases, such as rheumatoid arthritis or lupus, does not rule out a FM diagnosis.  Fibromyalgia is not a diagnosis of exclusion and must be diagnosed by its own characteristic features.

To receive a diagnosis of FM, the patient must meet the following diagnostic criteria:

• Widespread pain in all four quadrants of the body for a minimum duration of three months
• Tenderness or pain in at least 11 of the 18 specified tender points when pressure is applied (see figure above)

What causes FM?

While the underlying cause or causes of FM still remain a mystery, new research findings continue to bring us closer to understanding the basic mechanisms of Fibromyalgia.  Most researchers agree that FM is a disorder of central processing with neuroendocrine/neurotransmitter dysregulation.  The FM patient experiences pain amplification due to abnormal sensory processing in the central nervous system.  An increasing number of scientific studies now show multiple physiological abnormalities in the FM patient, including:  increased levels of substance P in the spinal cord, low levels of blood flow to the thalamus region of the brain, HPA axis hypofunction, low levels of serotonin and tryptophan and abnormalities in cytokine function.

Recent studies show that genetic factors may predispose individuals to a genetic susceptibility to FM.  For some, the onset of FM is slow; however, in a large percentage of patients the onset is triggered by an illness or injury that causes trauma to the body.  These events may act to incite an undetected physiological problem already present.

Exciting new research has also begun in the areas of brain imaging and neurosurgery.  Continued work will look at the hypothesis that FM is caused by an interpretative defect in the central nervous system that brings about abnormal pain perception.  Medical researchers have just begun to untangle the truths about this life-altering disease.

How is FM treated?

One of the most important factors in improving the symptoms of FM is for the patient to recognize the need for lifestyle adaptation.  Most people are resistant to change because it implies adjustment, discomfort and effort.  However, in the case of FM, change can bring about recognizable improvement in function and quality of life.  Becoming educated about FM gives the patient more potential for improvement.

An empathetic physician who is knowledgeable about the diagnosis and treatment of FM and who will listen to and work with the patient is an important component of treatment. It may be a family practitioner, an internist or a specialist (rheumatologist or neurologist, for example). Conventional medical intervention may be only part of a potential treatment program.  Alternative treatments, nutrition, relaxation techniques and exercise play an important role in FM treatment as well.  Each patient should, along with the healthcare practitioner, establish a multifaceted and individualized approach that works for them.

Pain Management  Over-the-counter pain medications, such as acetaminophen or ibuprofen, may be helpful in relieving pain.  The physician may decide to prescribe one of the newer non-narcotic pain relievers (e.g. tramadol) or low doses of antidepressants (e.g. tricyclic antidepressants, serotonin reuptake inhibitors) or benzodiazepines.  Patients must remember that antidepressants are "serotonin builders" and can be prescribed at low levels to help improve sleep and relieve pain.  If the patient is experiencing depression, higher levels of these or other medications may need to be prescribed.  Another beneficial pain therapy, which works well on localized areas of pain, is lidocaine injections into the patient's tender points.  An important aspect of pain management is a regular program of gentle exercise and stretching, which helps maintain muscle tone and reduces pain and stiffness.

Sleep Management  Improved sleep can be obtained by implementing a healthy sleep regimen, which includes going to bed and getting up at the same time every day, making sure that the sleeping environment is conducive to sleep (i.e. quiet, free from distractions, a comfortable room temperature, a supportive bed), avoiding caffeine, sugar and alcohol before bed, doing some type of light exercise during the day, avoiding eating immediately before bedtime and practicing relaxation exercises as you fall to sleep.  When necessary, there are new sleep medications that can be prescribed, some of which can be especially helpful if the patient's sleep is disturbed by restless legs or periodic limb movement disorder.

Psychological Support  Learning to live with a chronic illness often challenges an individual emotionally.  The FM patient needs to develop a program that provides emotional support and increases communication with family and friends.  Many communities throughout the United States and abroad have organized Fibromyalgia support groups.  These groups often provide important information and have guest speakers who discuss subjects of particular interest to the FM patient.  Counseling sessions with a trained professional may help improve communication and understanding about the illness and help to build healthier relationships within the patient's family.

Other Treatments 

Complementary therapies can be very beneficial.  These include:  physical therapy, therapeutic massage, myofascial release therapy, water therapy, light aerobics, acupressure, application of heat or cold, acupuncture, yoga, relaxation exercises, breathing techniques, aromatherapy, cognitive therapy, biofeedback, herbs, nutritional supplements, and osteopathic or chiropractic manipulation.

What is the prognosis?

Better than ever before!  The efforts of individuals, support groups, organizations and medical professionals to help improve the quality of life for people with FM are starting to pay off.  Better ways to diagnose and treat FM are on the horizon.  The symptoms of FM can vary in severity and often wax and wane, but most patients do tend to improve over time.  By actively seeking new information,  talking to others who have FM, re-evaluating daily priorities, making lifestyle changes, and working hard to keep a hopeful attitude, the FM sufferer can become the FM survivor!

Tender Point Examination

This exam is based on the standardized ACR criteria.  Proper implementation of the exam determines the presence of multiple tender points at characteristic locations.

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