I read a great article on ImmuneSupport.com by Karen Lee Richards, an expert patient who writes for HealthCentral’s ChronicPainConnection on ME/CFS and Fibromyalgia. Karen is also one of the co-founders of the National Fibromyalgia Association.
It has been debated for years by doctors whether or not ME/CFS and Fibromyalgia are one & the same, closely related or completely different illnesses. What has fueled the debate even further is that approximately 70% who are diagnosed with one of the illnesses also have been diagnosed with the other.
Karen says that several years ago Muhammad B. Yunus, MD reported that ME/CFS & FM and other conditions such as IBS, migraines and multiple chemical sensitivities were all part of a larger group he referred to as Central Sensitivity Syndromes.” He said that all of these illnesses have one factor in common – central sensitization. This is when there is an exaggerated response of the central nervous system to stimuli.
A Brief Overview of FM & ME/CFS
Fibromyalgia is a malfunction of the central nervous system that causes disordered pain processing, and results in pain amplification. The primary symptoms of FM are:
- Widespread chronic pain
- Extreme fatigue
- Sleep problems.
Other symptoms that may occur include: allergies, irritable bowel, irritable bladder, headaches, migraines, dizziness, numbness and tingling, sensitivity to cold or heat, depression, restless legs syndrome, chemical or environmental sensitivities, impaired balance or coordination, dry eyes and mouth, vision problems, or problems with memory, concentration and cognitive functioning.
ME/CFS (Myalgic Encephalopathy or Myalgic Encephalomyelitis / Chronic Fatigue Syndrome) is an illness characterized by prolonged and debilitating fatigue accompanied by a number of other symptoms, including: memory and concentration problems, recurrent sore throats, unrefreshing sleep, muscle and joint pain, and headaches.
ME/CFS includes at least four of the following:
- Post-exertional malaise lasting more than 24 hours
- Non-refreshing sleep
- Short-term memory or concentration problems
- Muscle pain
- Multi-joint pain without joint swelling or redness
- Headaches of a new type, pattern or severity
- Tender cervical or axillary lymph nodes
- Sore throat
Differences & Similarities Between FM & ME/CFS
Similarities – In addition to some symptom similarities, FM and ME/CFS have several things in common:
- Reduced cerebral blood flow to the cortex and midbrain
- HPA (hypothalamic pituitary axis) suppression
- Reduced levels of serotonin
- Non-restorative sleep
- Reduced levels of growth hormone
- Evidence of a genetic component.
Differences – Although there are many similarities, there are also significant differences.
- FM is identified by 18 distinct tender points (designated points on the body that are painful when four kilograms of pressure are applied), while ME/CFS is distinguished by post-exertional malaise (deep fatigue and exhaustion following physical exertion, which lasts more than 24 hours).
- Substance P (a neurotransmitter that sends pain signals) is elevated in FM but not in ME/CFS.
- RNaseL (a cellular antiviral enzyme) is frequently elevated in chronic fatigue syndrome but not in fibromyalgia.
- ME/CFS is often triggered by an infectious or flu-like illness, while FM is usually triggered by a severe physical or emotional trauma (for example, injury, illness, surgery, prolonged stress).
Diagnosis
- Getting an accurate diagnosis of either disorder can be difficult to say the least.
- People are rarely diagnosed with both at the same time or by the same doctor.
- Even though each illness has its own set of diagnostic criteria, sometimes the diagnosis you receive may depend more on which one your doctor is most familiar with.
- The fact that such a large percentage of patients have both FM and ME/CFS makes it especially difficult to distinguish between them.
Treatment
- Treatment of both FM and ME/CFS is primarily aimed at relieving symptoms.
- To date two medications have received FDA approval for the treatment of FM.
- No medication has yet been approved for treating ME/CFS, but clinical trials are being conducted with the hope that at least one will be approved soon.
- It is becoming apparent that there are a number of subtypes of ME/CFS, which further complicates the search for effective treatments.
- It’s usually a matter of trial and error for patients with either illness to find an effective treatment plan.
- Most who have had some success in improving symptoms report using a combination of medication, alternative/complementary therapies and lifestyle changes.
Even though there are a lot of cross-diagnoses and confusion, ME, CFS, and Fibromyalgia are in fact 3 distinct clinical entities.
Fibromylagia, unlike ME or CFS, is helped by exercise – a very simple way to tell them apart, as well as being the only one diagnosed by tender trigger points.
ME is in essence a brain stem injury, always shows neurological involvement, is of sudden onset, and is classified by the WHO as a neurological disease. Fatigue is not particularly a defining factor. It seems to be infectious and occurs in epidemics.
CFS is a syndrome, not a disease, and fatigue is the central defining factor. Even the CDC website distinguishes between ME & CFS.
There, now that wasn’t so hard, was it? Sincerely, Aylwin Catchpole