Fibromyalgia & Chronic Fatigue Syndrome

What is Fibromyalgia?

Fibromyalgia is a condition involving painful muscles, ligaments, and tendons. It is not disfiguring or life threatening or progressive (i.e., does not necessarily worsen over time). It is not related to tissue inflammation like arthritis. Similar to migraine headache, fibromyalgia affects mostly women in middle age, and less often affects children and the elderly.

The pain from fibromyalgia may occur in four or more distinct areas of the body, and may be related to distinct "trigger points". "Trigger points" or "tender points" in the body can affect pain and muscle spasm when pressure is applied. Trigger points are often found in the elbows, shoulders, back of the head, knees, and the sides of the breast bone. The presence of widespread pain and trigger points, occurring for three or more months, is necessary for the diagnosis of fibromyalgia. Migraine headache is a common associated problem. Other associated symptoms include fatigue, sleep disturbance (especially feeling tired in the morning after a night's sleep), depressed and anxious mood, poor concentration and memory, and gastrointestinal symptoms such as spastic colon.

In July, 1996 the National Institute of Health sponsored a scientific workshop entitled "The Neuroscience and Endocrinology of Fibromyalgia". The latest scientific findings on fibromyalgia were presented by prominent medical researchers. One goal of the workshop was to inform the public of sophisticated research which is identifying the causes of fibromyalgia and to stimulate other scientists to do this research. Fibromyalgia may be related to brain chemical changes resulting in abnormalities in the central pain process and disturbances in biological rhythms such as sleep cycles.

Recently, at MHNI's monthly Multidisciplinary Meeting, Drs. Biondi and Silverman updated clinical staff on the current methods of diagnosis and treatment of fibromyalgia. Because the causes of fibromyalgia are not known, there is no cure, but effective treatments have been identified. Dr. Biondi stated that "a graduated stretching, exercise and fitness program may be a critical treatment intervention. A variety of medications have been shown to be effective in controlling the symptoms and can be prescribed. I also instruct patients to improve dietary and sleep habits and consider learning biofeedback skills. With a positive attitude and proper therapy most people suffering from fibromyalgia can improve and lead a productive, active life."

Is there a relationship between chronic fatigue syndrome, fibromyalgia, and migraine headaches?

Many patients with fibromyalgia suffer from migraine-like headaches. It is currently believed that fibromyalgia may be the result of disturbances in the brain's "pain center," a theory very similar to that which explains migraine. In fact, there are many who believe that chronic pain disorders, including migraine and fibromyalgia, may arise from the same type of disturbance. Though the pain of fibromyalgia is frequently found throughout the body, it is associated with a variety of other symptoms, including sleep disturbance, depression, anxiety, and headaches. Migraine is associated with many of these symptoms as well. Many patients who are successfully treated for migraine find that their fibromyalgia is improved.

Chronic fatigue syndrome remains an uncertain clinical entity. Many believe that it is due to a virus that affects the central nervous system which can produce a variety of symptoms which overlap migraine and fibromyalgia. This includes pain, depression, sleep disturbance, and of course recurrent and persistent fatigue. If it is a virus, then it is likely that the virus affects the production of neurotransmitters or their connecting sites (the receptors) on brain cells. Thus, the brain malfunctions, and the symptoms of fatigue, pain, depression, and sleep disturbance develop. Some authorities believe that low blood pressure accounts for its symptoms. Because depression, headaches, and sleep disturbance are common to chronic fatigue, fibromyalgia, and migraine, there may well be overlap in the origin of these. Much more must be known, however, before a definitive solution is available.