Overlaps with Fibromyalgia

By Fibromyalgia Network
Fibromyalgia syndrome (FMS), chronic fatigue syndrome (CFS), multiple chemical sensitivity syndrome (MCS), myofascial pain syndrome (MPS), and other conditions form a family of overlapping syndromes. In fact, researcher Muhammad Yunus, M.D., of the University of Illinois College of Medicine, claims, most patients have more than one syndrome. Thus, he views FMS and CFS as being part of a larger spectrum of conditions, which he calls Dysregulation Spectrum Syndrome or DSS (see diagram below). Dr. Yunus uses the term dysregulation to mean biophysiological abnormalities, possibly in the body's neurological, hormonal and chemical systems.

Backing up Dr. Yunus’ commentary are studies by Dedra Buchwald, M.D., of the University of Washington, Anthony Komaroff, M.D., of Brigham and Women’s Hospital and Don Goldenberg, M.D., of Newton-Wellesley Hospital. It is always important to keep these overlapping syndromes in mind because the presence of one or more syndromes could impact your treatment. These three researchers have shown that CFS and FMS overlap in patients by as much as 75%. When it comes to MCS, this syndrome is present in roughly 50% of FMS- and CFS-diagnosed patients.

Most practicing physicians and researchers alike will tell you that the chronic pain diagnosis a person first receives is often colored by their chief symptom complaint. For example, widespread muscular pain is often diagnosed by rheumatologists as fibromyalgia syndrome. A person who is overcome by extreme fatigue and flu-like symptoms might consult an infectious disease expert and receive the diagnosis of chronic fatigue syndrome. A person who has severe jaw pain might see a dentist and be told that they have temporomandibular joint dysfunction (TMJD). People who appear to have allergic-type symptoms to a number of chemicals, foods, or odors may be informed by an allergist that they have MCS. Similar situations occur with the other conditions in the family of Dysregulation Spectrum Syndrome.

Click here to print this page: Overlaps with Fibromyalgia

Funny Fibromyalgia Cartoon

Click here to see a funny fibromyalgia cartoon. The Fibromyalgia Network plans to post these on a weekly basis. Enjoy!

Chronic Pain Treatment: Working Through the Pain

Here is a great article on how physical therapy can be a benifit to treating your chronic pain.

Chronic Pain Treatment: Working Through the Pain

Along with this article, here are two additional tips to finding a good physical therapist:

1) Look for a physical therapist that treats patients for more than 30 minutes at a time. Thirty minutes or less is not enough time to really get in there and work on those trigger points.

2) Look for a physical therapist that is knowledgeble in manual therapy techniques (i.e. strain-counterstrain, soft tissue massage, muscle energy techniques, and trigger point release to name a few). While theraputic exercise is important as well, manual techniques are critical to chronic pain management.

Hope this helps,
Kelsey Thorson
Writer of the physical therapy section titled "Ken's Corner" in the Fibromyalgia Network Journal
Fibromyalgia Network

"Fatigue Centers" in the Brain

While many areas in the brain are known to correlate with the sensation of pain, the processes that produce fatigue are much less understood. At the IACFS meeting, Yasuyoski Watanabe, M.D., of Japan, described his work to identify the “fatigue centers” in the brain using positron emission tomography (PET), an imaging technique that measures brain blood flow. A reduction of blood flow in any brain region represents a drop in metabolic activity and a depletion of the energy supply in that region. Watanabe evaluated what happened in the brains of healthy subjects undergoing ten consecutive sessions of mental tasks that lasted two hours. A total of ten PET scans were taken during the two-hour series of testing and, after each one, the subjects rated their level of perceived fatigue on a scale from 0 to 100. As anticipated, each consecutive test led to the subject’s increase in fatigue scores and by the last test, most of the 12 subjects rated their fatigue close to 100. In other words, their cognitive abilities were zapped.

As the fatigue ratings of the subjects increased, Watanabe noticed a significant drop in blood flow to two important areas in the prefrontal and frontal cortex. He says that these areas are involved in motivation, sensory evaluation, and the process of habituation to a new environment. Summing up the study findings, Watanabe says, “These two parts of the brain are related to our fatigue sensation.”

The foregoing study was done in twelve healthy volunteers. What about the PET findings in patients with CFS? PET studies indicate that additional areas within the anterior cingulate cortex (ACC) have reduced blood flow in the brains of people with CFS. Watanabe pointed out that the ACC contains important pain processing areas that use the neurotransmitter, serotonin, to combat pain. Using a tracer to measure the serotonin content in the ACC, he found that the lower the serotonin level, the greater the CFS patient’s pain. The close proximity of the pain and fatigue centers in the ACC could explain the high pain levels in many CFS-diagnosed patients and the overlap between FMS and CFS.

This above article is a sample from one of our eNews Alerts that are sent out monthly to Members of the Fibromyalgia Network. Sign up and recieve news that you can't find anywheres else. Membership to the Network includes:

• 20-page, ad-free Fibromyaliga Network Journal
• Monthly eNews Alerts
• Patient-endorsed physician referrals
• Support group listings
• Participation in surveys
• A say in future article topics including our Q&A Column
• Free articles and brochures
• Privacy protection

Become a Member of a self-help organization devoted to improving the lives of patients with fibromyalgia and chronic fatigue syndrome (FMS/CFS). Get connected to the most beneficial resource around with a Membership to Fibromyalgia Network. (Fibromyalgia Network Journal is published in January, April, July, and October) Membership includes the current Issue.

CLICK HERE

Patients Weigh in on New Diagnostic Criteria

Nearly 10,000 people responded to a survey by the Fibromyalgia Network that revealed the American College of Rheumatology's (ACR) new criteria to diagnose fibromyalgia.


The new criteria, posted through the Fibromyalgia Network website on April 14, caused quite a stir among patients and the general public. In April, the American College of Rheumatology (ACR) revealed the new criteria.*


The ACR hopes the new criteria will make it easier for doctors to diagnose the illness. Patients and others who responded to the survey offered mixed reviews. Doctors who developed the new criteria are hoping to standardize the process so all physicians can use the same procedures. They also did away with the tender point criteria as it did a poor job of measuring symptom severity or charting the effectiveness of new treatments. These objectives are important since most fibro patients are being diagnosed and treated by rheumatologists and family practitioners or primary care physicians.


In the Fibromyalgia Network survey, almost all (97%) of the individuals responding to the survey were officially diagnosed with fibro or at least strongly suspected they have the illness. Of the 9,946 people responding, 51 percent (5,084) were diagnosed by a rheumatologist, and 17 percent (1,736) were diagnosed by their primary care physician/family doctor. Professionals who are at the forefront in providing ongoing treatment, however, are primary care physicians (37%) followed by rheumatologists (22%). The next closest type of doctor who is primarily in charge of your current fibromyalgia treatment are pain specialists at a mere 7 percent.


While nearly half of those responding to the survey felt the new criteria gave a fair and reasonable assessment of symptoms, patients gave us a whopping 3,400 comments debating the pros and cons.


One of the more popular critiques of the new diagnostic criteria told us that patients were confused when they were asked to answer questions based on "how they felt over the past week." However, one of the three major criteria in scoring instructions state that "symptoms be present at a similar level for at least 3 months."


"I think it is misleading that the Symptom Severity Score only is applicable to the ‛past week.' If a person just had a good week, as I sort of did, then the score is lower than if they just came through a bad week, like I had the week before. The Symptom Severity Score should perhaps be the average of four (or more) weekly tabulations to be more accurate," suggests one individual. Other patients commented that they experience more severe symptoms or flares through weeks or months, then followed by periods of less pain and symptoms, which could undermine a proper diagnosis.


More detailed information on the survey results including how many patients were actually diagnosed using the new tool will be printed in the July 2010 issue of the Fibromyalgia Network Journal. Read what the treatment experts have to say about the new criteria. Will they be using it, and do they think this checklist-type criteria will help the front-line physicians take on the challenge of diagnosing fibromyalgia? How helpful and accurate do they suspect the new criteria will be? Most importantly, how will these new guidelines affect your care and the image of fibromyalgia?


If you have not seen the new criteria, you are welcome to Take the Survey and offer your own comments.


* Wolfe F, et al. Arthritis Cares & Research 62:600-610, 2010.