You will need to read this all to see how FM and GWI tie into each other.
Jim
WHAT IS FIBROMYALGIA SYNDROME?
FMS (fibromyalgia syndrome) is a widespread musculoskeletal pain and fatigue
disorder for which the cause is still unknown. Fibromyalgia means pain in
the muscles, ligaments and tendons--the fibrous tissues in the body. FMS
used to be called fibrositis, implying that there was inflammation in the
muscles, but research later proved that inflammation did not exist.
Most patients with fibromyalgia say that they ache all over. Their muscles
may feel like they have been pulled or overworked. Sometimes the muscles
twitch and at other times they burn. More women than men are afflicted with
fibromyalgia, but it shows up in people of all ages.
To help your family and friends relate to your condition, have them think
back to the last time they had a bad flu. Every muscle in their body shouted
out in pain. In addition, they felt devoid of energy as though someone had
unplugged their power supply. While the severity of symptoms fluctuate from
person to person, FMS may resemble a post-viral state and this is why
several experts in the field of FMS and CFS believe that these two syndromes
are one and the same.
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SYMPTOMS AND ASSOCIATED SYNDROMES
Pain - The pain of fibromyalgia has no boundaries. People describe the pain
as deep muscular aching, burning, throbbing, shooting and stabbing. Quite
often, the pain and stiffness are worse in the morning and you may hurt more
in muscle groups that are used repetitively.
Fatigue - This symptom can be mild in some patients and yet incapacitating
in others. The fatigue has been described as "brain fatigue" in which
patients feel totally drained of energy. Many patients depict this situation
by saying that they feel as though their arms and legs are tied to concrete
blocks, and they have difficulty concentrating.
Sleep disorder - Most fibromyalgia patients have an associated sleep
disorder called the alpha-EEG anomaly. This condition was uncovered in a
sleep lab with the aid of a machine which recorded the brain waves of
patients during sleep. Researchers found that fibromyalgia syndrome patients
could fall asleep without much trouble, but their deep level (or stage 4)
sleep was constantly interrupted by bursts of awake-like brain activity.
Patients appeared to spend the night with one foot in sleep and the other
one out of it. In most cases, a physician doesn't have to order expensive
sleep lab tests to determine if you have disturbed sleep. If you wake up
feeling as though you have just been run over by a Mack truck--what doctors
refer to as unrefreshed sleep--it is reasonable for your physician to assume
that you have a sleep disorder. It should be noted that most patients
diagnosed with chronic fatigue syndrome have the same alpha-EEG sleep
pattern and some fibromyalgia-diagnosed patients have been found to have
other sleep disorders, such as sleep myoclonus or PLMS (nighttime jerking of
the arms and legs), restless leg syndrome and bruxism (teeth grinding). The
sleep pattern for clinically depressed patients is distinctly different from
that found in FMS or CFS.
Irritable Bowel Syndrome - Constipation, diarrhea, frequent abdominal pain,
abdominal gas and nausea represent symptoms frequently found in roughly 40%
to 70% of fibromyalgia patients.
Chronic headaches - Recurrent migraine or tension-type headaches are seen in
about 50% of fibromyalgia patients and can pose as a major problem in coping
for this patient group.
Temporomandibular Joint Dysfunction Syndrome - This syndrome, sometimes
referred to as TMJD, causes tremendous face and head pain in one quarter of
FMS patients. However, a 1997 report indicates that as many as 90% of
fibromyalgia patients may have jaw and facial tenderness that could produce,
at least intermittently, symptoms of TMJD. Most of the problems associated
with this condition are thought to be related to the muscles and ligaments
surrounding the joint and not necessarily the joint itself.
Multiple Chemical Sensitivity Syndrome - Sensitivities to odors, noise,
bright lights, medications and various foods is common in roughly 50% of FMS
or CFS patients.
Other common symptoms - Painful menstrual periods (dysmenorrhea), chest
pain, morning stiffness, cognitive or memory impairment, numbness and
tingling sensations, muscle twitching, irritable bladder, the feeling of
swollen extremities, skin sensitivities, dry eyes and mouth, frequent
changes in eye prescription, dizziness, and impaired coordination can occur.
Aggravating factors - Changes in weather, cold or drafty environments,
hormonal fluctuations (premenstrual and menopausal states), stress,
depression, anxiety and over-exertion can all contribute to symptom
flare-ups.
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POSSIBLE CAUSES
The cause of fibromyalgia and chronic fatigue syndrome remains elusive, but
there are many triggering events thought to precipitate its onset. A few
examples would be an infection (viral or bacterial), an automobile accident
or the development of another disorder, such as rheumatoid arthritis, lupus,
or hypothyroidism. These triggering events probably don't cause FMS, but
rather, they may awaken an underlying physiological abnormality that's
already present in the form of genetic predisposition.
What could this abnormality be? Theories pertaining to alterations in
neurotransmitter regulation (particularly serotonin and norepinephrine, and
substance P), immune system function, sleep physiology, and hormonal control
are under investigation. Substance P is a pain neurotransmitter that has
been found by repeat studies to be elevated threefold in the spinal fluid of
fibromyalgia patients. Two hormones that have been shown to be abnormal are
cortisol and growth hormone. In addition, modern brain imaging techniques
are being used to explore various aspects of brain function--while the
structure may be intact, there is likely a dysregulation in the way the
brain operates. The body's response to exercise, stress and simple
alterations in position (vertical versus horizontal) are also being
evaluated to determine if the autonomic nervous system is not working
properly. Your body uses many neurotransmitters, such as norepinephrine and
epinephrine, to regulate your heart, lungs and other vital organs that you
don't have to consciously think about. Ironically, many of the drugs
prescribed for FMS/CFS may have a favorable impact on these transmitters as
well.
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COMMON TREATMENTS
Traditional treatments are geared toward improving the quality of sleep, as
well as reducing pain. Because deep level (stage 4) sleep is so crucial for
many body functions, such as tissue repair, antibody production, and perhaps
even the regulation of various neurotransmitters, hormones and immune system
chemicals, the sleep disorders that frequently occur in fibromyalgia and
chronic fatigue patients are thought to be a major contributing factor to
the symptoms of this condition. Medicines that boost your body's level of
serotonin and norepinephrine--neurotransmitters that modulate sleep, pain
and immune system function--are commonly prescribed. Examples of drugs in
this category would include Elavil, Flexeril, Sinequan, Paxil, Serzone,
Xanax and Klonopin. A low dose of one of these medications may be of help.
In addition, nonsteroidal, anti-inflammatory drugs (NSAIDs) like ibuprofen
may also be beneficial. Most patients will probably need to use other
treatment methods as well, such as trigger point injections with lidocaine,
physical therapy, acupuncture, acupressure, relaxation techniques,
osteopathic manipulation, chiropractic care, therapeutic massage, or a
gentle exercise program.
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WHAT IS THE PROGNOSIS?
Long term follow-up studies on fibromyalgia syndrome have shown that it is
chronic, but the symptoms may wax and wane. The impact that FMS can have on
daily-living activities, including the ability to work a full-time job,
differs among patients. Overall, studies have shown that fibromyalgia can be
equally as disabling as rheumatoid arthritis. On the other hand, follow-up
of people meeting the chronic fatigue sydnrome criteria indicates that as
many as 40% may significantly improve but few are thought to completely
recover from this syndrome. Longer term follow-up studies are not available
to indicate whether these "improved" CFS patients later relapse with an
increase in symptoms. A preliminary follow-up study by the CDC (Centers for
Disease Control) reveals that for those individuals with chronic fatigue
syndrome who do not recover or significantly improve after five years
duration, their most prominent symptom changes from fatigue to muscle pain
with concentration problems (sounds a lot like the permanent syndrome of
fibromyalgia but the CDC is not checking patients for tender points).
According to a research study by Dedra Buchwald, M.D., people who meet the
criteria for both FMS and CFS tend to be at the more severe end of the
spectrum of symptoms and are more likely to become work-disabled. Buchwald
says her findings underscore the importance of recognizing concurrent
fibromyalgia and chronic fatigue syndrome (Rheumatic Disease Clinics of
North America 22(2):219-243, 1996).
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SELF-HELP STRATEGIES
Lifestyle modifications may help you conserve your energy and minimize your
pain. Learn what factors aggravate your symptoms and avoid them if possible.
Join your local support group and become informed about your condition by
subscribing to Fibromyalgia Network newsletter. In the newsletter, you will
read about research findings, new treatment options, and tips on coping with
fibromyalgia and chronic fatigue syndrome. In addition, Fibromyalgia Network
maintains a list of support group contacts and health care referrals, which
is free with your subscription. To subscribe click on the pink
"Newletters/Resources" side button above, or call our toll-free number,
(800) 853-2929. Other educational materials may be ordered from Fibromyalgia
Network as well.