Fibromyalgia versus CFIDS

July 10, 2002

Fibromyalgia versus CFIDS

By Mark Leavitt, Email

Introduction

The intent of this document is explain the differences between Fibromyalgia Syndrome (FMS or FM) and Chronic Fatigue Immune Dysfunction Syndrome (CFIDS or CFS).

The Medical Definitions

In order to have diagnosis, you need a medical definition. Unfortunately, the definitions for both disorders have changed over time, but here are the final results. The Merck's Manual, a medical reference book used since 1879 states that FM is:

A group of common nonarticular disorders characterized by achy pain, tenderness, and stiffness of muscles, areas of tendon insertions, and adjacent soft tissue structures (1).

The American College of Rheumatology in 1990 came up with a better definition and it's consider the official FM definition:

The FM Syndrome is a group of disorders characterized by unexplained achy pain/stiffness (not arthritis) in soft tissues, including muscles, tendons and ligaments. In addition to pain, fatigue is also present. The diagnosis of FM is based on history and presence of 18 possible tender points located on the surface of the body. Most patients with FM have 11 or more tender points (2).

CFIDS has gone through a couple of definition changes. In fact, a name change campaign has been going on over a decade to better represent the name of the illness. The Centers of Disease Control and Prevention (CDC) published the official case definition of CFIDS in 1994 as:

1. Clinically evaluated, unexplained persistent or relapsing that is not new or definite onset, does not result from ongoing exertion, and not alleviated by rest and results in substantial reduction in previous levels of occupation, educational, social or personal activities (3)

2. Concurrent occurrence of four or more of the following symptoms: substantial impairment in short-term memory or concentration, sore throat, muscle pain or multi-joint pain without joint swelling or redness, tender lymph nodes, headaches of a new type, pattern or severity and unrefreshing sleep. The fatigue has to be symptoms which have persisted or recurred during a six month consecutive period and not have predated the fatigue (3,4)

The Confusion

A Little History
FM has been medically classified in the 1900's with many different names and observed since the early 1800's. It receive recognition in 1987 as a debilitating illness in 1987 by the America Medical Association (5). In relation to CFIDS, it's grand appearance appeared in the mid-80's with only a few historical cases since the 1900's. At present, millions of people suffer from FM as well as CFIDS in the United States.

What's In A Name
FM and CFIDS is perplexed not only to the patient but the medical community. What's even more confusing, many doctors feel it's the same illness or share similar symptoms. FM is rheumatic condition (musculoskeletal system) and is a cousin to muscle diseases. Some cases of FM can be traced to physical injury caused by trauma. The predominant symptom in FM is widespread muscle pain (not in joints) and associated tender sites. FM can include manifestations from the CFIDS definitions such as persistent fatigue, dizziness, headaches and sleeping disorders.

CFIDS is generally a ful-like illness with many patient having an initial onset such as a post-viral infection like the flu or series of bad colds. Dr. Robert Benett, M.D has been in the forefront of FM for a long time. He is Professor of Medicine and heads up the Arthritis and Rheumatic Department of Diseases in Oregon, he agrees that "CFS differs from FM in that CFS requires recent onset. Impaired memory, sore-throat, new headaches, post-exertional malaise, muscle and/or multi-joint pain are included in CFS while they are not part of the definition of FM. If you have the positive criteria for FM, you have it, regardless of whatever else you might have." (6)

In both illnesses, patients can have different severity levels with wax and wane states. In severe cases, complete disability can result from either illness.

What's In The Blood
CFIDS usually shows abnormalities in blood test. FM does not. For example, many people with CFIDS show high levels to the Epstein Barr (mono) virus, cytomegalovirus (the cousin of EBV) and/or the human herpes virus 6 (7). EBV was first suspected as the cause of CFIDS, the agreement now is that these viruses are just an opportunist that create an infection when the immune system is already worn down.

Biochemical or Neuromuscular
FM is considered a biochemical disorder. The neurotransmitters (communication process) between the body and brain get disrupted. Neuromuscular conditions are mechanical, not biochemistry (8). An example of this would be a muscle or soft tissue subjected to stress due to a fall or auto accident. The area specific in pain may develop trigger points (lumps in muscle tissue) which can activate pain symptoms as well as repeated stress to the area.

Still Confused
Jacob Teitelbaum, MD, a specialist in CFIDS/FM , calls CFS the "drop-dead" flu and fibromyalgia the "aching-all-over" disease. He prefers to put both in the same category and calls them chronic fatigue states (9). David Bell, MD, a leading expert and pioneer in CFIDS points out that nearly all CFIDS patients have muscle pain, many do not have enough muscle pain to elicit the tender points on examination, the basis of fibromyalgia diagnosis. It's an ongoing controversy and it is likely that CFIDS and FM are the same illness (10). On a different side of things, Maid Ali, M.D. author of the Canary and Chronic Fatigue Syndrome asks "Why are so many people confused about the cause of FM and CFIDS? Because it doesn't fit into some neat model of disease category. It's not treated successfully by mainstream doctors because there is no effective drugs for it." (11)

Summary
A percentage of people with FM also have CFIDS. Not all people with FM have CFIDS and vice-versa. The diagnosis for FM or CFIDS depends on whether your doctor is more familiar with FM or CFIDS. It's best to seek out a specialist in chronic illness who understands both disorders. Exploring integrative medicine offers mixture of mainstream and alternative approaches. Integrative medical doctors look at viral, fungal and parasitic infection as well as environmental factors such as multiple allergies, chemical sensitivities and toxic metals.

The Treatment

The treatment for FM and CFIDS is to provide symptom relief. Prescription medications are generally used for pain as well as antidepressants or benzodiazepines for sleep disorders. Ultram, a new class of analgesic acts on the central nervous system for moderate to severe pain has been reported with positive results. Naturopatic remedies such as malic acid, magnesium and tender point injections, vitamins and supplements have been reported with some success. Intravenous oxygen and chelation therapy is sometimes used to reverse FM or CFIDS. Acupunture, massage, reflexology and stress management therapy can help to alleviate pain.

Charles Lapp, MD, a CFIDS specialist strongly believes in treating what he calls, perpetuating factors (12). These include airborne allergies, fungal (yeast) infections and hormonal (thyroid, adrenal). Preventive care is also prescribed which includes pacing yourself depending on ones activities and severity level, annual examination and laboratory testing. He also recommends that patients document year to year progression and regression including medications that are being taken to make sure no interactions are going on.

The Future

The causes of FM and CFIDS is still unknown. Many theories are plentiful as the cause for both conditions. However, none of these theories are consistent for a proven course of treatment as well as a cure.

The road of research continues.

References

1.  Merck Research Laboratories, The Merck Manual, 17th editon, 1999; p 481.
2. Starlanyl, Devin, M.D., Mary Copeland, M.S., MA, Fibromyalgia & Chronic Myofascial Pain Syndrome, 8th editon.,
             New Harbinger Publications, 1996; p 9-10.
3. Fukuda, Keiji, "The Chronic Fatigue Syndrome: A Comprehensive Approach to its Definition and Study."
            Annals of Internal Medicine 121 (December 15, 1994), 953-959.
4. Victor Maurice, M.D., Allan Ropper, M.D., Principles of Neurology, 7th Editon, McGraw-Hill, 2001; p 529.
5. GoldBerg, Burton, Chronic Fatigue, Fibromyalgia & Environmental Illness, Future Medicine Publishing, 1998; p 18.
6. Bennet, Robert, M.D., Fibromyalgia Has Much in Common with CFS, The CFIDS Chronicle, 12, 1, (Jan/Feb1999). p 25.
7. Starlanyl, Devin, M.D., Mary Copeland, M.S., MA, Fibromyalgia & Chronic Myofascial Pain Syndrome, 8th editon.,
             New Harbinger Publications, 1996; p 8-10.
8.  Starlanyl, Devin, M.D., Mary Copeland, M.S., MA, Fibromyalgia & Chronic Myofascial Pain Syndrome, 8th editon.,
             New Harbinger Publications, 1996; p 31-32.
9. Teitelaum, Jacob, M.D., From Fatigued To Fantastic, 1st edition., Avery Publishing, 1996; p 5-9.
10. Bell, David, M.D., The Doctor's Guide to Chronic Fatigue Syndrome, 4th edition, Addison-Wesley Publishing, 1995; p 63.
11. Ali, Majidi, M.D., The Canary and Chronic Fatigue Syndrome, First Edition, Life Span Press, 2000; p 124.
12. Lapp, Charles, M.D., The Treatment of CFS – the Perspective of a Private Specialty Practice in Charlotte, NC.
            December 28, 2000, from www.immunesupport.com