Many doctors and researchers are convinced that
Fibromyalgia Syndrome (FMS) and Chronic
Fatigue Syndrome (CFS) are simply different
manifestations of the same underlying disorder. In
fact, many patients suffer from both conditions.
While both have been acknowledged as real
physical diseases, neither one has a known cause
or cure. Is the lack of a cure all that the two
illnesses have in common? Not by a long shot.
When looking at what is known about FMS and
CFS, they appear to be more alike than they are
different.
Fibromyalgia Syndrome (FMS) and Chronic
Fatigue Syndrome (CFS) are simply different
manifestations of the same underlying disorder. In
fact, many patients suffer from both conditions.
While both have been acknowledged as real
physical diseases, neither one has a known cause
or cure. Is the lack of a cure all that the two
illnesses have in common? Not by a long shot.
When looking at what is known about FMS and
CFS, they appear to be more alike than they are
different.
Fibromyalgia means pain in the fibrous tissues of
the body--the muscles, ligaments and tendons.
FMS used to be called fibrositis, which implied
that there was inflammation in the muscles, but
recent research has proved that there is no
inflammation. FMS does not damage the tissues
and is not progressive. Because various other
symptoms often accompany the muscle pain, it's
often called Fibromyalgia Syndrome. Routine
laboratory tests usually reveal nothing abnormal
in patients with FMS. However, FMS sufferers are
sensitive to pressure in specific areas of the body
called "tender points."
In 1990 the American College of Rheumatology
established formal criteria for diagnosing
Fibromyalgia (primarily for research purposes). To
meet the diagnostic criteria, patients must have:
1. Widespread pain in all four quadrants of the
body for at least three months
2. At least 11 of the 18 specified tender points
Other common symptoms associated with
Fibromyalgia include fatigue, sleep disorder,
cognitive impairments, numbness and tingling
sensations, irritable bowel symptoms, and more.
the body--the muscles, ligaments and tendons.
FMS used to be called fibrositis, which implied
that there was inflammation in the muscles, but
recent research has proved that there is no
inflammation. FMS does not damage the tissues
and is not progressive. Because various other
symptoms often accompany the muscle pain, it's
often called Fibromyalgia Syndrome. Routine
laboratory tests usually reveal nothing abnormal
in patients with FMS. However, FMS sufferers are
sensitive to pressure in specific areas of the body
called "tender points."
In 1990 the American College of Rheumatology
established formal criteria for diagnosing
Fibromyalgia (primarily for research purposes). To
meet the diagnostic criteria, patients must have:
1. Widespread pain in all four quadrants of the
body for at least three months
2. At least 11 of the 18 specified tender points
Other common symptoms associated with
Fibromyalgia include fatigue, sleep disorder,
cognitive impairments, numbness and tingling
sensations, irritable bowel symptoms, and more.
For both FMS and CFS, patients should be
evaluated for other problems that could be
causing the symptoms, such as low thyroid
function, iron deficiency, arthritis, and other
medical conditions.
A CFS diagnosis as opposed to one of FMS often
depends merely on whether fatigue or pain is the
most dominant symptom. Although there are
certain symptoms--such as fever, sore throat, and
swollen glands--that are found more commonly in
CFS than in patients with FMS, the similarity in
symptoms between the two conditions is
undeniable. In addition, research has revealed
similar physical abnormalities in CFS and FMS,
such as reduced blood flow in key areas of the
brain. Technologies for analyzing brain function
such as SPECT and PET scans have documented
these abnormalities, and there is little difference
between the scans of CFS sufferers and those of
FMS patients. What is still unclear is whether
these abnormalities are a result or the origin of
the disease.
evaluated for other problems that could be
causing the symptoms, such as low thyroid
function, iron deficiency, arthritis, and other
medical conditions.
A CFS diagnosis as opposed to one of FMS often
depends merely on whether fatigue or pain is the
most dominant symptom. Although there are
certain symptoms--such as fever, sore throat, and
swollen glands--that are found more commonly in
CFS than in patients with FMS, the similarity in
symptoms between the two conditions is
undeniable. In addition, research has revealed
similar physical abnormalities in CFS and FMS,
such as reduced blood flow in key areas of the
brain. Technologies for analyzing brain function
such as SPECT and PET scans have documented
these abnormalities, and there is little difference
between the scans of CFS sufferers and those of
FMS patients. What is still unclear is whether
these abnormalities are a result or the origin of
the disease.
Similarities Between CFS and FMS
Other similarities between the two syndromes can
be summarized as follows:
be summarized as follows:
Both disorders affect people of any age and
gender, but they are more common among
women.
The two conditions can be extremely debilitating,
though their symptoms are largely invisible.
Onset often occurs during childbearing years.
Many symptoms are common to both illness
groups, including headaches, numbness or
tingling, dizziness, irritable bowel, cognitive
problems, and more.
Most sufferers have sleep disorders, such as
"alpha-delta" or unrefreshing sleep.
Symptoms wax and wane, and flare-ups can be
triggered by stress.
Viruses or traumatic injury have been suspected
as triggers.
Immune system and/or neuroendocrine system
abnormalities are thought to be a possible
underlying cause of the disorders.
Differences Between CFS and FMS
Some of the key differences between Chronic
Fatigue Syndrome and Fibromyalgia are as
follows:
gender, but they are more common among
women.
The two conditions can be extremely debilitating,
though their symptoms are largely invisible.
Onset often occurs during childbearing years.
Many symptoms are common to both illness
groups, including headaches, numbness or
tingling, dizziness, irritable bowel, cognitive
problems, and more.
Most sufferers have sleep disorders, such as
"alpha-delta" or unrefreshing sleep.
Symptoms wax and wane, and flare-ups can be
triggered by stress.
Viruses or traumatic injury have been suspected
as triggers.
Immune system and/or neuroendocrine system
abnormalities are thought to be a possible
underlying cause of the disorders.
Differences Between CFS and FMS
Some of the key differences between Chronic
Fatigue Syndrome and Fibromyalgia are as
follows:
FMS is more prevalent, affecting at least 2 percent
of the population in the United States. CFS
prevalence numbers vary; the CDC claims that
CFS affects at least .2 percent of the population,
while recent research reveals estimates that are
twice that number.
Specific tender points are the hallmarks of FMS
and are used for diagnosis, while CFS is a
"diagnosis of exclusion" in which any other
potential causes of the symptoms must be ruled
out.
There is some evidence that graded aerobic
exercise improves muscle function and reduces
pain in FMS but exercise is often impossible for,
and may even hinder, CFS patients.
Source: OnHealth
Overlapping Syndromes
of the population in the United States. CFS
prevalence numbers vary; the CDC claims that
CFS affects at least .2 percent of the population,
while recent research reveals estimates that are
twice that number.
Specific tender points are the hallmarks of FMS
and are used for diagnosis, while CFS is a
"diagnosis of exclusion" in which any other
potential causes of the symptoms must be ruled
out.
There is some evidence that graded aerobic
exercise improves muscle function and reduces
pain in FMS but exercise is often impossible for,
and may even hinder, CFS patients.
Source: OnHealth
Overlapping Syndromes
A number of researchers have studied the
relationship between CFS and FMS. Dr.
Muhammad Yunus from the University of Illinois
College of Medicine, views FMS and CFS as being
part of a larger spectrum of conditions that he
calls Dysregulation Spectrum Syndrome (DSS).
Other researchers like Dr. Dedra Buchwald and Dr.
Anthony Komaroff have shown that CFS and FMS
overlap in patients by as much as 75%.
relationship between CFS and FMS. Dr.
Muhammad Yunus from the University of Illinois
College of Medicine, views FMS and CFS as being
part of a larger spectrum of conditions that he
calls Dysregulation Spectrum Syndrome (DSS).
Other researchers like Dr. Dedra Buchwald and Dr.
Anthony Komaroff have shown that CFS and FMS
overlap in patients by as much as 75%.
Furthermore, research has revealed that many
associated disorders and underlying
abnormalities are common to both illnesses. For
example, in a 1998 review Dr. Robert Bennett
points out that neurally mediated hypotension has
been documented in both CFS and FMS. Similarly,
abnormalities of the growth factor-1 axis have also
been documented in both patient groups. A small
2000 study found a significant clinical overlap
between the two illnesses: among females, 58% of
fibromyalgia patients met the full CDC criteria for
CFS, while for males this number was 80%.
Finally, a study published in the Archives of
Internal Medicine in January 2000 provided
evidence that patients with CFS, FMS, and TMJ
share key symptoms.
associated disorders and underlying
abnormalities are common to both illnesses. For
example, in a 1998 review Dr. Robert Bennett
points out that neurally mediated hypotension has
been documented in both CFS and FMS. Similarly,
abnormalities of the growth factor-1 axis have also
been documented in both patient groups. A small
2000 study found a significant clinical overlap
between the two illnesses: among females, 58% of
fibromyalgia patients met the full CDC criteria for
CFS, while for males this number was 80%.
Finally, a study published in the Archives of
Internal Medicine in January 2000 provided
evidence that patients with CFS, FMS, and TMJ
share key symptoms.
Current treatments for CFS and FMS are also
similar and typically focus on enhancing the
quality of sleep and controlling pain. Low doses
of tricyclic antidepressants such as Elavil or
Sinequan are often of some benefit.
similar and typically focus on enhancing the
quality of sleep and controlling pain. Low doses
of tricyclic antidepressants such as Elavil or
Sinequan are often of some benefit.
Since the cause and ultimately the cure for CFS
and FMS remain elusive, more information will be
needed about both conditions before we can say
with certainty that they are manifestations of a
similar disease mechanism. In the meantime,
researchers and practitioners can benefit from
clinical investigation in both areas. Most of all, as
patients who have one or both of these
syndromes, we have a great deal to learn from
each other.
FIBROMYALGIA - BREAKING NEWS.
muscles and soft tissues accompanied by fatigue,
is a fairly common condition that does not
manifest any structural damage in an organ.
Twenty-five years ago, Muhammad B. Yunus, MD,
and colleagues published the first controlled
study of the clinical characteristics of fibromyalgia
syndrome.
That seminal article, published in Seminars in
Arthritis and Rheumatism, led directly to formal
recognition of this disease by the medical
community. In the June 2007 issue of Seminars in
Arthritis and Rheumatism, Dr. Yunus once again
makes an enormous contribution to the field of
chronic pain and fatigue by meticulously
synthesizing and interpreting the extensive body
of scientific literature on fibromyalgia and his own
insights into the concept of central sensitivity
syndromes (CSS).
Fibromyalgia, affecting approximately 2% of the
US population, is an example of a class of
maladies called CSS. These diseases are based on
neurochemical abnormalities and include irritable
bowel syndrome, migraine and restless legs
syndrome.
Incorporating a critical review of over 225
publications and the author’s broad experience in
fibromyalgia and related diseases, Dr. Yunus
describes 13 separate conditions that are related
to central sensitization (CS), where the central
nervous system (spinal cord and brain) becomes
extremely sensitized on certain parts of the body,
so that even mild pressure or touch would cause
much pain. Such hypersensitivity may also be
associated with other symptoms such as poor
sleep and fatigue.
According to Dr. Yunus, “CSS are the most
common diseases that are based on real
neurochemical pathology and cause real pain and
suffering. In some patients stress and depression
may contribute to the symptoms but they are all
based on objective changes in the central nervous
system.”
Dr. Norman L. Gottlieb, Editor of Seminars in
Arthritis and Rheumatism, believes that this article
"advances our understanding of fibromyalgia,
unifies and advances concepts, and suggests that
this and several other common disorders have
much in common in terms of their
biopsychosocial development. This, hopefully,
will expand both clinical and research interest in
this group of diseases and lead to advances in
therapy for many of them."
In an accompanying editorial John B. Winfield,
MD, comments, “Without question, Muhammad
Yunus is the father of our modern view of
fibromyalgia…. Yunus, who took a rather more
biological approach to fibromyalgia in the past,
now emphasizes a biopsychosocial perspective.
In my view, this is tremendously important
because it is the only way to synthesize the
disparate contributions of such variables as genes
and adverse childhood experiences, life stress
and distress, posttraumatic stress disorder, mood
disorders, self-efficacy for pain control,
catastrophizing, coping style, and social support
into the evolving picture of central nervous
system dysfunction vis-a-vis chronic pain and
fatigue ….Science and medicine now have a
rational scaffolding for understanding and
treating chronic pain syndromes previously
considered to be ‘functional’ or ‘unexplained.’
…Neuroscience research will continue to reveal
the mechanisms of CS, but only if informed
through a biopsychosocial perspective and with
the interdisciplinary collaboration of basic
scientists, psychologists, sociologists,
epidemiologists, and clinicians.”
Dr. Yunus concludes that CSS is an important new
concept that embraces the biopsychosocial model
of disease. He advocates further critical studies to
fully test this concept which seems to have
important significance for new directions for
research and patient care involving physician and
patient education. “Each patient, irrespective of
diagnosis,” says Dr. Yunus, “should be treated as
an individual, considering both the biological and
psychosocial contributions to his or her
symptoms and suffering.”
The article is “Fibromyalgia and Overlapping
Disorders: The Unifying Concept of Central
Sensitivity Syndromes” by Muhammad B. Yunus,
MD, Professor of Medicine, Section of
Rheumatology, The University of Illinois College
of Medicine at Peoria, Peoria, Illinois. The
accompanying editorial is “Fibromyalgia and
Related Central Sensitivity Syndromes:
Twenty-Five Years of Progress” by John B.
Winfield, MD, University of North Carolina School
of Medicine. Both appear in the June issue of
Seminars in Arthritis and Rheumatism, Vol. 36:6,
published by Elsevier.
Source Article http://www.innovations-report.de
/html/berichte/medizin_gesundheit/bericht-
86441.html
and FMS remain elusive, more information will be
needed about both conditions before we can say
with certainty that they are manifestations of a
similar disease mechanism. In the meantime,
researchers and practitioners can benefit from
clinical investigation in both areas. Most of all, as
patients who have one or both of these
syndromes, we have a great deal to learn from
each other.
FIBROMYALGIA TRIGGER POINTS
(1 & 2) Occiput: on both sides (bilateral), at the
sub-occipital muscle insertions.
(3 & 4) Low Cervical: bilateral, at the anterior
aspects of the inter-transverse spaces.
(5 & 6) Lateral Epicondyle: bilateral, 2 cm distal to
the epicondyles
(7 & 8) Knee: bilateral, at the medial fat pad
proximal to the joint line.
(9 & 10) Second Rib: bilateral, at the second
costochondral junction, just lateral to the
junctions on upper surfaces.
(11 & 12) Trapezius: bilateral, at the midpoint of
the upper border of the muscle.
(13 & 14) Supraspinatus: bilateral, at origins,
above the spine of the scapula (shoulder blade)
near the medial border
(15 & 16) Gluteal: bilateral, in upper outer
quadrants of buttocks in anterior fold of muscle.
(17 & 18) Greater Trochanter: bilateral, posterior to
the trochanteric prominence.
sub-occipital muscle insertions.
(3 & 4) Low Cervical: bilateral, at the anterior
aspects of the inter-transverse spaces.
(5 & 6) Lateral Epicondyle: bilateral, 2 cm distal to
the epicondyles
(7 & 8) Knee: bilateral, at the medial fat pad
proximal to the joint line.
(9 & 10) Second Rib: bilateral, at the second
costochondral junction, just lateral to the
junctions on upper surfaces.
(11 & 12) Trapezius: bilateral, at the midpoint of
the upper border of the muscle.
(13 & 14) Supraspinatus: bilateral, at origins,
above the spine of the scapula (shoulder blade)
near the medial border
(15 & 16) Gluteal: bilateral, in upper outer
quadrants of buttocks in anterior fold of muscle.
(17 & 18) Greater Trochanter: bilateral, posterior to
the trochanteric prominence.
FIBROMYALGIA - BREAKING NEWS.
Further Legitimization of Fibromyalgia as a True
Medical Condition
muscles and soft tissues accompanied by fatigue,
is a fairly common condition that does not
manifest any structural damage in an organ.
Twenty-five years ago, Muhammad B. Yunus, MD,
and colleagues published the first controlled
study of the clinical characteristics of fibromyalgia
syndrome.
That seminal article, published in Seminars in
Arthritis and Rheumatism, led directly to formal
recognition of this disease by the medical
community. In the June 2007 issue of Seminars in
Arthritis and Rheumatism, Dr. Yunus once again
makes an enormous contribution to the field of
chronic pain and fatigue by meticulously
synthesizing and interpreting the extensive body
of scientific literature on fibromyalgia and his own
insights into the concept of central sensitivity
syndromes (CSS).
Fibromyalgia, affecting approximately 2% of the
US population, is an example of a class of
maladies called CSS. These diseases are based on
neurochemical abnormalities and include irritable
bowel syndrome, migraine and restless legs
syndrome.
Incorporating a critical review of over 225
publications and the author’s broad experience in
fibromyalgia and related diseases, Dr. Yunus
describes 13 separate conditions that are related
to central sensitization (CS), where the central
nervous system (spinal cord and brain) becomes
extremely sensitized on certain parts of the body,
so that even mild pressure or touch would cause
much pain. Such hypersensitivity may also be
associated with other symptoms such as poor
sleep and fatigue.
According to Dr. Yunus, “CSS are the most
common diseases that are based on real
neurochemical pathology and cause real pain and
suffering. In some patients stress and depression
may contribute to the symptoms but they are all
based on objective changes in the central nervous
system.”
Dr. Norman L. Gottlieb, Editor of Seminars in
Arthritis and Rheumatism, believes that this article
"advances our understanding of fibromyalgia,
unifies and advances concepts, and suggests that
this and several other common disorders have
much in common in terms of their
biopsychosocial development. This, hopefully,
will expand both clinical and research interest in
this group of diseases and lead to advances in
therapy for many of them."
In an accompanying editorial John B. Winfield,
MD, comments, “Without question, Muhammad
Yunus is the father of our modern view of
fibromyalgia…. Yunus, who took a rather more
biological approach to fibromyalgia in the past,
now emphasizes a biopsychosocial perspective.
In my view, this is tremendously important
because it is the only way to synthesize the
disparate contributions of such variables as genes
and adverse childhood experiences, life stress
and distress, posttraumatic stress disorder, mood
disorders, self-efficacy for pain control,
catastrophizing, coping style, and social support
into the evolving picture of central nervous
system dysfunction vis-a-vis chronic pain and
fatigue ….Science and medicine now have a
rational scaffolding for understanding and
treating chronic pain syndromes previously
considered to be ‘functional’ or ‘unexplained.’
…Neuroscience research will continue to reveal
the mechanisms of CS, but only if informed
through a biopsychosocial perspective and with
the interdisciplinary collaboration of basic
scientists, psychologists, sociologists,
epidemiologists, and clinicians.”
Dr. Yunus concludes that CSS is an important new
concept that embraces the biopsychosocial model
of disease. He advocates further critical studies to
fully test this concept which seems to have
important significance for new directions for
research and patient care involving physician and
patient education. “Each patient, irrespective of
diagnosis,” says Dr. Yunus, “should be treated as
an individual, considering both the biological and
psychosocial contributions to his or her
symptoms and suffering.”
The article is “Fibromyalgia and Overlapping
Disorders: The Unifying Concept of Central
Sensitivity Syndromes” by Muhammad B. Yunus,
MD, Professor of Medicine, Section of
Rheumatology, The University of Illinois College
of Medicine at Peoria, Peoria, Illinois. The
accompanying editorial is “Fibromyalgia and
Related Central Sensitivity Syndromes:
Twenty-Five Years of Progress” by John B.
Winfield, MD, University of North Carolina School
of Medicine. Both appear in the June issue of
Seminars in Arthritis and Rheumatism, Vol. 36:6,
published by Elsevier.
Source Article http://www.innovations-report.de
/html/berichte/medizin_gesundheit/bericht-
86441.html
page views: ###