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Fibromyalgia and Chronic Fatigue Syndrome - common yet often misunderstood

30 August 2017

Fibromyalgia (FMS) and Chronic Fatigue Syndrome (CFS) are common conditions that cause tiredness and widespread pain.  There is considerable overlap between the two and many clinicians consider them to be the same condition. FMS is characterised by chronic widespread pain and CFS by chronic fatigue that is present for more than six months. Both ailments are often associated with other symptoms including; poor concentration, headaches, sleep disturbance, irritable bowel syndrome, depression and anxiety.  The conditions are seven times more common in women than men, with peak onset between 30 and 50 years, and they are estimated to affect 4% of the population. 

What causes FMS and CFS?

The cause of FMS and CFS is a topic of much debate in the scientific and medical fields. The term fibromyalgia was first presented by a Rheumatologist named Fredrick Wolfe in the early 1990s. Since then he has stated that he doesn’t think FMS is a disease but rather a physical response to stress and depression. Indeed there is a strong association with depression and anxiety and some clinicians believe that the physical sensations experienced by patients are purely symptoms of underlying anxiety and depression. Some studies suggest a possible link with traumatic events, childhood illness and glandular fever. Rheumatologists define the syndrome of FMS and CFS as being caused by ‘central sensitisation’. This involves an initial stimulation of the amygdala, part of the brain limbic system which is involved in the ‘fight or flight response’ and results in the release of adrenaline and other stress hormones. The initial stimulation of the amygdala may have been caused by traumatic event, illness or stress. If the amygdala then becomes chronically stimulated by fear or stress then it becomes ‘sensitised’. This results in chronic release of adrenaline and cortisol, heightened pain perception and subsequent muscular tension, fatigue, poor sleep in addition to a multitude of other symptoms. 

How is it diagnosed?

There are currently no diagnostic tests for FMS and CFS. There is no demonstrable abnormality on either clinical examination or laboratory testing. Your GP may undertake blood tests, X-rays and scans to exclude underlying medical conditions that can cause similar symptoms.  Such conditions include thyroid disorders, rheumatoid arthritis and certain bowel problems. However, the laboratory tests are usually normal and the diagnosis is therefore based on the overall clinical assessment made by your doctor.  

What are the treatment options?

GPs are best placed to make the diagnosis and offer treatment. A referral to a hospital specialist, usually a Rheumatologist, is only required if there is some uncertainty over the diagnosis. The treatment approach is usually three fold:

  • Physical exercise - studies have shown that aerobic physical exercise results in significant improvement in symptoms at one year.  The exercise regime must be undertaken in a graded, step-wise fashion to allow the body time to adjust to the increased physical work
  • Psychological therapy - many patients benefit greatly from the input of a clinical psychologist, and sometimes a psychiatrist, to help learn strategies to manage symptoms and deal with issues of underlying stress, anxiety and depression if present. Dr Claire Weekes, an Australian psychologist described the basic tenants of therapy as understanding why the symptoms arise (sensitization), acceptance of symptoms, then ‘loosening resistance and tension’ and letting time pass
  • Medication - where sleep disturbance is prominent, your doctor can prescribe you medication that is helpful in restoring a normal sleep pattern. Antidepressants are sometimes prescribed but only if there is moderate to severe anxiety and/or depression.  Painkillers are generally ineffective and steroids have no place in the management of these conditions. However, most clinicians feel FMS and CFS patients should onlky receive such medications for a short period of time.

 

Prognosis

Historically, clinicians’ have believed that Fibromyalgia and CFS are lifelong conditions. However, there is fresh hope for sufferers, with recent studies showing that most patients will improve with treatment and approximately a quarter of people will go through remission at some stage. In other cases residual symptoms can persist for many years and a person will go through periods of increased and decreased effects.

If you are concerned that you may be suffering from Fibromyalgia (FMS) or Chronic Fatigue Syndrome (CFS) you should see your GP to have the diagnosis confirmed and appropriate treatment recommended. Your doctor might refer you to a specialist Rheumatologist if necessary.

Dr Abbas Ismail is a Consultant Rheumatologist at HCA UK’s The Wilmslow Hospital. For an appointment with Dr Ismail please call 01625 545 036.

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