by Fibromyalgia Network

This is a description of fibromyalgia syndrome (FMS), but because of its substantial symptom overlap with chronic fatigue immune dysfunction syndrome (CFIDS), it can be viewed as applying to CFIDS patients as well.

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 FM and CFIDS believe that these two syndromes are one and the same.

• Pain - The pain of FM 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 FM patients have an associated sleep disorder called the alpha-EEG anomaly. Researchers found that FM 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. 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 FM 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).
   

• Irritable Bowel Syndrome - Constipation, diarrhea, frequent abdominal pain, abdominal gas and nausea represent symptoms frequently found in roughly 40% to 70% of FM patients.
   

• Chronic headaches - Recurrent migraine or tension-type headaches are seen in about 50% of FM patients.
   

• 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 FM 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, 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, stress, depression, anxiety and over-exertion can all contribute to symptom flare-ups.

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 FM and CFIDS 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.

Long term follow-up studies on FM have shown that it is chronic, but the symptoms may wax and wane. The impact that FM can have on daily-living activities, including the ability to work a full-time job, differs among patients. Overall, studies have shown that FM can be equally as disabling as rheumatoid arthritis. Follow-up of people meeting the CFIDS criteria indicates that possibly 15-30% 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" CFIDS 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 CFIDS who do not recover or significantly improve after five years duration, their most prominent symptom changes from fatigue to muscle pain with concentration problems.