What are Fibromyalgia and Chronic Fatigue Syndrome/Myalgic Encephalomyelitis?

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Fibromyalgia and Chronic Fatigue Syndrome are chronic disorders with substantial overlap of symptomatology, with a fibromyalgia diagnosis requiring the presence of musculoskeletal pain.  This overlap is so noteworthy that one group of researchers observed  80% of fibromyalgia patients met the Chronic Fatigue Syndrome criteria of fatigue lasting more than 6 months with a 50% reduction in activity.

Fibromyalgia (FM) is a condition that causes pain all over the body (also referred to as widespread pain), sleep problems, fatigue, and often emotional and mental distress, among other symptoms.  There have been several iterations of the definition of FM by different agencies across the globe, with the emphasis expanding out from a stricter pain focus to be more comprehensive and multifaceted definition in nature, as is reflected in the establishment of a widespread pain index, which replaced the assessment of tender points, as well as considerations around sleep.  However, people with fibromyalgia may be more sensitive to pain than people without fibromyalgia, which is called 'abnormal pain perception processing'.

Fibromyalgia affects about 4 million US adults, about 2% of the adult population.   It is more likely to occur as people age and women seem more likely to develop it than men, as are persons with certain auto-immune diseases, repetitive injuries or traumatic events.   To date, a singular clear cause for fibromyalgia is not known.

A diagnosis of FM requires that multiple criteria be met including:

  • Multisite pain (6/9 body areas, present at least three months)

  • Sleep problems OR fatigue

  • These criteria additionally highlight the role of environmental sensitivity in FM by including it in four common features (along with tenderness, dyscognition, and musculoskeletal stiffness), which may be used to support the diagnosis of FM.

Chronic Fatigue Syndrome (CFS), also known as 'Myalgic encephalomyelitis'(ME), is a disabling and chronic illness which is poorly understood and has no 'typical' case presentation.  There may well be different underlying causes which combine to manifest in the symptoms that get identified as this CFS/ME.   The 'CFS' name was coined by a group of clinicians in the late 1980s to develop a research definition for an increasingly recognized illness, which, at the time, was called 'Chronic Epstein-Barr Virus Syndrome'; however, subsequent evidence showed that acute or reactivated Epstein-Barr virus infection was not associated with the majority of cases.

The incidence of CFS/ME continues to rise in many developed countries, with women diagnosed two to four more times than men.  According to the CDC and NIH, an estimated 836,000 to 2.5 million Americans suffer from CFS/ME and a staggering 90 percent of people with CFS/ME have not been diagnosed!

CFS/ME diagnosis requires all three symptoms listed here occur at least half of the time with moderate, substantial, or severe intensity:

  • Profound fatigue and impairment that lasts more than six months

  • Post-exertional malaise (PEM), during which the fatigue may get worse after any activity, whether it’s physical or mental.

  • Unrefreshing sleep

In addition, at least one of the following symptoms must be present:

  • Impaired memory or ability to concentrate

  • Orthostatic intolerance

Why use integrative medicine to treat Fibromyalgia?

FM is a serious chronic condition with patients having higher documented rates of depression, hospitalizations, suicides, injuries, rheumatic conditions and lower quality of life.  And with such a high incidence occurring in the population, no objective diagnostic markers accepted through conventional laboratories and no clear cause identified, it is prudent to thoroughly review alternative methods of assessment and treatment.

The conventional management of FM is largely restricted to medications such as anti-depressants or pain-relievers, and patients are instructed to reduce stress, sleep and exercise.  Though it is encouraging that conventional medicine has promoted a lifestyle component to their therapeutic approach, patients deserve more.

natural treatment for chronic fatigue

At this time there is peer-review evidence to support many of the naturopathic interventions used to treat patients diagnosed with FM as well as treatments which address many of the hypothesized underlying reasons that cause FM.  Some of these include serotonin deficiency,  hypometabolism, subclinical impaired thyroid function, immune-system dysregulation, neuroinflammation, mitochondrial dysfunction, hypothalamic-pituitary-adrenal axis dysregulation, phosphate accumulation and small fiber neuropathy.

Why use integrative medicine to treat
Chronic Fatigue Syndrome/Myalgic Encephalomyelitis?

The overwhelming majority of CFS/ME cases not even being diagnosed is directly related to what the CDC themselves state on their website:

  • "Most medical schools in the United States do not have ME/CFS as part of their physician training.

  • The illness is often misunderstood and might not be taken seriously by some healthcare providers."

As there are no objective laboratory findings which can be used to definitively make this diagnosis, many conventional clinicians are at a loss with how to manage such patients.  Unfortunately, people will often be denied treatment, with doctors refusing to treat what they cannot isolate and see.

 

Successful management of CFS/ME can have far reaching affects on a person's life, including their ability to work and earning potential.  The CDC estimates that this condition costs the U.S. economy about $17 to $24 billion annually in medical bills and lost incomes.

natural treatment for fibromyalgia

Naturopathic physicians that are board certified and practicing in licensed states have received four years of rigorous training and passed multiple licensing exams.  This allows for a therapeutic approach that does more than just manage symptoms with pills and five to ten minute follow-ups.  Rather, individualized testing and lifestyle considerations, used in conjunction with revitalizing energetic and/or physical medicine therapies are major tenants to a successful program which seeks to enable a person's recovery and succeed where others have not.

Support for patients with Fibromyalgia
and Chronic Fatigue Syndrome

Evidenced-based herbal medicine

Many medicinal herbs have been shown in the peer-review literature to improve and support  mechanisms associated with persisting pain and fatigue as well as etiologies thought to possibly contribute to causing FM and CFS symptoms.  Often the careful selection of an herbal remedy comes not just from cookbook approaches or protocols for labeled diagnoses, but from getting a good case history and insights from diagnostic or functional medicine tests, which give perspective into what types of mechanisms may be misfiring in a person and contributing to symptoms.  Botanical medicines also contain many constituents and can act in many different therapeutic ways.

 

Advanced specialty testing

FM and CFS can have roots that extend into many body systems including immune, neurologic, gastrointestinal, endocrine, metabolic and more.  Yet local laboratory options do not always offer the most comprehensive means of analysis.  Although no one laboratory marker exists for diagnostic purposes with either of these conditions, some patients have benefited from modulating things like neuroinflammation, thyroid hormone and  testosterone levels.  And there have long been associations with people having symptoms onset soon after bouts with infectious disease.  However, insufficient work-ups may have been done .

Effective use of vitamins, minerals and nutritional supplements

Another way to improve outcomes for those with FM or CFS/ME is to include daily additional nutritional supplementation.  Attempting to restore balance to our bodies in the least invasive manner possible is part of the philosophic approach of naturopathic physicians.  Thus we often seek to use the body's constituents to see if better health can be achieved, especially in light of findings from advanced nutritional testing.  These may include vitamins, minerals, amino acids, fatty acids, supplemental hormones and more.

Don't get stuck not trying acupuncture

An extensive meta-analysis published in The Cochrane Database of Systematic Reviews found acupuncture, notably electro-acupuncture, improves pain and stiffness in people with FM when compared with no treatment and standard therapy.  Another group of researchers performed a meta-analysis on the treatment of CFS/ME and found good efficacy and safety data for the treatment, though the quality of the data was poor. 

Exploring endocrine disruptors, environmental contaminants, and how we detoxify them

While many chemicals, both natural and man-made, may mimic or interfere with our hormones, some have become so common in our day to day lives, that they have warranted special investigation and review.  Called "endocrine disruptors", these chemicals are linked with developmental, metabolic, reproductive, brain, immune, and other problems in different organs and glands of the endocrine system, which is the hormone-based communication network in the body. Endocrine disruptors include bisphenol A, dioxins, perchlorate, perfluoroalkyl and polyfluoroalkyl substances (PFAS), phthalates, phytoestrogens, polybrominated diphenyl ethers (PBDEs), polychlorinated biphenyls (PCBs), and triclosan, among others.

But how could this affect FM or CFS/ME?  For example, women experience both of these conditions more often than men, and hormones, like estrogen, have been shown to affect nociception, the sensation of pain. Bisphenol A (BPA), a highly prevalent xenoestrogen, is known to have estrogenic activity and influence expression of genes related to sensation of pain.  Exploring these avenues is often not done under conventional care. 

Therapeutic lifestyle medicine

If conventional medicine has come around to actually suggest activities like aerobic exercise and muscle strengthening exercise, ​stress management techniques such as meditation and massage, sleep hygiene, ​and cognitive behavioral therapy (CBT), then you know any reputable naturopathic or functional medicine practitioner will consider these.  However, it may take time for a patient to feel well enough to undertake some of these therapies on the journey to wellness. 

So if you are seeking guidance, support or treatment, consider contacting our clinic at the number above.

 

 

 

 

 

 

 

 

 

 

 

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References:

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  2. Buchwald, D, and D Garrity. “Comparison of patients with chronic fatigue syndrome, fibromyalgia, and multiple chemical sensitivities.” Archives of internal medicine vol. 154,18 (1994): 2049-53.

  3. Arnold, Lesley M et al. “AAPT Diagnostic Criteria for Fibromyalgia.” The journal of pain vol. 20,6 (2019): 611-628. doi:10.1016/j.jpain.2018.10.008

  4. Ryabkova, Varvara A et al. “Neuroimmunology: What Role for Autoimmunity, Neuroinflammation, and Small Fiber Neuropathy in Fibromyalgia, Chronic Fatigue Syndrome, and Adverse Events after Human Papillomavirus Vaccination?.” International journal of molecular sciences vol. 20,20 5164. 18 Oct. 2019, doi:10.3390/ijms20205164.

  5. Center for Disease Control and Prevention.  Fibromyalgia. https://www.cdc.gov/arthritis/basics/fibromyalgia.htm. Accessed 10-24-22.

  6. Unger ER, Lin JS, Brimmer DJ, et al. CDC Grand Rounds: Chronic Fatigue Syndrome — Advancing Research and Clinical Education. MMWR Morb Mortal Wkly Rep 2016;65:1434–1438. DOI: http://dx.doi.org/10.15585/mmwr.mm655051a4external icon. Accessed 10-17-22.

  7. Center for Disease Control and Prevention.  What is ME/CFS?https://www.cdc.gov/me-cfs/about/index.html.  Accessed 10-17-22.

  8. National Institutes of Health.  About ME/CFS. https://www.nih.gov/mecfs/about-mecfs.  Accessed 10-18-22.

  9. Deare, John C et al. “Acupuncture for treating fibromyalgia.” The Cochrane database of systematic reviews vol. 2013,5 CD007070. 31 May. 2013, doi:10.1002/14651858.CD007070.pub2

  10. Yin, Zi-Han et al. “Acupuncture for Chronic Fatigue Syndrome: An Overview of Systematic Reviews.” Chinese journal of integrative medicine vol. 27,12 (2021): 940-946. doi:10.1007/s11655-020-3195-3

  11. Endocrine Disruptors and Your Health. National Institute of Environmental Health Sciences. 2020. May.

  12. White, Hillary D et al. “Treatment of pain in fibromyalgia patients with testosterone gel: Pharmacokinetics and clinical response.” International immunopharmacology vol. 27,2 (2015): 249-56. doi:10.1016/j.intimp.2015.05.016

  13. Chen, Qing et al. “Estrogen receptors in pain modulation: cellular signaling.” Biology of sex differences vol. 12,1 22. 10 Feb. 2021, doi:10.1186/s13293-021-00364-5.

  14. Dias, Rejane Camila Alvarenga et al. “Fibromyalgia, sleep disturbance and menopause: Is there a relationship? A literature review.” International journal of rheumatic diseases vol. 22,11 (2019): 1961-1971. doi:10.1111/1756-185X.13713.

  15. Vermeer, Lydia M M et al. “Exposure to bisphenol A exacerbates migraine-like behaviors in a multibehavior model of rat migraine.” Toxicological sciences : an official journal of the Society of Toxicology vol. 137,2 (2014): 416-27. doi:10.1093/toxsci/kft245.

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