These are complex conditions in which people suffer from constant body pain, fatigue, sleep problems, and sometimes mood problems. The American College of Rheumatology has developed the diagnostic criteria. The painful points are shown below. Chronic Fatigue Syndrome is even less well understood and the diagnosis is made only when no other explanations for the symptoms can be identified. You can learn more about the criteria here.

While scientists are far from completely understanding FMS and CFS, many of the symptoms can be explained by alterations in neurotransmitters. Neurotransmitters are the chemicals that send signals from our brains. Serotonin is an example and serotonin plays a significant role in these conditions. Studies show that in people with FMS and CFS, the serotonin pathway is disrupted. This disruption prevents normal sleep-wake cycles (among other things); sleep is never refreshing enough and during the day, people often feel drowsy or foggy. Researchers have observed correlations between low levels of serotonin precursors and higher numbers of trigger points. In naturopathic medicine, we use a number of supplements to restore healthy levels of serotonin including 5-HTP and tryptophan.

However, not every person with these symptoms has serotonin imbalances. Some people have alterations in other neuroendocrine pathways, in particular in their adrenal glands, thyroid, and pituitary. These can translate into low cortisol levels, hypothyroidism, and growth hormone (GH) deficiency, all of which are stress-related. It is widely accepted that the hypothalamic- pituitary adrenal (HPA) axis serves as the link between a stressor, such as pain, and the individual's endocrine, autonomic, and behavioral response. In a healthy person, this means that we can adequately response to threats and when the threat is over, that we can rest and rejuvenate to be ready for the next event. Classically, the HPA axis is regarded as a system programmed to react to changes in the environment by producing chemical messengers (neurotransmitters) to trigger physiologic changes to maintain balance in the body such as increasing your blood sugar to provide fuel to your muscles to run in an emergency. People with FMS and CFS may have an impaired ability to initiate this response, which results in too little cortisol and forces the body to use other mechanisms to accomplish the same thing, such as triggering your nervous system. People with FMS and CFS often have increased sympathetic and decreased parasympathetic tone, as evidenced by exaggerated changes in blood pressure and heart rate with postural change. That is, they respond with too much “adrenalin” and have a hard time quieting their nervous systems when trying to sleep or eat.

Does all of this sound complicated? It is! And to make it more so, no two people are exactly the same! While some treatments help most people with FMS and CFS, with other patients, we resort to individualized testing of neurotransmitter levels to identify exactly how one individual is out of balance compared to someone else with the same symptoms. We are then able to customize treatment recommendations.

There are several effective treatments for most people – one is a supplement we will be testing in a new research study (see above and contact your ICM physician if you or someone you know wants to participate). Another effective treatment is exercise. Most people with FMS and CFS are surprised to hear this because they are so exhausted that the idea of exercise is overwhelming. However, several high quality research studies show that regular exercise results in long-term benefits for almost all FMS patients. It is important to put together an exercise plan that works for the individual; one that starts slowly and includes some resistance training (weight bearing exercise). All of the ICM physicians can put together a good training plan. Another therapy that has been proven effective is cognitive behavioral therapy (CBT). This type of psychological counseling is very different from “classic therapy” in that it doesn’t focus on so much processing old emotions; rather it teaches people how to cope with their current stressors by learning to respond differently. Ultimately, most people learn strategies that help them reduce stressors in their lives and therefore gain control of the situations that trigger the faulty neuroendocrine pathways.

Fibromyalgia and Chronic Fatigue Syndrome are frustrating conditions for patients. People often hear that it is “all in their head” or are simply prescribed antidepressants. With what we now know about the physical changes inside the brain, we can help people with these conditions more effectively than ever before. We would be honored to help any of your friends or family, either with treatment or determining if they really have these conditions. You can help them as well by forwarding this educational information to them!

References
http://www.medscape.com/viewarticle/569749_4
Clauw DJ.J Clin Psychiatry. 2008 Nov 6;69(11):e33
http://www.nfra.net/Diagnost.htm
http://www.cdc.gov/CFS/cfsdiagnosis.htm