Professional Education And Training
The RLHIM is also a teaching hospital and from time to time other healthcare professionals may observe in outpatient clinics as part of a training course. We will always ask your permission for students to sit in during your consultation. You do not have to have students present if you would prefer not to.
Defining Chronic Fatigue Syndrome
There has been considerable controversy over whether CFS is a specific disorder or at the severe end of the spectrum of idiopathic exhaustion. There also has been confusion regarding the overlap of CFS with FM and other functional somatic syndromes, and with psychiatric illness. In some reports the majority of subjects with CSF also have a comorbid psychiatric disorder, and psychiatric disorders increase the risk of later chronic fatigue. Some researchers have claimed that fatigue cannot be distinguished from depression, whereas others believe chronic fatigue should be considered a separate diagnostic category.
CFS was first identified as a new illness in 1985 following a series of 31 cases of unexplained fatigue reported from Lake Tahoe, Nevada.¹ In the report, the authors presented initial evidence that the Lake Tahoe cases were related to the Epstein-Barr virus. Chronic exhaustion, or neurasthenia, had previously been linked to potential infections, including outbreaks reported from Los Angeles County General Hospital in 1934.¹ During the next 50 years, other epidemics of exhaustion, generalized body aches, and general misery were reported from South Africa, Australia, England, as well as in Florida and Washington, DC. The clustering of cases, flu-like symptoms, and the beliefs of healthcare professionals suggested an infectious etiology but none was ever found.
At least 1 of the 2 following manifestations is also required:
Differences Between Fibromyalgia And Chronic Fatigue Syndrome
Although fatigue and chronic pain are common symptoms of both chronic fatigue syndrome and fibromyalgia, there are still differences. Some of these include:
- Causative Factor: Most people with fibromyalgia report that symptoms manifested after a traumatic experience such as emotional stress/shock or physical injury. Symptoms of chronic fatigue syndrome commonly occur due to a viral infection such as influenza or mononucleosis but in some cases it also starts after experiencing a physical trauma too or some combination of both.
- Inflammation: While there is no evidence of inflammation in people with fibromyalgia, patients with chronic fatigue syndrome often report inflammatory signs such as swollen glands and fever.
- Sleep: Although people with fibromyalgia are affected by REM sleep, recent medical research in Japan has reported differences in sleep disturbances for both conditions.
- Tender Points/Distinct Pain Spots: Tenderness is an important sign of fibromyalgia. On the other hand, medical experts have found no evidence that patients with chronic fatigue syndrome have any distinct pain sites or tender points. But, pain can affect chronic fatigue syndrome sufferers too to a usually lesser degree.
In the case of fibromyalgia vs chronic fatigue syndrome, although the symptoms overlap, there will be more emphasis on some symptoms than others depending on the illness.
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Difference Between Fibromyalgia And Chronic Fatigue Syndrome
July 13, 2011 Posted by Dr.Dinusha
Fibromyalgia vs Chronic fatigue syndrome
Fatigue is a term to describe the awareness of a person related to the exhaustive physical and psychological effects due to variant pathologies, or as a physiological response. Here, the person experiences muscle pain, lethargy, tiredness, sleepiness etc. The physical fatigue is usual following strenuous exercise, or some pathological condition, also this may exist for a long time. The mental fatigue is experienced as a feeling of burn out, sleepiness, and can further its effects to depression as well. Fibromyalgia and Chronic fatigue syndrome are two of the least understood conditions, and we will discuss them in terms of cause, symptoms, diagnosis, and management.
Chronic Fatigue Syndrome
What is the difference between Fibromyalgia and Chronic Fatigue Syndrome?
Due to its unknown origin, people and health care professionals tend to dismiss regular complaints of aches and pains in females. But careful observations and investigations would help to cope with these conditions. Both these conditions are with constellations of non specific variant symptoms. But poor sleep, painful sites, pain stretched throughout the day are some of the symptoms that would point in the right direction.
Fibromyalgia Is Believed To Be Caused By An Abnormal Sensory Processing In The Central Nervous System Which Intensifies Pain Experienced By Fibromyalgia Patients Physiologic Abnormalities Have Also Been Seen Such As Decreased Blood Flow To The Thalamus Decreased Levels Of Serotonin And Tryptophan Increased Levels Of Substance P In The Spinal Cord And Abnormalities In The Function Of Cytokine Genetics And Trauma Are Also Linked To The Occurrence Of Fibromyalgia
The exact cause of chronic fatigue syndrome is not known. However, its development is associated with viruses, a weak immune system, low blood pressure and hormonal imbalance. Another speculation for CFS is that some people have a genetic predisposition on developing the condition. Epstein-Barr virus, rubella, human herpes virus 6, mycoplasma, Ross River virus, and Coxiella bumetti are studied to be possible causes of chronic fatigue syndrome.
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Overlapping Symptoms: Fatigue Mood Pain
It is not clear that this updated definition for CFS will advance the understanding of the disorder or its acceptance as a diagnosable condition.22,25 There was little evidence that the new case definition was an improvement over prior CFS case definitions given continued diagnostic uncertainty.28 The new diagnostic criteria do not offer clinicians the ability to distinguish CFS from overlapping functional somatic syndromes, and in particular FM.
Most studies have found a significant clinical overlap of FM and CFS symptoms, with the majority of individuals meeting criteria for both syndromes.29,30 In 1 report, 50 patients with primary FM who had been followed in an academic rheumatology practice frequently reported symptoms thought to be typical of chronic Epstein-Barr virus infection , but not of FM. These included recurrent sore throat , recurrent rash , chronic cough , recurrent adenopathy , and recurrent low-grade fevers .29 In 55% of the patients, the illness had begun suddenly, with what seemed to be a viral syndrome.30 However, antibody titers to Epstein-Barr virus in the patients were not significantly different from those in age- and sex-matched healthy and unhealthy control subjects.30 This overlap is not surprising since fatigue is the second most prominent symptom in FM, right after chronic widespread pain.
Signs And Symptoms Of Fibromyalgia
Body wide tenderness and widespread chronic pain are the notable features of fibromyalgia. This pain affects several areas of the body, significantly affecting the tendons, joints, and muscles.
Stiffness is common in the joint, as well. Although the pain generally affects the areas below and above the waist, localized regions such as the neck, lower back, or shoulders may be affected. People with fibromyalgia often feel flu-like symptoms, as though they hurt all over.
It is common for some sufferers to experience flare-ups situations where the chronic pain and other symptoms last for prolonged periods of time.
Another symptom of fibromyalgia is fatigue. It especially manifests upon waking up in the morning, but it may also be noticeable mid-afternoon. It is common for people to be awakened with a light feeling, even after sleeping all night. This feeling may be combined with multiple disturbances during the night, with difficulty getting back to sleep.
Although body wide pain, sleeping difficulty, and fatigue are hallmarks of fibromyalgia, the illness is also associated with other symptoms such as disordered thinking. Patients have reported cognitive disturbances, brain fog and difficulty with enough focus to complete set tasks.
Other symptoms may include headaches, abdominal pain, pelvic pain, heart palpitations, diarrhea, dry eyes and mouth, tingling and numbness in extremities, nausea, and weight gain.
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Fibromyalgia What Is It
Fibromyalgia is a complex pain disorder that affects the musculoskeletal system, causing widespread chronic pain, aches and tenderness to touch. Fibromyalgia pain can be located in only one part of the body at a time, moving from one area to the next, or pain may be felt all over the body at the same time.
A chronic pain disorder, fibromyalgia heightens the sense of pain in an individual, and is accompanied by sleep issues, fatigue, digestive symptoms as well as mental and social problems.
More women are at the risk of developing fibromyalgia than are men. In fact, of the approximately 10 million Americans suffering from this condition, women are affected more than men with a ratio of about 8 to 2.
Although fibromyalgia is literally translated to mean pain in the tendons, ligaments, and muscles, this condition presents as much more than just pain, with a wide range of symptoms that vary from one person to another.
Numeric Rating Scales Show Prolonged Post
- 2Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- 3Onze Lieve Vrouwe Gasthuis , Amsterdam, Netherlands
Introduction: Muscle pain, fatigue, and concentration problems are common among individuals with myalgic encephalomyelitis/chronic fatigue syndrome . These symptoms are commonly increased as part of the phenomenon of postexertional malaise . An increase in the severity of these symptoms is described following physical or mental exercise in ME/CFS patients. Another important symptom of ME/CFS is orthostatic intolerance, which can be detected by head-up tilt testing . The effect of HUT on PEM has not been studied extensively. For this purpose, we assessed numeric rating scales for pain, fatigue, and concentration pre- and post-HUT. As pain is a core symptom in fibromyalgia , we subgrouped ME/CFS patients by the presence or absence of FM.
NRS scores of pain, fatigue, and concentration were significantly increased even at 7 days post-HUT compared with pre-HUT in ME/CFS patients with and without FM, suggesting that orthostatic stress is an important determinant of PEM.
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Other Tips On Management Of Fibromyalgia
- Timed Exercises: Consistent exercises can improve your nighttime sleep, but avoid exercises 3 hours before bedtime, to ensure you do not experience any sleep breaks and interruptions at night due to overstimulation.
- Avoid mid-day naps: Sleeping at mid-day could affect your nighttime sleep. If you must sleep, set your alarm for a limited period say 1 hour only.
- Night time is sleep time: Engaging in activities such as working with your laptop, seeing the late night news, or reading a novel can keep you awake long into the night.
- Epsom salts baths: A warm bath before bed with a couple of handfuls of Epsom salts dissolved in the water can help ease sore muscles and ensure a restful sleep.
- Other therapies: include massage, acupressure, acupuncture, myofascial release therapy, and light aerobic activities.
- Pacing:Learning to pace activitiescan be helpful in managing the symptoms of fibromyalgia and in reducing flares.
Tender Points Of Fibromyalgia
Widespread tenderness is a common symptom, particularly affecting anatomic regions such as the back of the neck at the connection between the muscle and the skull. There are 18 such specific regions in the body, and they are known as fibromyalgia tender points.
In the past, clinical studies were only carried out on patients who had 11 out of the 18 tender points, but this approach has changed in recent years.
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Predictors Of New Onsets Of Irritable Bowel Syndrome Chronic Fatigue Syndrome And Fibromyalgia: The Lifelines Study
Background: It has been claimed that functional somatic syndromes share a common etiology. This prospective population-based study assessed whether the same variables predict new onsets of irritable bowel syndrome , chronic fatigue syndrome and fibromyalgia .
Methods: The study included 152 180 adults in the Dutch Lifelines study who reported the presence/absence of relevant syndromes at baseline and follow-up. They were screened at baseline for physical and psychological disorders, socio-demographic, psycho-social and behavioral variables. At follow-up new onsets of each syndrome were identified by self-report. We performed separate analyses for the three syndromes including participants free of the relevant syndrome or its key symptom at baseline. LASSO logistic regressions were applied to identify which of the 102 baseline variables predicted new onsets of each syndrome.
Results: There were 1595 , 296 and 692 new onsets of IBS, CFS, and FM, respectively. LASSO logistic regression selected 26, 7 and 19 predictors for IBS, CFS and FM, respectively. Four predictors were shared by all three syndromes, four predicted IBS and FM and two predicted IBS and CFS but 28 predictors were specific to a single syndrome. CFS was more distinct from IBS and FM, which predicted each other.
What Are The Aims Of The Service
The service is based on NICE and EULAR guidelines for these conditions.
- Help you understand your condition
- Enable you to develop helpful coping strategies to manage symptoms
- Reduce distress and disability
- Improve your quality of life
We use a holistic approach, meaning that we look at the physical and the psychological aspects of the illness.
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What Is Myalgic Encephalomyelitis
“Myalgic encephalomyelitis” is another name for chronic fatigue syndrome. It means muscle pain with brain and spinal cord inflammation. This term is used in part because its more descriptive of the illness. Its also because ME/CFS is now considered a disease, not a syndrome.
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Create A Relaxing Bedtime Routine
Fibro fatigue isnt necessarily something that can be fixed with a good nights sleep, but quality sleep can help over time.
A relaxing bedtime routine is an important first step toward getting a good nights rest.
Here are a few tips for a healthy sleep routine:
- go to bed and get up at the same time every day
- avoid alcohol, nicotine, and caffeine
- invest in a good quality mattress
- keep your bedroom cool and dark
- turn off screens at least an hour before bedtime
- keep electronics out of the bedroom
- avoid having a large meal before bedtime
- take a warm bath before bed
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What Are Chronic Fatigue Syndrome And Fibromyalgia
They are chronic conditions which affect daily functioning and involve chronic fatigue not much relieved by rest and made worse by exertion, chronic widespread muscle pain , sleep disturbance , concentration difficulties, and sometimes mood disturbance, headaches, intestinal, urinary and a range of other possible symptoms.
Smiling Through Pain: Living On
Fibromyalgia and Chronic Fatigue Syndrome: Differences
Chronic pain and fatigue are common symptoms of both fibromyalgia and chronic fatigue syndrome. The difference is that, in fibromyalgia, fatigue often takes a backseat to debilitating muscle pain. In chronic fatigue syndrome, people have an overwhelming lack of energy, but also can experience some pain.
Some more important differences between the two include:
- What prompted the condition. Many people diagnosed with fibromyalgia fatigue report that their symptoms followed some sort of trauma a physical injury or an emotional shock. On the other hand, chronic fatigue syndrome appears to spring from a viral infection like mononucleosis or influenza.
- Distinct pain sites. People are diagnosed with fibromyalgia fatigue if they feel tenderness or pain in at least 11 of 18 distinct locations on their bodies. People with chronic fatigue syndrome do not have these pain sites.
- Inflammation. People with chronic fatigue syndrome often complain of fever, swollen glands, and other signs of inflammation. Doctors find no evidence of inflammatory response in patients with fibromyalgia fatigue.
- Sleep. Although chronic fatigue syndrome and fibromyalgia are both associated with disrupted REM sleep, a recent study from Japan found key differences in other sleep disturbances between people with CFS alone and those with CFS and fibromyalgia.
Fibromyalgia and CFS: Similarities
Treating Fibromyalgia Fatigue and Chronic Fatigue Syndrome
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Cfs Versus Fm: Twins Cousins Or Just Acquaintances
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Editor’s Note: Dr. Lapp is Director Emeritus of the Hunter-Hopkins Center in Charlotte, one of the few medical practices in the US specializing in the treatment of ME/CFS and fibromyalgia.
Chronic Fatigue Syndrome is a disorder characterized by debilitating fatigue and recurrent flulike symptoms, such as muscle and joint aches, sore throat, swollen glands, and difficulty thinking. Fibromyalgia Syndrome is a disorder characterized by widespread muscle pain. Can such different descriptions share anything in common?
Most experts agree that the symptoms of CFS and FM are so close that they are – for all intents – the same disorder. It’s a bit like Jekyll and Hyde, or perhaps like Chang and Eng Bunker, the Siamese twins made famous by P.T. Barnum. They were both the same “person” but had two different names, two similar but different personalities.
Assigning a Diagnosis
Patients who present to their primary care providers frequently relate a litany of complaints such as fatigue, vague aching, and trouble with memory or concentration.
Based on these complaints, the primary care doctor will most likely diagnose Chronic Fatigue Syndrome using the 1994 international case definition published by the Centers for Disease Control.
Overlaps and Shadows
Fibromyalgia & CFS Compared
- Reduced cerebral blood flow in cortex and midbrain
- HPG Axis suppression
- Reduced serum and/or CSF serotonin
- Low growth hormone
How Your Family Can Help
Always remember that youre not alone. Support from your family can make your condition easier to bear by spending time with you on good days as well as the bad days.
I try to make family members a partner in treatment, he says. When you just want to spend the day in bed watching TV because of fatigue or pain, a family member can encourage simple, fun activities to help get you moving.
Whether your diagnosis is chronic fatigue or fibromyalgia, a doctors role in treating the disease small. A doctor is there as the coach and can help you with the first 10% to 15% of improvement, while you have to help yourself manage the remaining 85% to 90%.
If youre suffering with chronic pain and/or fatigue, talk to your doctor. A diagnosis can put you in a better position to manage your symptoms even if there are still some mysteries surrounding your disease.
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