Chronic Fatigue /
Fibromyalgia Syndrome

Cold, damp weather can worsen the pain at fibromyalgia tender points.  Fibromyalgia produces a shortening and tightening of muscle fibers; cold weather also contracts muscles, making symptoms worse.

Cold, damp weather can worsen the pain at fibromyalgia tender points.  Fibromyalgia produces a shortening and tightening of muscle fibers; cold weather also contracts muscles, making symptoms worse.

The lymph nodes involved in CFS are small, moveable, not tender and most commonly involve the neck, axillary region or inguinal region.  A single lymph node that is very large, tender or immovable suggests a diagnosis other than CFS.  Similarly, generalized adenopathy suggests a diagnosis other than CFS.

The lymph nodes that are associated with CFS are small, moveable, not tender and most commonly involve the neck, axillary region or inguinal region.

The lymph nodes that are associated with CFS are small, moveable, not tender and most commonly involve the neck, axillary region or inguinal region.

Fibromyalgia sufferers can have difficulty speaking or making themselves understood.

Fibromyalgia patients often complain of generalized morning pain and stiffness that may not get better for hours.

Based on doctors' estimates, sleep disturbances are experienced by approximately 75% of Chronic Fatigue and Fibromyalgia sufferers.

Based on doctors' estimates, sleep disturbances are experienced by approximately 75% of Chronic Fatigue and Fibromyalgia sufferers.

MCS is a distinct illness that many times is diagnosed secondarily to CFS and/or fibromyalgia.

If anemia is identified as a problem then the likelihood of CFS is reduced.  Therefore, it is wise to rule out anemia first, because both can contribute to similar symptomology.  Of course, it is not impossible for both to occur simultaneously, but this is less likely.

Dr. St. Amand, MD, specializing in fibromyalgia and author of What Your Doctor May Not Tell You About Fibromyalgia believes that all women with chronic vulvodynia have a form of fibromyalgia.  He discovered that at least 11% of his female patients with fibromyalgia also have vulvodynia (painful genitals).  The guaifenesin therapy for chronic fatigue enhances oxalate crystal excretion which has been shown to be beneficial in vulvodynia also.

Depression or anxiety may occur as a result of the chronic pain and fatigue, or the frustration felt with this condition.  It is also possible that the same chemical imbalances in the brain that cause fibromyalgia also cause depression and anxiety.  Some 24% of patients suffer from anxiety.

TMJ disorders occur more often among those with CFS.

Studies show that 79-92% of CFS/FMS patients have a hypercoagulation defect.

Raynaud's phenomenon is found in between 30% to 50% of CFS/FMS sufferers.

Research has shown that IBS frequently co-exists with CFS and fibromyalgia.  Depending on the study quoted, between 34% and 73% of CFS/FMS sufferers have Irritable Bowel Syndrome.

The leakage of toxic waste from the gut into the bloodstream is believed to be a primary cause of Chronic Fatigue.

It has been known for 25 years that FM patients have an abnormal sleep pattern involving stages 3 and 4 of non-REM sleep.  As GH is secreted predominantly during stages 3 and 4 of non-REM sleep, it was originally hypothesized that FM patients may have impaired GH secretion.  IGF-1 levels are abnormally low in some fibromyalgia patients.

In an analysis of IGF-1 levels in 500 female FM patients and 152 age matched non-FM subjects the mean IGF-1 level in the FM patients was 137 +/- 58ng/ml versus 216 +/- 86ng/ml in controls.  Eighty-five percent of the FM patients had IGF-1 levels below the 50th percentile of the control population and 56% fell below the 20th percentile.

CFS patients are Th2 activated.  This means they over-respond to toxins, allergens, normal bacteria and parasites, and under-respond to viruses, yeast, cancer and intracellular bacteria.

Almost all (98%) of Rheumatoid Arthritis patients report fatigue.  They also report that it is more of a problem than the stiffness and pain.

In one evaluation of 200 Chronic Fatigue and Fibromyalgia patients it was found that 80% had a significant impairment of liver detoxification function.

Patients suffering from toxic burdens may experience a wide range of symptoms, among them fatigue and poor tolerance for exercise.  These processes have been postulated to be a central factor in the development of CFS.  Oxidative damage to mitochondria and the detoxification process itself is being considered as a fundamental mechanism in the development of CFS. [1 Bland JS, HealthComm Inc., 1997; Int Clin Nutr Rev 1988;8(4): pp.173-5]

Raynaud's phenomenon (severe cold hands and feet) affects about 16% of fibromyalgia sufferers.

70% to 100% (different studies show various numbers) of fibromyalgia patients are found to have depression, though many consider that this is more likely to be a result of the muscular pain rather than part of the cause.

A sample of 69 patients with FM underwent a standardized tender point examination and a semistructured psychological interview and completed a set of self-report inventories.  Of the sample, 39 met criteria for depressive disorder and 30 did not. [Evaluation of the Relationship Between Depression and Fibromyalgia Syndrome: Why Aren't All Patients Depressed?  Akiko Okifuji, Dennis C. Turk, Jeffrey J. Sherman]

Severe headaches are experienced by 44-56% of fibromyalgia sufferers.

Although there is not yet a case definition for Gulf War Illness, the chronic signs and symptoms loosely fit the clinical criteria for Chronic Fatigue Syndrome and/or Fibromyalgia Syndrome.

Lyme disease should be a differential diagnosis for all fibromyalgia patients who could have been exposed to a tick bite.

Some doctors automatically test the vitamin D status of anyone who comes to them with "fibromyalgia", since fibromyalgia is easily misdiagnosed and vitamin D deficiency is easily cured.

Hypersensitivity to dental metals and nickel is frequent in patients with CFS and MCS-like syndromes.  Ongoing metal-induced inflammation can be present in the oral cavity and/or in any other place of metal deposition.  Metal-driven chronic inflammation may affect the hypothalamic-pituitary-adrenal axis (HPA-axis) and trigger a myriad of non-specific symptoms characterizing CFS, MCS and other related diseases.  The removal of metallic restorations can reduce lymphocyte sensitization and improve the health of patients. [Neuroendocrinology Letters, 20: pp.289-298, 1999]

In one study, 30 people participated in a dietary intervention using a mostly raw, pure vegetarian diet.  The diet consisted of raw fruits, salads, carrot juice, tubers, grain products, nuts, seeds, and a dehydrated barley grass juice product.  19 of 30 subjects were classified as responders, with significant improvement on all measured outcomes, compared to no improvement among non-responders.  This dietary intervention shows that many fibromyalgia subjects can be helped by a mostly raw vegetarian diet. [BMC Complement Altern Med 2001;1(1): p.7]

In another study, the effect of a strict, low-salt, uncooked vegan diet rich in lactobacteria in 18 fibromyalgia patients both during and after a 3-month intervention period was evaluated.  15 patients continued their omnivorous diet as controls.  The results revealed significant improvements in pain reduction, joint stiffness, quality of sleep, and overall scoring in all 3 questionnaires which were used.

The majority of patients were overweight to some extent at the beginning of the study and shifting to a vegan food caused a significant reduction in body mass index.  Total serum cholesterol showed a statistically significant lowering and urinary sodium dropped to ¹⁄₃ of the beginning value indicating good diet compliance.  It can be concluded that a raw vegan diet has beneficial effects on fibromyalgia symptoms at least in the short run. [Scand J Rheumatol 2000;29(5): pp.308-13]

See the link between Chronic Fatigue / Fibromyalgia and Raw Food Diet.

May be an effective aid in the destruction of lipid-enveloped viruses, such as HIV, HHV-6 (strains A and B), EBV, CMV, and herpes.

According to researchers and physicians studying the adverse effects of aspartame, chronic fatigue syndrome and fibromyalgia among other conditions can be triggered or worsened by ingesting aspartame.

Fasting is reported to help in cases of fibromyalgia, but probably not chronic fatigue syndrome.

GHB has been reported to help decrease pain and improve sleep amongst fibromyalgia patients.

Exercise is often a problem for people with CFS because physical activity can worsen symptoms.  Medical opinion has been divided on whether CFS patients should attempt regular exercise or not – some believe that gentle exercise is helpful, while others caution against any form of aerobic activity at all.  However, a study published in the British Medical Journal found that patient education on CFS and a graded exercise program can greatly improve CFS symptoms in many cases.

Some people with CFS, especially in the weeks or months following onset, are unable to perform the most basic activities, such as showering or walking from one room to another.  In such cases of extreme exhaustion and pain, the person may be confined to their bed.  As time passes, they may feel a little better and attempt regular exercise.  However, aerobic activity can cause a relapse of symptoms that forces the person back to their bed again.  The added problem for CFS sufferers is that a sedentary lifestyle causes a range of other health problems including muscle wastage, loss of bone mass, and increased risk of obesity and cardiovascular disease.

A person with CFS needs a gentle approach to physical activity and should only make tiny increases in the frequency, duration and intensity of their exercise program.  General suggestions include:

• Aim for no more than three exercise sessions per week.
• Experiment to find the type of exercise that works best for you.  Choose from a range of gentle activities such as stretching, yoga, Tai Chi, walking and light weight training.
• Stretching seems to be well tolerated by people with CFS.  You may prefer to perform your stretching program while lying down in bed.
• Aerobic exercise seems to cause relapses for many people with CFS.  If this is true for you, try non-aerobic forms of exercise like weight training with one-kilogram dumbbells.
• Learn from past relapses.  For example, if walking for 20 minutes worsened your symptoms, try walking for five minutes and see how that goes.  It may be helpful to keep a diary to keep track of what works and what doesn't.
• Stop the physical activity well before you feel tired.
• Remember that your exercise tolerance will differ from one day to the next.
• Listen to your body – if you don't feel up to exercising on a particular day, don't.
• Only increase the intensity, time spent or frequency of exercise when you know you can cope with it.  For example, if you can exercise for five minutes without suffering a relapse, try for six minutes.

A randomized, placebo-controlled study found that melatonin supplementation (either alone or in conjunction with fluoxetine/Prozac) significantly reduced fibromyalgia symptoms.

Some dentists report treating chronic fatigue and arthritic pain by removing infected bone in the third molar area.  These problems disappear in many patients after removing dental infections.

A Fatigue Illnesses and Pain Panel (Blood) can test for the presence of Mycoplasma fermentans, Mycoplasma pneumoniae, Mycoplasma penetrans, Chlamydia pneumoniae, Epstein Barr Virus (EBV), Cytomegalovirus (CMV) and Human Herpes Virus (HHV-6).

According to Dr. Stanley Jacobs, MD, MSM can be helpful in most musculoskeletal pain and inflammation conditions, including fibromyalgia.

Fatigue is sometimes reduced with magnesium (and potassium) supplementation.  The many enzyme systems that require magnesium help restore normal energy levels.

Studies from Texas Tech University found that the yoga postures helped increase circulation to the limbs and decreased physically related anxiety.  FMS sufferers frequently complain about decreased energy, but the Tech subjects reported that the yoga exercises actually increased energy levels.

DMAE increases the body's release of energy.