The Medical Minute: Chronic fatigue syndrome and fibromyalgia

[Guest guest]

The Medical Minute: Chronic fatigue syndrome and fibromyalgia

Wednesday, March 15, 2006

By Messmer

Penn State Family and Community Medicine

Penn State Milton S. Hershey Medical Center

Penn State College of Medicine

Fatigue is one of the more common complaints patients bring to

primary-care doctors. It is a challenging problem for the patient and

the physician. Being " tired all the time " is frustrating for the

person who can not manage a full day of work or school or stay awake

for a normal day's activities. For physicians, it means sorting

through all the possible causes of fatigue to find and, hopefully,

fix the problem.

Almost everyone has experienced fatigue from working too hard or

studying too long or from transient difficulty staying or falling

asleep. Usually the problem passes and life gets back to normal. For

some, however, it lasts for months and is severe enough to interfere

with work, school or home obligations. When it is that severe, it may

be more than simple fatigue.

Chronic fatigue syndrome or CFS combines the hallmark symptom of

fatigue with impaired concentration and memory, and may include sore

muscles and joints, headaches and swollen lymph nodes. If symptoms

like these last more than six months and sleep is not refreshing and

if work, educational, social or personal activities are impaired, it

could be CFS.

Fibromyalgia is similar to CFS but the fatigue is less and pain and

stiffness are greater. People with fibromyalgia have chronic pain in

the muscles and tissues that surround and move joints, particularly

the neck, spine, shoulders and back. Sleep is also impaired and poor

sleep may be the inciting problem. People with either condition can

experience bloating, dry mouth and eyes, irregular heart rhythms,

irritability and depression, tingling and numbness, difficulty

breathing, diarrhea, and abdominal pain.

People with CFS or fibromyalgia not only face the problem of having

these illnesses, but because there are no blood tests or X-rays to

diagnose them, some physicians and patients' families do not believe

they have a true illness. Many other illnesses, including psychiatric

problems, have similar symptoms and sorting them out can be

frustrating. Hypothyroidism, sleep apnea, narcolepsy, depression,

schizophrenia, autoimmune disorders, various cancers, hormonal

disorders, infections, alcohol and substance abuse and adverse drug

reactions all overlap symptoms and physical findings of CFS and

fibromyalgia.

Faced with the nonspecific nature of these problems, patients and

physicians have searched for a diagnostic test to explain the

conditions and prove it's not " all in their heads. " Tests for various

viruses including Epstein-Barr, herpes virus, retroviruses and

intestinal viruses have not proven helpful. Various assays of

impaired immune function have been inconsistent and should not be

used to diagnose CFS or fibromyalgia. CT scans, MRIs, nuclear

medicine imaging all are useless diagnostic tests except to rule out

other diseases that have similar symptoms. The only recommended lab

tests are a blood count, chemistry profile, thyroid level, urinalysis

and a test for inflammation called a sedimentation rate.

So far, there is no specific treatment for CFS or fibromyalgia. Each

person's treatment must be specifically tailored, although some

facets of care are universally recommended. Education for the patient

and family is essential as in all chronic illnesses. Understanding

the problem fosters a positive attitude and effective communication

while reducing the impact the problem has on family dynamics.

Exercise is essential for everyone, including CFS and fibromyalgia

patients. It might seem counterintuitive to ask someone experiencing

fatigue to exercise, but a gentle and gradually progressive exercise

program prevents deconditioning from lack of activity and begins to

restore tolerance of exertion. Exercise helps improve mood and

encourages restful sleep. Physical therapy, massage, hypnosis,

acupuncture, yoga, chiropractic and aquatic exercises have shown

benefits in many cases.

Some medications can be helpful. Anti-inflammatory medications

relieve pain although chronic use might irritate the stomach or

affect the kidneys. The patient's doctor can advise the person about

the relative safety for their particular case. Antidepressants,

particularly a group of older ones called tricyclic antidepressants,

in doses far lower than are used for depression, have been very

helpful for pain relief and restoring restful sleep. Stimulants may

have a role in treating fatigue, particularly a newer agent,

modafinil, which is approved for narcolepsy. Occasionally,

medications to control heart rate or low blood pressure are used in

specific circumstances.

Unfortunately, since there is no sure-fire cure, CFS and fibromyalgia

patients desperate for treatment have tried unproven therapies and

even treatments shown to be ineffective. Immune system stimulants,

steroids, DHEA, gamma globulin, enemas, extracts of various animal

organs and surgical treatments have not proven effective. Mineral

supplements, amino acids, coenzyme Q-10, herbal supplements and

dietary supplements have yet to show any benefit.

Approximately 15 of every 100,000 people have CFS and about one in 50

have fibromyalgia. Although they are not fatal, they are chronic and

can be debilitating. Treatment is not simple and it requires effort

by the patient, but improvement is possible for most people.

For information on CFS go to http://www.cdc.gov/ncidod/diseases/cfs/

index.htm and for fibromyalgia go to: http://www.niams.nih.gov/hi/

topics/fibromyalgia/fibrofs.htm on the Web.

http://live.psu.edu/story/16622