Is it Not Possible for a Person with Chronic Fatigue to have Fibromyalgia?

[Mya Symons]

I am so confused right now (nothing unusual). Can a person with Chronic Fatigue not also have Fibromyalgia?

I was reading an abstract regarding "diffferential diagnosis" and CFS/ME that someone here had a link to at http://emedicine.medscape.com/article/235980-diagnosis

The author states that Fibromyalgia does not cause cognitive defects, so it is readily differentiated from CFS. Furthermore, patients with CFS do not have trigger points, which are characteristic of fibromyalgia.

(Fibromyalgia definately does cause cognitive difficulties, so at least that part is wrong.)

I got this summary of the Canadian Criteria for Chronic Fatigue from about.com.

Canadian Diagnostic Criteria for Chronic Fatigue
From the Canadian Consensus Document:
A patient with ME/CFS will meet the criteria for fatigue, post-exertional malaise and/or fatigue, sleep dysfunction, and pain; have two or more neurological/cognitive manifestations and one or more symptoms from two of the categories of autonomic, neuroendocrine, and immune manifestations; and adhere to item 7 [below].
1. Fatigue
The patient must have a significant degree of new onset, unexplained, persistent, or recurrent physical and mental fatigue that substantially reduces activity level.
2. Post-Exertional Malaise and/or Fatigue
An inappropriate loss of physical and mental stamina, rapid muscular and cognitive fatigability, post-exertional malaise and/or fatigue and/or pain and a tendency for other symptoms to worsen. The recovery period is pathologically slow -- usually 24 hours or longer.
3. Sleep Dysfunction
Unrefreshing sleep or sleep quality, or rhythm disturbances such as reversed or chaotic sleep rhythms.
4. Pain
A significant degree of pain, which can be in the muscles and/or joints, and is often widespread and migratory. Often, there are headaches of a new type, pattern or severity.
5. Two or more of the following neurological/cognitive manifestations:
Confusion
Impairment of concentration and short-term memory consolidation
Disorientation
Difficulty with information processing
Categorizing and word retrieval
Perceptual and sensory disturbances (such as spatial instability and disorientation, inability to focus vision)
Ataxia (inability to coordinate muscular movement), muscle weakness or twitching
Cognitive, sensory or emotional overload, which may cause a crash or anxiety
6. At least 1 symptom from two of the following categories:
Autonomic manifestations, including: neurally mediated hypotension, postural orthostatic tachycardia syndrome, delayed postural hypotension, light-headedness, pallor, nausea and irritable bowel syndrome, urinary frequency and bladder dysfunction, palpitations with or without cardiac arrhythmias, exertional dyspnea (difficult or labored breathing)
Neuroendocrine manifestations, including: subnormal body temperature and marked temperature fluctuation, sweating episodes, recurrent feelings of feverishness and cold extremities, intolerance of extreme heat or cold, marked weight change (anorexia or abnormal appetite), loss of adaptability and worsening of symptoms with stress
Immune manifestations, including: tender lymph nodes, recurrent sore throat, recurrent flu-like symptoms, general malaise, or new sensitivities to food, medications and/or chemicals.
7. Illness persists for at least 6 months
Onset is usually distinct but may be gradual. In children, only 3 months is needed for a diagnosis.
The criteria also state that a small number of patients have no pain or sleep dysfunction but fit no other diagnosis. Those people can be diagnosed with ME/CFS if they had an infectious illness at onset.
These criteria are from the Canadian Consensus Document, which also offers objective measures and biomarkers for doctors to follow and recommends treatments.


This is a summary of Fibromyalgia symptoms from the National Fibromyalgia Association

Pain
The pain of fibromyalgia is profound, chronic and widespread. It can migrate to all parts of the body and vary in intensity. FM pain has been described as stabbing and shooting pain and deep muscular aching, throbbing, and twitching. Neurological complaints such as numbness, tingling, and burning are often present and add to the discomfort of the patient. The severity of the pain and stiffness is often worse in the morning. Aggravating factors that affect pain include cold/humid weather, non-restorative sleep, physical and mental fatigue, excessive physical activity, physical inactivity, anxiety and stress.


Fatigue
In today's world many people complain of fatigue; however, the fatigue of FM is much more than being tired after a particularly busy day or after a sleepless night. The fatigue of FM is an all-encompassing exhaustion that can interfere with occupational, personal, social or educational activities. Symptoms include profound exhaustion and poor stamina


Sleep problems
Many fibromyalgia patients have an associated sleep disorder that prevents them from getting deep, restful, restorative sleep. Medical researchers have documented specific and distinctive abnormalities in the Stage 4 deep sleep of FM patients. During sleep, individuals with FM are constantly interrupted by bursts of awake-like brain activity, limiting the amount of time they spend in deep sleep.


Other symptoms/overlapping conditions
Additional symptoms may include: irritable bowel and bladder, headaches and migraines, restless legs syndrome (periodic limb movement disorder), impaired memory and concentration, skin sensitivities and rashes, dry eyes and mouth, anxiety, depression, ringing in the ears, dizziness, vision problems, Raynaud's Syndrome, neurological symptoms, and impaired coordination.


Some websites include more information on circulation problems with FMS. They state that blood flow remains in the abdomen area and does not circulate like it should to the limbs (especially to the hands and feet). There is a name for this, but I cannot find it right now.

The two are so similar, but are also different. Could it be possible they are both caused by the same thing? Why do some doctors lump them together? If they are caused by something different, is it possible to have both illnesses at the same time?

 

[caledonia]

Yes, you can have both. Many of us do.

FM does cause cognitive defects - patients call it "fibro fog" - seems to be a very common symptom, so I don't know what that researcher was thinking.

Very preliminary testing by the WPI (not in a study and a small group) has shown XMRV in FM patients too.

Since nobody knows what causes either CFS or FM (yet), the jury is still out on if they are the same or two different diseases with overlapping symptoms. Maybe with the XMRV research we'll get some definite answers over the next few years - wouldn't that be cool?

 

[Mya Symons]

Since nobody knows what causes either CFS or FM (yet), the jury is still out on if they are the same or two different diseases with overlapping symptoms. Maybe with the XMRV research we'll get some definite answers over the next few years - wouldn't that be cool?

Thanks for the info. Yes! that would be cool.

 

[ukxmrv]

The problem is that you are comparing apples with oranges. Are you sure that there is a Canadian consensus for "chronic fatigue"?

There is a Canadian Guideline for ME/CFS and that contains a criteria.

The National Fibromyalgia Association is just a summary, it is not a criteria for diagnosing Fibromyalgia.

You need to compare a criteria to a criteria. For example the Canadian Guideline for ME/CFS vs the ACOR criteria for Fibromyagia.

It's not unusual for diseases to have symptoms that overlap, that's why you need to be quite specific when comparing them.

 

[*GG*]

Is it Not Possible for a Person with CFS to have Fibromyalgia? Yes.

Is it Not Possible for a Person with Chronic Fatigue to have Fibromyalgia? this question confuses me, double negative? So I deleted the not from the question to try to understand it, and my answer would be yes. So I take it by adding NOT, you are asking if you have been diagnosed with either CFS or FIbro, singularly. And my understanding is that lot of people are only diagnosed with one or the other, althought they are found in both in rather large numbers, perhaps greater than 50%?, so I would say the majority.

I clicked on the Medscape link and it mentions CFS, not CF. For what it's worth.

 

[Mya Symons]

I tried to access the ACR new criteria for fibromyalgia that came out February 2010 on google scholar, but I could not access the full article. I found this: ScienceDaily (June 6, 2010) — The American College of Rheumatology (ACR) is proposing a new set of diagnostic criteria for fibromyalgia that includes common symptoms such as fatigue, sleep disturbances, and cognitive problems, as well as pain.

It is my understanding that what they are saying is that the new criteria includes more then just the pressure points. In that case, the symptoms of CFS and FMS would overlapp.

I have no idea how to go about medical research and finding the most current information. That is why I come here. Because you all know what you are doing. Thank you, though, for the advice on how to compare criteria.

 

[richvank]

I tried to access the ACR new criteria for fibromyalgia that came out February 2010 on google scholar, but I could not access the full article. I found this: ScienceDaily (June 6, 2010) — The American College of Rheumatology (ACR) is proposing a new set of diagnostic criteria for fibromyalgia that includes common symptoms such as fatigue, sleep disturbances, and cognitive problems, as well as pain.

It is my understanding that what they are saying is that the new criteria includes more then just the pressure points. In that case, the symptoms of CFS and FMS would overlapp.

I have no idea how to go about medical research and finding the most current information. That is why I come here. Because you all know what you are doing. Thank you, though, for the advice on how to compare criteria.

Hi, Mya and the group.

I have read a copy of the ACR's new "preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity." I didn't see CFS mentioned anywhere in the 11-page document. No attempt was made to distinguish between CFS and FM. As you noted, Mya, these new criteria overlap extensively with the diagnostic criteria for CFS and ME/CFS in the Fukuda et al. document and in the Canadian consensus document, respectively. These documents were not referenced in the paper on the new ACR diagnostic criteria for FM.

Another interesting point is that these new diagnostic criteria were tested against a set of patients that certain rheumatologists had diagnosed as having FM, and a set of control patients who had other rheumatalogical pain-causing disorders. The set of patients deemed to have FM could have been diagnosed by the previous ACR criteria (the tender point count) or they could have just been diagnosed on the basis of symptoms, as judged by the rheumatologists. So it seems that these criteria were developed to help sort between FM and other painful disorders, primarily, and CFS was ignored in the process.

I think it's very possible, and perhaps likely, that the new FM diagnostic criteria will cause physicians to diagnose more people with FM than the old ones did.

It's interesting to note that the development of these new criteria was funded by Lilly, though it was stated in the paper that Lilly was not involved in the details of the development of the criteria.
It was also noted in the paper that of the ten authors, five have been paid fees or honoraria by Lilly, and some of the others have received them from other drug companies.
As you may know, Lilly is the producer of the drug Cymbalta, which is prescribed for fibromyalgia.

Best regards,

Rich

 

[caledonia]

My brother who has the exact same symptoms as me (diagnosed with CFS), and who has no pain or tender points (me neither), went to a rheumatologist and got diagnosed with FM.

So to me it seems it almost depends on which doctor you go to and which color lens they're looking through.

 

[Victoria]

It is said by many internet sites, books & Dr's, that FM & CFS overlap about 85%. Apparently FM is dominated more by pain & CFS is dominated more by fatigue. I don't think it is quite so simple, but I have been formally diagnosed with FM in 2006. My Dr conceded last year that it's highly probable that I do have CFS as well.

Going by all the member's stories since I joined PR in July 2009, I definitely have or had, nearly all the CFS symptoms - I just didn't know over the years that my health & brain issues were symptoms.

Now ME (to me) is a different thing.

Depends what country you live in. Some countries call it ME, some CFS, some CFIDS, some FM. Various sources seem to suggest that CFS & FM are one & the same thing - not so. I always though ME, CFS & FM referred to 3 different "diseases". Actually CFS & FM are syndromes. They have multiple symptoms.

i'm sorry I don't know enough about ME to talk about that.

I have to refer back to my old health diary from 2004,5 & 6 to remember how bad I really was in those days.

For Fibromyalgia, I think the concensus is that apart from all the shared symptoms, FM sufferers need to have pain in at least 11 of 18 tender points all over their body, for over 3 months. They must have pain in each quadrant ie both left & right sides of the body, & both upper & lower parts of the body (for over 3 months).

Having said that (which was what I read back when I was first diagnosed in May 2006), I think there's more to the diagnosis than just "x" number of tender points. If tender points were the main symptom, then I have had FM for 30 years (I have been having chiropractic treatment, xrays, scans, physio etc for 30 years _ I thought I had a bad back...............and hips, and shoulders, and neck, and headaches, and elbow pain, and knee pain. and so on. I thought I was a weak, feeble, wimp. I was always tired, then always exhausted. I never really slept. and so on down the years with symptom after symptom appearing & disappearing for brief, & not so brief periods. I've had MCS for many years - I just never heard the term MCS until last year. There were days when I could barely move - which I put down to food intolerances).

But people can definitely have both FM and CFS. And I'm sure there are many people like me, who never knew they were chronically ill. Maybe like me, they just knew they were never 100% healthy & always in pain!

And I can assure you that all those nights back in 2003/4/5 when I lay in bed nearly all night in excruciating pain wishing I was dead, were NOT simple fatigue from lack of sleep. I sometimes had bruises & marks where I'd dug my fingernails in so deep to try & stop the pain. Many times I ended up in the local hospital emergency dept).

I agree with Caledonia, it also depends on which doctor you go to & which colour lens they're looking through.

PS I might add that I was brought up in a family where, when you hurt yourself you got no sympathy, you didn't go the doctor & you had to just grin & bare it, & get on with your day.

No one ever believed me, so in the end I just assumed I was a wimp & didn't dare complain. I just put up with the pain & symptoms & tried to keep working to pay the rent.

 

[taniaaust1]

A world famous CFS expert once said that he viewed FM and CFS as the same things... for the following reasons. One quarter of his FM patients.. would end up getting CFS/ME.... and 75% of his CFS/ME patients, also had FM. These overlap so strongly.

i personally think the two of them do need to be separated and placed separate.. for the sake of studies etc.

Also i have personally found (many times over) that FM patients, often do not at all understand the greater amount of malise or fatigue CFS/ME patients get. Many of them can exercise fine so think those with CFS/ME can. (i ran into this issue with my nanna who has FM that it wrecked the relationship we had before, nowdays i dont see her at all.... she used to tell me to go out for a walk and i'd be fine!! which was soo not true). CFS/ME patients can be as in extreme pain thou as FM ones sometimes are (ive heard it said that those with CFS have less pain then those with fibro.. this is so not true!...

 

[Victoria]

Also i have personally found (many times over) that FM patients, often do not at all understand the greater amount of malise or fatigue CFS/ME patients get. Many of them can exercise fine so think those with CFS/ME can.

I'm sorry that you've found that some FM patients do not understand the severe malise or fatigue. As an FM suffererer who has had debilitating exhaustion for many years (not now, I might add), I can assure you I understand it well.

I remember the days of not being able to move or go to work due to severe fatigue, including not being able to get out of bed to phone my Boss to say I would not be in (again) - it's a situation I hope I never encounter again.

You certainly have my sympathy.

I feel blessed every day in the last 4-5 months (in being able to get a life back again after all these years).

I am so lucky.

 

[Mya Symons]

Hi, Mya and the group.

Another interesting point is that these new diagnostic criteria were tested against a set of patients that certain rheumatologists had diagnosed as having FM, and a set of control patients who had other rheumatalogical pain-causing disorders. The set of patients deemed to have FM could have been diagnosed by the previous ACR criteria (the tender point count) or they could have just been diagnosed on the basis of symptoms, as judged by the rheumatologists. So it seems that these criteria were developed to help sort between FM and other painful disorders, primarily, and CFS was ignored in the process.

I think it's very possible, and perhaps likely, that the new FM diagnostic criteria will cause physicians to diagnose more people with FM than the old ones did.

Rich

I wonder if this will lead to many people being misdiagnosed with Fibromyalgia? One the one hand, I am very grateful to the drug companies. I waited 6 years to be diagnosed and I think if it weren't for Lyrica being approved by the FDA for FMS, I would still be waiting. On the other hand they lobby goverment agencies to do things like this to make more of a profit, which is upsetting.

 

[Mya Symons]

A
Also i have personally found (many times over) that FM patients, often do not at all understand the greater amount of malise or fatigue CFS/ME patients get. Many of them can exercise fine so think those with CFS/ME can. (i ran into this issue with my nanna who has FM that it wrecked the relationship we had before, nowdays i dont see her at all.... she used to tell me to go out for a walk and i'd be fine!! which was soo not true). CFS/ME patients can be as in extreme pain thou as FM ones sometimes are (ive heard it said that those with CFS have less pain then those with fibro.. this is so not true!...

I am going to agree with you on this Tania. In my case it seemed that the fatigue part went into remission for several years and I was left with the Fibromyalgia. I thought there was nothing worse than the pain. How quickly I forgot. The fatigue part has come back. I've got good medication and I've learned to live with the pain. However, I don't think I will ever get used to living completely drained all the time. It takes away so much of a person's life.

 

[Victoria]

I agree with you Mya, that it does take away much of one's life - out of the last 30 years of pain & chronic illness, I really feel that I completely lost the last 5 years (up to mid Feb this year) in particular, but now that I'm so much better & can get out & about, I urge you to NOT give up hope.

In fact, I urge everyone not to give up hope.

HOPE is what kept me going through the "dark" years - even though it lapsed from time to time & I contemplated suicide, I eventually picked up & feel as though I'm now through the worst.

Never, ever give up HOPE.

 

[August59]

Diagnosed with both / Had flares of both at same time

Had both of them flare at same time and was in so much pain, but could barely re-situate myself in efforts to relieve pain. I was taking Fentanyl patch 100 mcg, 60 mg oxycodone, Lyrica and Cymbalta and was still hurting bad.
I don't take fentanyl, lyrica or cymbalta anymore. I'm down to 30mg of oxycodone a day, but will probably reduce again soon on my way to "0" (I hope)!

 

[ixchelkali]

Fibromyalgia does not cause cognitive defects, so it is readily differentiated from CFS

That's just a bizarre statement. I can see why it confused you. It is in direct opposition to the information from the American College of Rheumatology, who developed the diagnostic criteria for fibromyalgia, and from the National Fibromyalgia Association. Where do they come up with this nonsense? It's so much a part of the disease that it's called "fibro fog."

I've been diagnosed with both. For me, the ME/CFS symptoms are more limiting that the fibro pain (although that not fun, either).

 

[*GG*]

Had both of them flare at same time and was in so much pain, but could barely re-situate myself in efforts to relieve pain. I was taking Fentanyl patch 100 mcg, 60 mg oxycodone, Lyrica and Cymbalta and was still hurting bad.

I don't take fentanyl, lyrica or cymbalta anymore. I'm down to 30mg of oxycodone a day, but will probably reduce again soon on my way to "0" (I hope)!

Wow, were you taking all these pain killers at the same time? I was on Oxycodone (exteme pain only) and then went to Fentanyl 25 to 50, I still had a major flare up! I was waking up every hour with massive pain in my shoulder that I was sleeping on so I would toss and turn every hour that I tried to sleep. So I kicked the heavy duty pain killers altogether! I think I even quit OTC pain meds, so I went into another Flare up for months! That's when I heard from a Dr that you need to keep your pain in check, otherwise you go into a Flare up! Wish I had heard that before!!

I went to my Dr in really bad shape, not the one who prescribed the meds, that was a Neurologist, He asked me what I was going to do with the rest of my life or something to that effect? I knew the pain meds were not working! It really made me think! He is my good CFIDS/FIbro doctor that I have been seeing for about 2 years now. I have been ill for over 7 years now. Just thought I would share some of my experience.

 

[Tammie]

"The author states that Fibromyalgia does not cause cognitive defects, so it is readily differentiated from CFS. Furthermore, patients with CFS do not have trigger points, which are characteristic of fibromyalgia."

not only is the cognitive part totally wrong as you and others pointed out, but people with fibro do not have TRIGGER points; they have TENDER points.....they are different - trigger points are the major muscle knots that re a part of myofacial pain syndrome and tender points are the fibro type of pain

personally I believe that fibro and ME are two very distinct illnesses, though a lot of people seem to get both.....fibro does not have the immune involvement, among other things that ME does

 

[Misfit Toy]

I developed CFS first, then 12 years into that I developed FM. They are not one in the same but I believe the culprit is. I developed Interstitial Cystitis as the years went on too. I know these are all related. Many with CFS have the triad of ailments.

 

[Carrigon]

I got Fibro first around 1985 or 86. I was still able to do things part time and to workout up until I caught CFIDS in 1991. But I was very sick for the first year or so of Fibro. And then it went into a quasi remission where I could function part time. Then I was hit with CFIDS. So, I always thought they were two different entities or two different immune system hits. First you get one, then the other completely disables you.