ME-CFS compared to FM

 A simple way of comparing the reality of two illnesses is that with ME-CFS, fatigue is the primary symptom, and with FM, pain is the primary symptom. Other than this difference in what is the main symptom, symptoms tend to be the same (although they do of course vary from patient to patient). Many people will argue that the two illnesses are very different and part of their argument is often that while ME is classified by the WHO as a “Disease of the “Nervous system. Other disorders of brain”¹, FM is classified as an “Other soft tissue disorders, not elsewhere classified. Rheumatism, unspecified.”^{1 2} However, this is out of date, because:

1.       Research in recent years has proved the neurological changes present in Fibromyalgia patients. It is clear that FM is not simply a musculoskeletal or pain disorder, but a disorder of some kind of the central nervous system^{3 4 5}. It isn’t a condition in the joints or connective tissue, therefore it is not a rheumatological condition at all.

2.       The WHO considers ME to be benign Myalgic Encephalomyelitis¹, the original meaning of ME and a condition with definite inflammation in the brain or spinal cord, following a viral infection, that can occur in epidemics. ME is now more often used to stand for Myalgic Encephalopathy, the inference to inflammation having been taken out when it became clear that many people suffering from ME do not have any sign of this inflammation, whether or not they may have possibly had inflammation at one time.^{6 7 8}

FM and CFS (now known as ME-CFS) are considered by some experts to both be types of Central Sensitivity Syndromes³⁴. Although it is ME that is officially known as a neurological disease, there has been more research done into the actual neurological changes in people with FM, not ME, especially in recent years. It has been found that people with FM have:

·         accelerated Grey Brain Matter loss.^9.

·         reduced levels of biogenic amines^{4 5}, including serotonin, norepinephrine and dopamine⁷.

·         increased concentrations of excitatory neurotransmitters, including substance P, the chemical which transmits pain signals.^{4 13 14}

·         dysregulation of the hypothalamic-pituitary-adrenal axis.^{4 5}

·         abnormal blood flow within the brain.^{11 12}

·         and that there is a subset of people with Fibromyalgia who have a growth hormone deficiency. ^{5 15}

Although the causes of FM and ME/CFS may be different, certainly between subsets of the illnesses, how they present in patients is very similar. When you compare lists of symptoms for both illnesses, the similarities are obvious.

ME-CFS symptoms include ¹⁶:

·         Fatigue.

·         Pain, including flu-like aching and nerve pain.

·         Sleep disturbances, including non-restorative, unrefreshing sleep, insomnia, sleep reversal and hypersomnia.

·         Cognitive difficulties, including reduced attention span, memory problems, trouble with words and speaking, poor concentration and mood changes, including irritability.

·         Irritable Bowel Syndrome.

·         Headaches and migraines.

·         Hypersensitivity to light and sound, among other stimuli.

·         Autonomic dysfunction, which includes many of the symptoms mentioned here, but also includes the “classic” Dysautonomia symptoms of NCS (Neuro-Cardiogenic Syncope – fainting) and POTS (Postural Orthostatic Syndrome – when your heart races when you stand up, among other times).

·         Heart problems.

·         Loss of co-ordination.

·         Allergies and intolerances.

·         Poor temperature regulation, including chills and hot sweats for no reason.

·         Exercise intolerance, including a delayed reaction to overdoing it, muscle weakness and poor stamina, unrelated to fitness levels.

·         Susceptibility to infection, especially viral, and slow recovery from illness or injury.

·         Swollen glands, sore throat and nasal drip.

·         Muscle twitches and tremors.

·         Anxiety and depression.

FM symptoms include ^{17 18}:

·         Pain. This can be joint, muscle or nerve pain. Achiness similar to that you get with flu is a classic symptom. Hypersensitivity to pain stimuli is part of this – what would be merely uncomfortable to a healthy person is agony to a person with FM. Pain levels are also affected by hypersensitivity to other stimuli, such as the weather and noise.

·         Fatigue is present as a major symptom in almost all FM patients.

·         Sleep disturbances – FM patients tend to not get enough deep sleep and so wake feeling unrefreshed. Insomnia can also be a problem.

·         Cognitive difficulties. These include poor memory, brain fog, trouble with words and speaking (asphasia), poor concentration, confusional states and mood changes, including irritability and the tendency to cry easily.

·         Irritable Bowel Syndrome is present in most FM patients. Linked to this is reflux disease.

·         Irritable Bladder.

·         Headaches and migraines.

·         Hypersensitivity to any stimuli, including noise, cold, hot, light and chemicals. Linked with this is sensory overload, when the brain effectively shuts down because of too many sensory stimuli.

·         Autonomic dysfunction, which includes many of the symptoms mentioned here, but also includes the “classic” Dysautonomia symptoms of NCS (Neuro-Cardiogenic Syncope – fainting) and POTS (Postural Orthostatic Syndrome – when your heart races when you stand up among other times).

·         Mitral Valve Prolapse.

·         Loss of co-ordination.

·         Allergies and intolerances.

·         Poor temperature regulation, including chills and hot sweats for no reason. Lower than standard temperature as normal and low-grade fevers are part of this.

·         Exercise intolerance, including a delayed reaction to overdoing it, muscle weakness and poor stamina, unrelated to fitness levels.

·         Susceptibility to infection, especially viral, and slow recovery from illness or injury.

·         Swollen glands, sore throat and nasal drip.

·         Muscle twitches and tremors.

·         Myoclonus.

·         Problems with the menstrual cycle in women.

·         Tinnitus.

·         Anxiety and depression.

References:

1: http://www.who.int/classifications/apps/icd/icd10online/

2: http://www.who.int/classifications/help/icdfaq/en/

3: http://fibroresearch.blogspot.com/2007/03/fibromyalgia-and-concept-of-central.html quoting an article in Seminars in Arthritis and Rheumatism (2007 Mar 10).

4: http://www.fmaware.org/site/News2?page=NewsArticle&id=5690 showing the abstract of ‘Fibromyalgia syndrome: review of clinical presentation, pathogenesis, outcome measures, and treatment.’ from J Rheumatol Suppl. 2005 Aug;75:6-21.

5: http://www.emedicine.com/PMR/topic47.htm  - WebMD/eMedicine article on Fibromyalgia by Regina P Gilliland, MD.

6: http://www.nervecentre.org.uk/Myalgic%20Encephalopathy%20(ME).htm

7: http://www.ncf-net.org/library/goudsmit.html

8: http://www.meassociation.org.uk/

9:  http://fibroresearch.blogspot.com/2007/04/study-finds-greatly-accelerated-brain.html quoting an article in Journal of Neuroscience (2007 Apr 11).

10: Wood, J. Patterson II, J. Sunderland, K. Tainter, M. Glabus, D. Lilien ‘Reduced Presynaptic Dopamine Activity in Fibromyalgia Syndrome Demonstrated With Positron Emission Tomography: A Pilot Study.’ The Journal of Pain, Volume 8, Issue 1, Pages 51-58 P.

11: Kwiatek R, Barnden L, Tedman R, et al. ‘Regional cerebral blood flow in fibromyalgia: single- photon-emission computed tomography evidence of reduction in the pontine tegmentum and thalami. Arthritis Rheum 2000;43:2823-2833.

12: Mountz JM, Bradley LA, Modell JG, et al. ‘Fibromyalgia in women. Abnormalities of regional cerebral blood flow in the thalamus and the caudate nucleus are associated with low pain threshold levels. Arthritis Rheum 1995;38:926-938.

13: Henriksson KG, Mense S. ‘Pain and nociception in fibromyalgia: clinical and neurobiological considerations on aetiology and pathogenesis.’ Pain Rev 1994;1:245-260.

14: Vaeroy H, Helle R, Forre O, et al. ‘Elevated CSF levels of substance P and high incidence of Raynaud phenomenon in patients with fibromyalgia: new features for diagnosis.’ Pain 1988;32:21-26.

15: http://fibroresearch.blogspot.com/2007/02/growth-hormone-deficiency-in.html quoting an article in Growth Hormone IGF Research, 2007 Feb 5.

16: ‘All About ME’ from Action for ME http://www.afme.org.uk/res/img/resources/All%20about%20ME.pdf

 17: ‘Devin’s Diagnostic’ by Devin Starlanyl, adapted from "The Fibromyalgia Advocate" http://www.sover.net/~devstar/phsympt.htm

18: Symptoms of Fibromyalgia as described by the US National Fibromyalgia Association http://www.fmaware.org/site/PageServer?pagename=fibromyalgia#symptoms

"New research indicates that dark or bittersweet chocolate with high cocoa content may be useful as a remedy for chronic fatigue syndrome (CFS). Researchers at the University of Hull, United Kingdom, found that the fatigue symptoms of CFS patients improved significantly after 8 weeks of high cocoa polyphenol rich chocolate."

Woot!  I've always felt that chocolate helps my symptoms and actually made the subject Topic of the Week once on BYDLS. But now there's PROOF!