Fibroymyalgia, Chronic Fatigue Syndrome and Multiple Chemical Sensitivities

Fibromyalgia means that a previously healthy person develops unexplained exhaustion, fatigue and muscle aches and pains that last for more than six months, all blood tests are normal and doctors can't find a cause (1). One report shows that a large number of people who were diagnosed as having fibromyalgia really had polymyalgia rheumatica that does have an abnormal blood test (2).

Another study shows that many sufferers have low spinal fluid levels of vitamin B12 and can be treated with 1000 mcg oils of B12 each day (13). The diagnosis of fibromyalgia should be made only after all other causes have been ruled out. The concept of trigger points is nonsense (26). Many infections can cause fatigue and muscle pain, such as parvovirus B19, which was reported to be cured with intravenous injections of immunoglobulin (3). The evaluation should include tests for infectious diseases; such as Lyme disease and hepatitis B or C, cytomegalovirus, toxoplasmosis or the helicobacter that causes stomach ulcers;/ autoimmune diseases, such as rheumatoid arthritis, lupus, Crohn's disease or ulcerative colitis;/ hidden cancers such as those of the breast or prostate; hormonal diseases such as low thyroid/ or side effects from a medication or illicit drug. Around 20% will be depressed, and most people miss work and complain of illness long before their diagnosis (20), but the majority will not have a known cause (4) and doctors often diagnose fibromyalgia, chronic fatigue syndrome or multiple chemical sensitivities (5).

Chronic fatigue means that they are tired, but most also have constipation and diarrhea (6,7). Fibromyalgia usually means that muscle and joint pains are major symptoms, but muscle biopsies are normal (8,23,24,25), pressure points are not reproducible (22) and ultrasound is normal (26). Multiple chemical sensitivities means that the patients think that their symptoms are caused by factors in their environment or they consult doctors who think the same thing. These diagnoses mean that untreated, these symptoms will usually continue in adults for the rest of their lives (9,10,11).

A study in the New England Journal of Medicine announced that three months of antibiotics are not effective in curing people who have had Lyme disease and still suffer from muscle and joint pain, chronic fatigue, difficulty concentrating and many other vague and sundry signs and symptoms (28).

These studies show that there is no dependable way to define chronic fatigue syndrome or fibromyalgia. The authors did not treat Lyme disease, they treated a large group of people who suffered from what doctors call fibromyalgia or chronic fatigue syndrome. They treated 79 people with positive blood tests for Lyme disease and 51 who did not have positive blood test for Lyme disease. They showed that treating people with chronic fatigue syndrome or fibromyalgia for three months with antibiotics will not cure them.

Three months is not long enough to treat a person with reactive arthritis from any source. However, before a doctor is allowed to diagnose chronic fatigue syndrome or fibromyalgia or Lyme disease, he must rule out other diseases that can cause the same symptoms. There is little question that patients with hepatitis C can be treated successfully with interferon injections and that people with reactive arthritis can be treated successfully with antibiotics. However, people who have terrible fatigue and muscle and joint pain often cannot be cured by antibiotics.

Reactive arthritis patients who may be be cured by antibiotics are:

* Those who have positive blood tests for arthritis which are really measures of an overactive immunity that is trying to kill a germ,

* those who suffer from a chronic infection characterized by burning on urination, urgency or having to get up many times during the night

* those who have chronic diarrhea,

* those who have belching and burning in the stomach,

* those who have a chronic cough or sinus infections,

* those who have swelling in the middle of the hand which is characteristic of Rheumatoid arthritis.

The authors showed that three months of antibiotics does not cure fibromyalgia, chronic fatigue syndrome or presumed Lyme disease. However, people who have reactive arthritis must be treated for longer than three months, often for more than a year. We still do not know what chronic fatigue syndrome or fibromyalgia really are.

An article from the University of Washington, Seattle demonstrates that fibromyalgia, chronic fatigue syndrome, temporomandibular joint syndrome, irritable bowel syndrome, interstitial cystitis and chronic headaches share the same symptoms, occur in the same people and doctors can't find a cause or treatment (27). I have prescribed doxycycline 100 mg twice a day for several months, and sometimes azithromycin 500 mg twice a week, and some get better. However, this treatment is controversial and is not accepted by most doctors. Please check with your doctor. See also report #G144.

1) S Wessely. Chronic fatigue syndrome. Journal of the Royal College of Physicians of London. 30: 6 (NOV-DEC 1996):497-504.

2) MA Fitzcharles, JM Esdaile. The overdiagnosis of fibromyalgia syndrome. American Journal of Medicine 103: 1 (JUL 1997):44-50.

3) SK Jacobson, JS Daly, GM Thorne, K Mcintosh. Chronic parvovirus B19 infection resulting in chronic fatigue syndrome: Case history and review. Clinical Infectious Diseases 24: 6 (JUN 1997):1048-1051. Address SK Jacobson, Addenbrookes Hosp, Clin Microbiol & Publ Hlth Lab, Hills Rd, Cambridge CB2 2QQ, England.

4) AC Mawle, R Nisenbaum, JG Dobbins, HE Gary, JA Stewart,M Reyes, L Steele, DS Schmid, WC Reeves. Seroepidemiology of chronic fatigue syndrome: A case-control study. Clinical Infectious Diseases 21: 6 (DEC 1995):1386-1389. None found.

5) D Buchwald. Fibromyalgia and chronic fatigue syndrome: Similarities and differences. Rheumatic Disease Clinics of North America 22: 2:(MAY 1996):219. There are no diagnostic studies or widely accepted pathogenic,explanatory models for either illness.

6) A Sivri, A Cindas, F Dincer, B Sivri. Bowel dysfunction and irritable bowel syndrome in fibromyalgia patients. Clinical Rheumatology 15: 3 (MAY 1996):283-286.

7) JE Gomborone, DA Gorard, PA Dewsnap, GW Libby, MJG Farthing. Prevalence of irritable bowel syndrome in chronic fatigue. Journal of the Royal College of Physicians of London. 30: 6 (NOV-DEC 1996):512-513.

8) RW Simms. Is there muscle pathology in fibromyalgia syndrome? Rheumatic Disease Clinics of North America 22: 2(MAY 1996):245. muscles are not abnormal in the condition.

9) Bombardier CH, Buchwald D. Outcome and prognosis of patients with chronic fatigue vs chronic fatigue syndrome. Arch Intern Med 1995(Oct);155:2105-2110.

10) W Bruckle, J Lautenschlager. Treatment of Fibromyalgia Syndrome. Aktuelle Rheumatologie 20: 1 (JAN 1995):13-19.

11) O Miro, C Font, J Fernandezsola, J Casademont, E Pedrol, JM Grau, A Urbanomarquez. Chronic fatigue syndrome: Clinical and evolutive study of 28 cases. Medicina Clinica 108: 15 (APR 19 1997):561-565. 12) 200/100,000. PH Levine. Epidemiologic advances in chronic fatigue syndrome. Journal of Psychiatric Research 31: 1 (JAN-FEB 1997):7-18.

12) DJ Clauw, M Schmidt, D Radulovic, A Singer, P Katz, J Bresette. The relationship between fibromyalgia and interstitial cystitis. Journal of Psychiatric Research 31: 1 (JAN-FEB 1997):125-131.

13) similar complaints. B. Andersson, M Abrahamsson, L BaJ Dyrehag, L.E.; Gottfries, C.G. Increased concentrations of homocysteine in the cerebrospinal fluid in patients with fibromyalgia and chronic fatigue syndrome. Scandinavian Journal of Rheumatology. 1997;26(4):301-307. B Regland/Cent Hosp Molndal/Dept Psychiat/S-43180 Molndal, Sweden. We conclude that increased homocysteine levels in the central nervous system characterize patients fulfilling the criteria for both fibromyalgia and chronic fatigue syndrome.

14) E Shorter. Multiple chemical sensitivity: pseudodisease in historical perspective. Scandinavian Journal of Work Environment & Health. 23: Suppl. 3 (1997):35-42.

15) F Levy. Clinical features of multiple chemical sensitivity. Scandinavian Journal of Work Environment & Health. 23: Suppl. 3 (1997):69-73.

16) MH Vatn. Food intolerance and psychosomatic experience. Scandinavian Journal of Work Environment & Health. 23:Suppl. 3 (1997):75-78.

17)U Janlert. Unemployment as a disease and diseases of the unemployed. Scandinavian Journal of Work Environment & Health. 23: Suppl. 3 (1997):79-83.

18)L Getz. Clinical concepts and dilemmas between disease and adverse life events. Scandinavian Journal of Work Environment & Health. 23: Suppl. 3 (1997):91-96.

19) BB Arnetz. Technological stress: psychophysiological aspects of working with modern information technology. Scandinavian Journal of Work Environment & Health. 23: Suppl. 3 (1997):97-103.

20) GJ Hall, WT Hamilton, AP Round. Increased illness experience preceding chronic fatigue syndrome: a case control study. Journal of the Royal College of Physicians of London. 32: 1 (JAN-FEB 1998):44-48.

21) J Press, M Phillip, L Neumann, R Barak, Y Segev, M Abushakra, D Buskila. Normal melatonin levels in patients with fibromyalgia syndrome. Journal of Rheumatology 25: 3(MAR 1998):551-555.

22) JWG Jacobs, R Geenen, A Vanderheide, JJ Rasker, JWJ Bijlsma. Are tender point scores assessed by manual palpation in fibromyalgia reliable? An investigation into the variance of tender point scores. Scandinavian Journal of Rheumatology 24: 4 (1995):243-247.

23) RW Simms. Fibromyalgia is not a muscle disorder. American Journal of the Medical Sciences 315: 6(JUN 1998):346-350.

24) NJ Olsen, JH Park. Skeletal muscle abnormalities in patients with fibromyalgia. American Journal of the Medical Sciences 315: 6(JUN 1998):351-358.

25) LJ Crofford. Neuroendocrine abnormalities in fibromyalgia and related disorders. American Journal of the Medical Sciences 315: 6(JUN 1998):359-366.

26) J Lewis, P Tehan. A blinded pilot study investigating the use of diagnostic ultrasound for detecting active myofascial trigger points. Pain 79: 1 (JAN 1999):39-44.

27) Aaron L et al. Overlapping conditions among patients with chronic fatigue syndrome, fibromyalgia and temporomandibular disorder. Archives of Internal Medicine 2000(Jan 24);160:221-227

28) NEJM, July 12, 2001