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The Fibromyalgia Diagnosis

Expect Lots of Testing

By , About.com Guide

Updated March 16, 2011

It’s often difficult to distinguish between fibromyalgia and chronic fatigue syndrome. Are they unrelated, siblings or twins? Researchers and specialists are still trying to determine the answer to this question. Some experts believe they are two completely separate illnesses; others think they are two distinct disorders with many similar symptoms; still others feel they are different facets of the same disorder.

To complicate matters, a significant number of people with FM also have CFS and vise versa. In a September 2002 article in Fibromyalgia AWARE, a publication of the National Fibromyalgia Association, Charles W. Lapp, MD, CFS/FM expert and researcher, states that “about 70 percent of persons with CFS meet criteria for FM and about 70 percent of persons with FM also meet criteria for CFS.”
Central Sensitivity Syndromes:Muhammad B. Yunus, MD, a pioneer FM researcher, believes that there is a large group of illnesses with overlapping features that he calls “Central Sensitivity Syndromes.” What they all have in common is a sensitization of the central nervous system. Under this broad CSS category, he lists disorders such as FM, CFS, migraines, irritable bowel syndrome, TMJ, multiple chemical sensitivities, restless legs syndrome, myofascial pain syndrome, and others. All of these illnesses have some symptoms that overlap one another.
FM and CFS Similarities:Fibromyalgia and chronic fatigue syndrome share many of the same symptoms, such as: muscle and/or joint pain, debilitating fatigue, headaches, memory loss, difficulty with concentration, forgetfulness, depression, numbness and generalized weakness. Other clinical similarities include:
  • Reduced blood flow in the cerebral cortex and midbrain
  • Suppression of the hypothalamic pituitary axis
  • Disturbed Stage 4 sleep
  • Reduced levels of growth hormone
  • Lower than normal serotonin levels
  • Evidence of a genetic component
FM and CFS Differences:The simplest explanation of the difference between FM and CFS is that with FM, pain is the most predominant symptom, while with CFS, extreme fatigue with is most predominant.
Additional distinct differences include:
  • Substance P (a neurotransmitter that transmits pain signals) is elevated in FM but not CFS.
  • RNaseL (a cellular antiviral enzyme) is frequently elevated in CFS but not in FM.
  • Often CFS will be triggered by a flu-like or infectious illness, while FM is more often triggered by some kind of trauma to the body (i.e., accident, injury, surgery, etc.).
How Is a Diagnosis Determined?:Because the two illnesses are so similar, frequently the diagnosis you receive will depend upon the doctor you see. A rheumatologist is more likely to give you a fibromyalgia diagnosis, whereas if you consult an infectious disease specialist, you’ll be more apt to receive a diagnosis of chronic fatigue syndrome. If your doctor is a general practitioner or a family practice physician, your diagnosis may depend on which illness they are more familiar with.

Sources: 
Lapp, Charles. “Chronic Fatigue Syndrome vs. Fibromyalgia.” Fibromyalgia AWARE. September-December 2002: 72-73.
Yunus, Muhammad. “Central Sensitivity Syndromes: The Concept for Unifying.” Fibromyalgia AWARE. May-August 2002: 41-45.

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Anemia and Fibromyalgia

Many fibromyalgia patients suffer from other illnesses that appear alongside their fibromyalgia. These conditions can often worsen the symptoms of fibromyalgia syndrome and make daily responsibilities much more difficult to complete. If you have been feeling particularly exhausted lately, it is possible that fibromyalgia isn’t the only culprit behind your fatigue. Many fibromyalgia patients also suffer from anemia, a blood disorder that can cause extreme fatigue and a variety of other complications.

What is Anemia?
Anemia is a very common blood disorder affecting over 3 million men and women in the United States. It occurs when you don’t have enough healthy red blood cells in your bloodstream. Everyone’s blood is comprised of three types of cells: red blood cells, white blood cells, and platelets. Red blood cells help to carry oxygen from your lungs to various parts of your body. It is your red blood cells that give your body the necessary energy to carry out various different biological tasks. Sometimes, people stop producing enough red blood cells, leaving them tired and weak.

What are the Causes of Anemia?
There are many different types of anemia, and each is thought to be caused by a different factor. Some common causes of anemia include:

  • iron deficiency (due to poor diet or blood loss)
  • vitamin deficiency (due to poor diet)
  • chronic disease (including cancer, HIV/AIDS, and kidney disease)
  • genetic disorders (like sickle cell anemia)
  • certain medications (including certain anti-cancer agents)

Who Gets Anemia?
Because there are so many types of anemia, many different people suffer from the illness. Anemia affects men, women, and children from all cultures. Certain people are at increased risk of developing anemia. Risk factors include:

  • being female (1 in 5 women develop iron deficiency anemia)
  • having heavy menstrual periods
  • having a poor diet
  • being pregnant
  • having a chronic disease
  • having an intestinal disease
  • having a family history of anemia

What are the Symptoms of Anemia?
The signs of anemia tend to creep up slowly on most sufferers. Symptoms begin mildly before developing into more persistent problems. For this reason, many people suffering from anemia are never diagnosed or treated for the condition. The most common signs and symptoms of anemia are:

  • fatigue
  • weakness
  • shortness of breath
  • dizziness or fainting
  • loss of concentration
  • feeling cold
  • pale skin
  • depression

Do You Have Anemia and Fibromyalgia?
Many patients suffering from fibromyalgia also have concurrent anemia. Because anemia symptoms, like fatigue and loss of concentration, are also found in fibromyalgia syndrome, many patients are not diagnosed with anemia when they need to be. If you are suffering from extreme fatigue, it is a good idea to get tested for anemia. Anemia will only complicate your fibromyalgia symptoms and make life even more difficult.

Diagnosing Anemia
If you are experiencing severe fatigue or other anemia symptoms, it is important that you get diagnosed. Anemia is very common and can be discovered through a simple blood test. A sample of your blood will be taken and then sent to a laboratory for testing. Your health care provider will measure the amount of red blood cells in your sample, and use this to determine whether or not you have anemia.

Complications of Anemia
Anemia is a condition that should not be left untreated. If it is allowed to progress for a long period of time, anemia can become quite dangerous to your health. Anemia can result in the development of an irregular or rapid heartbeat (tachycardia) or an enlarged heart muscle (left ventricular hypertrophy). These conditions can increase your risk for heart disease or stroke. Anemia can also leave you feeling terribly exhausted, making it difficult to enjoy work, school, or social events.

Treating Anemia
Anemia treatment is based upon the cause of your particular type of anemia. Most anemias can be managed through careful medication or dietary supplementation. Commonly, vitamin injections or iron supplements are enough to rectify the blood disorder. Other anemias, like sickle cell anemia, have no cure and can cause serious physical damage. Speak with your health care provider about the treatment that is best suited for you.

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What’s Going On? A Simple Explanation of Fibromyalgia. Making Sense of a Complex Disorder, for Those Who Don’t Have It

By Adrienne Dellwo, About.com Guide  Updated September 22, 2009

Fibromyalgia is a complex condition that’s difficult to understand, especially if you don’t have a medical degree. Because it involves the brain and nervous system, fibromyalgia can have an impact on virtually every part of the body.

If you’re trying to understand this condition in someone you know, it can be incredibly confusing. When a lot of people see a bizarre collection of fluctuating symptoms that don’t show up in medical tests, they decide fibromyalgia must be a psychological problem. A host of scientific evidence, however, proves that it’s a very real physical condition.

Digging through that scientific research doesn’t help most of us, though. Terms like neurotransmitter dysregulation, nociceptors, cellular enzymes and opiate pathways aren’t exactly easy to grasp.

The goal of this article is to help you understand and relate to what’s going on in the body of someone with fibromyalgia, in plain terms and without medical jargon. At the end of each section, you’ll find relevant medical terms with links to definitions. They’ll be helpful if you want to go beyond a basic understanding, but you don’t need to understand the terms to get through this article.

Understanding the Pain of Fibromyalgia

Imagine you’re planning a party and expecting about 20 guests. Three or four friends told you they’d come early to help you out. But they don’t show, and instead of 20 guests, you get 100. You’re overwhelmed.

That’s what’s happening with pain signals in someone who has fibromyalgia. The cells send too many pain messages (party guests), up to five times as many as in a healthy person. That can turn mild pressure or even an itch into pain.

When those pain signals reach the brain, they’re processed by something called serotonin. People with fibromyalgia, however, don’t have enough serotonin (the friends who didn’t show up to help), leaving the brain overwhelmed.

This is why people with fibromyalgia have pain in tissues that show no sign of damage. It’s not imagined pain; it’s misinterpreted sensation that the brain turns into very real pain.

Other substances in the patient’s brain amplify signals — essentially, “turning up the volume” of everything. That can include light, noise and odor on top of pain, and it can overload the brain. This can lead to confusion, fear, anxiety and panic attacks.

Understanding the Ups & Downs of Fibromyalgia

Most people with a chronic illness are always sick. The effects on the body of cancer, a virus, or a degenerative disease are fairly constant. It’s understandably confusing to see someone with fibromyalgia be unable to do something on Monday, yet perfectly capable of it on Wednesday.

Look at it this way: Everyone’s hormones fluctuate, and even things like weight and blood pressure can rise and fall during the course of a day, week or month. All of the systems and substances in the body work that way, rising and falling in response to different situations.

Research shows conclusively that fibromyalgia involves abnormal levels of multiple hormones and other substances. Because those things all go up and down, sometimes one or more are in the normal zone and other times they’re not. The more things that are out of the zone, the worse they’ll feel.

Understanding Stress & Fibromyalgia

Some people think FM patients are emotionally incapable of dealing with stress, because a stressful situation will generally make symptoms worse.

The important thing to understand is that we respond to stress both emotionally and physically. A physical response, in everyone, includes a rush of adrenaline and other hormones that help kick your body into overdrive so you can deal with what’s happening.

People with fibromyalgia don’t have enough of those hormones, which makes stress very hard on their bodies and can trigger symptoms.

Also, when we talk about “stress” we usually mean the emotional kind, which can come from your job, a busy schedule, or personal conflict. A lot of things actually cause physical stress, such as illness, lack of sleep, nutritional deficiencies and injuries. Physical stress can have the same effect as emotional stress.

Understanding the Fatigue of Fibromyalgia

Think of a time when you were not just tired, but really exhausted. Maybe you were up all night studying for a test. Maybe you were up multiple times to feed a baby or take care of a sick child. Maybe it was the flu or strep throat.

Imagine being exhausted like that all day while you’re trying to work, take care of kids, clean the house, cook dinner, etc. For most people, one or two good night’s sleep would take that feeling away.

With fibromyalgia, though, comes sleep disorders that make a good night’s sleep a rarity. A person with fibromyalgia can have anywhere from one to all of the following sleep disorders:

Fibromyalgia In a Nutshell

A lot of illnesses involve one part of the body, or one system. Fibromyalgia, however, involves the entire body and throws all kinds of things out of whack. As bizarre and confusing as the varied symptoms may be, they’re tied to very real physical causes.

Fibromyalgia can take someone who is educated, ambitious, hardworking and tireless, and rob them of their ability to work, clean house, exercise, think clearly and ever feel awake or healthy.

  • It’s NOT psychological “burn out” or depression.
  • It’s NOT laziness.
  • It’s NOT whining or malingering.
  • It IS the result of widespread dysfunction in the body and the brain that’s hard to understand, difficult to treat, and, so far, impossible to cure.

The hardest thing for patients, however, is having to live with it. Having the support and understanding of people in their lives can make it a lot easier.

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