“Irritable Everything” is the best way to describe FM/CFS (Fibromyalgia/Chronic Fatigue Syndrome). Nothing in their body seems to work properly for people with FM/CFS and everything is annoying. There are pains in so many places that before one pain stops another starts. When I consult new FM/CFS and go over their initial case history questionnaire, it is not uncommon to see 70 or 80 different symptoms.
Since there aren’t any official diagnostic criteria, routine lab tests or x-rays to diagnose FM/CFS, most practitioners use the following criteria.
American College of Rheumatology (1990) Definition for Fibromyalgia
- Chronic, widespread, musculoskeletal pain for longer than three months in all four quadrants of the body. (“Widespread pain” means pain above and below the waist and on both sides of the body).
- Absence of another systemic disease that could be the same cause of the underlying pain (such as rheumatoid arthritis, lupus, or thyroid problems).
- Multiple tender points (of extreme tenderness) at characteristic locations. There are 18 tender points that doctors look for in making the diagnosis of Fibromyalgia. Approximately 4kg of pressure (about nine pounds) must be applied to tender points and the patient must indicate that the point was painful.
- Occiput (at the base of the skull)
- Lower cervicals (neck vertebrae, C5 to C7)
- Trapezius (the muscles that go from shoulder to the base of the neck)
- Supraspinatus (these are the muscles that are just above the shoulder blade)
- Second rib (in front, where the 2nd rib joins the sternum)
- Lateral Epicondyle (this is the outside of the elbow)
- Gluteal (the upper part of the buttox)
- Greater Trochanter (this is the hip region)
- Knees (the inside of the knees)
This definition for Chronic Fatigue was adapted from the Annuls of Internal Medicine (December 1994)
Chronic Fatigue is Defined By the Presence of the Following:
- Clinically evaluated, unexplained, persistent, or relapsing chronic fatigue that is of new or definite onset (has not been lifelong); is not the result of ongoing exertion; is not substantially alleviated by rest; and results in a substantial reduction in previous levels of occupational, educational, social, or personal activities.
- Concurrent occurrence of four or more of the following symptoms, all of which must have persisted or reocurred during six or more consecutive months of illness and must not have predated the fatigue.
- Self-reported impairment in short-term memory or concentration severe enough to cause substantial reduction in previous levels of occupational, educational, social, or personal activities
- Sore throat
- Tender cervical or auxiliary lymph nodes
- Muscle pains (this can include the 18 tender points)
- Multiple joint pains, without swelling or redness
- Headaches of a new type, pattern , or severity
- Unrefreshing sleep
- Post exertional malaise lasting more than 24 hours (feeling of fatigue and indifference)
In analyzing these two definitions it becomes apparent that FM is mainly concerned with pain, and CFS extreme fatigue is the main symptom. It depends on which doctor you go to, which diagnosis you receive. Rheumatologists primarily use Fibromyalgia and General Practitioners and internist’s choose Chronic Fatigue Syndrome. It seems that each syndrome can have the others symptoms. Confusing isn’t it? In my opinion the names can be interchangeable, and besides it’s only a name. The important issue here is what is causing the problems, and how can the causes be corrected. Not so much what it’s called.
Fibromyalgia, Major symptom Classifications
Pain must be present in 11 of the 18 tender points (some authors say there are 24 tender points and others say there are 36). Actually the number of tender points can be even higher than 36, as there are so many areas of the body that are pain sensitive.
Pain Is Rated In the Following Manner:
- Intensity: is rated on a scale from 1 to 10. One being the least painful and 10 being excruciating, or “the worst pain you have ever felt”
- Frequency: is the pain with you all the time? Does it come and go? Is it worse at certain times? Are their periods when there is no pain? Is it worse in the day, or at night? How long have you had the pain?
- Rhythm: Has there been a pattern to the pain? What time of the day does the pain appear? Does the intensity or frequency change?
- Type of pain: There are many adjectives that help to describe the pain. Here are a few of the common ones: sharp, stabbing, burning, ahing, dull, throbbing, piercing, cramping, knife-like and cutting. Other feelings that accompany the pain are: hot and cold sensations, pins and needles, numbness, swelling, bloating, dizziness, light, headaches, heavy feeling, weighted-down, immobile, paralyzed, and paresthesia.
The pain may be triggered by different stimuli. MOst FM/CFS sufferers feel their pain is altered with changes in the weather. Stress can also aggravate the pain. The stresses of environmental poisons, alcohol, cigarettes, drugs, emotional upsets, physical trauma, loud noises, and bright lights can increase in the intensity of the pain.
On the other hand the pain may be relieved by: rest, exercise, movement, heat, cold, chiropractic adjustments, massage, vitamins, herbs, water, holidays, winning lots of money, or some TLC.
Sensitivity to Pain:
When you’re stressed or your immune system is not functioning at its optimum, you’re more susceptible to feeling pain. In FM/CFS patients the nerves have been constantly irritated and are very sensitive to minor environmental changes. The pain can become constant. This constant pain causes you to be more sensitive, which increases the intensity of the pain and decreases your stamina. Thus, we have a vicious circle or loop. By Intense pain weakens you and makes you more susceptible to pain, which in turn increases its intensity and makes you even weaker. By the time you get to bed you’re exhausted from the pain that you have experienced all day. Then you can’t stay asleep because of the sharp pains that keep waking you up.
The next morning you wake up unrefreshed, with an ever-decreasing ability to handle pain and the circle continues. This eventually causes extreme fatigue.
Areas of Pain:
The pain sensitive nerve endings go to every area of the body. They are especially numerous and sensitive on the exterior part of the body. Example: a burn or cut can be detected virtually anywhere on the body.
There are certain areas of the body that are more susceptible to being tender than others. The primary centers of tension are where eight of the tender points are located. Two are at the base of the skull, two are the Trapezius muscles, two at the Supraspinatus muscles, and two more at the buttocks areas. This is because when you’re under stress these muscles contract a protective mechanism. For example, when it is really cold outside you tend to walk with your shoulders held high in an effort to stay warm. Another example is that some people clench their teeth when nervous or under stress. People also hold their stress in the calf area.
Any joint in the body can experience pain from trauma or stress. Some examples are: muscle tears, bruising, ligament strain, misaligned joints, and fractures.
The pain sensitive fibers in the organs are not as abundant as they are on the outside surfaces of the body. If the body is not functioning properly, or if you have ingested anything toxic, the body will let you know very quickly and you will experience pain in the affected area.
Limiting FM to only 18 tender points is rather unrealistic because there are so many potential areas of pain. In my opinion, a more accurate definition could be simplified to read “chronic pain in multiple areas of the body”.
Primary Areas of Dysfunction
The immune system is one of the most significant areas of dysfunction in FM/CFS. Drugs and toxins have bombarded the immune system for years, it becomes exhausted and is no longer able to handle the level of invaders and toxins present. Deterioration becomes chronic, and is perpetuated by more drugs and an even higher level of toxins. When the immune system is constantly under attack, flu like symptoms becomes prevalent. Low-grade fever, chills, sore throat, runny nose, watery eyes, headaches and the accompanying body aches are also present.
The nervous system is the primary system of involvement in almost every condition. If there’s interference to the nervous system, whatever those nerves control, it will not function properly and/or you will feel pain in that area. This will be explained in greater detail in the section on causes.
The digestive system is commonly involved as well. When the ability to digest and metabolize your food is interfered with, a number of different symptoms will arise: bad breath, heartburn, indigestion, hiatus hernia, reflux, gas, bloating, cramping, ulcers, constipation, diarrhea, to some food sensitivities and allergies.
The organs of elimination are affected in many cases. If the liver is not cleansing the blood, as it should, this will show up in the next largest organ of elimination, the skin. This produces symptoms of rashes, blemishes, and other dermatological symptoms. When the liver is not eliminating properly the amount of toxins in the body it becomes a contributing factor. One’s level of health is affected greatly by the amount of toxins consumed related to the ability of the body to eliminate or neutralize them.
Therefore, if the liver is sluggish, the amount of toxins still circulating in the body would be higher. If the level of toxins consumed remains high, the whole body becomes toxic. Every person with FM/CFS is toxic and must be cleaned out and the amount of toxins consumed must be decreased drastically.
The kidney, urinary tract and genitals are sometimes involved with such symptoms as; recurrent bladder, kidney, and vaginal infections, frequency, urgency, jock itch, P.M.S., impotency, infertility, decreased libido, and menopausal symptoms.
The hormonal and endocrine glands play a role in so many functions in the body that they must be included as well. Thyroid malfunctions and hormonal deficiencies can cause some of the symptoms associated with FM/CFS.
To make a list of all the possible signs and symptoms would be redundant, as the list is endless. As I mentioned earlier some of the Fibromyalgia/Chronic Fatigue Syndrome patients have as many as 70 or 80 different symptoms. All these symptoms can be included in either FM or CFS. Each FM/CFS patient have different symptoms in different parts of the body and with varying severity, depending on which causative factors are present.
Why Do I Feel So Fatigued All the Time?
Fatigue is a common factor in both FM/CFS. Fatigue can result from a combination of a number of different causes such as: lack of sleep, malnutrition, lack of certain nutrients, toxicity, interference to the nerve supply, decreased blood supply, decreased pH levels, parasites, yeast, bacterial and viral infections, environmental sensitivities, allergies, emotional factors, inability to handle stress, boredom, lack of oxygen, pain and sickness or disease.
When systems in the body are not functioning properly, one of the first signs is fatigue. If your body is fighting an infection or disease, this will consume a lot of energy and will leave you exhausted. Being in constant pain also zaps your energy.
When fatigue is a problem, just giving you a substance to improve your energy is not good enough. You have not corrected the cause of fatigue, but only masked the symptoms. The correct approach is to examine all of the above possibilities to determine why it is that you are fatigued.
Sleep disorders are common in FM/CFS. Being as sick as one gets with these conditions, sleep quality and quantity usually suffers too. When the pain is bad, it either wakes you up or prevents you from getting to sleep. Some of the various infecting agents can also interfere with regular sleeping patterns. People can’t get to sleep, others can’t stay asleep. While some get to sleep ok but wake up at 2, 3, or 4. A.m. unable to get back to sleep.
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