Fibromyalgia syndrome, formerly called muscular rheumatism and fibrositis, is a syndrome of chronic, widespread pain accompanied by some degree of fatigue.  In addition, persons suffering with fibromyalgia often have a wide spectrum of health complaints.  Since fibromyalgia is a syndrome, it is defined by a collection of symptoms common to its sufferers.  Not all symptoms appear in everyone with the syndrome.  Some symptoms associated with fibromyalgia syndrome include sleep disturbances, cognitive dysfunction, paresthesia, headaches, muscle spasms, muscle twitches, depression, fatigue, hypoglycemia, Temporomandibular joint dysfunction, and irritable bowel syndrome to name a few.

Eighteen designated points are evaluated for tenderness when a patient is checked for fibromyalgia.  During the examination, four kilograms of pressure is applied to each of the eighteen points.  If the patient feels pain at eleven or more of these points, the diagnosis of fibromyalgia is issued, providing there is an absence of any other underlying disease processes that can account for the symptoms.

Chronic fatigue syndrome is a name given to a disorder characteristic of severe, chronic physical exhaustion, often accompanied with mental exhaustion.  The fatigue is often reported as incapacitating, disrupting every facet of a person’s life.  The onset can be abrupt, or occur over a long time.  In addition, the person suffering from chronic fatigue syndrome will likely experience cognitive dysfunction, muscle pain, inflammation of lymph nodes, headaches, joint pain, and sleep disturbances.  Not all the symptoms appear in everyone diagnosed with chronic fatigue syndrome.

No identifiable specific cause of chronic fatigue syndrome is known, subsequently, no one treatment protocol is directed toward a cure.  Treatment is often consisting of purely palliative measures, or, as often happens, no treatment whatever is offered to the patient.  Antidepressants have been used to treat the chronic fatigue syndrome patient, and have been shown to reduce some symptoms to a limited degree.  Since antidepressants have their mechanism of action on neurotransmitter receptors, some degree of evidence suggests that dopamine, norepinephrine, and serotonin all may play a role.  Neurotransmitter involvement may also implicate the hypothalamus, which is the link between the nervous system and endocrine system.  When examining literature and research on chronic fatigue syndrome, every system of the body, to some degree, is clearly affected.  For a syndrome that has markedly severe symptoms, surprisingly, no direct causative factor is evident.

No objective criteria, consistent subjective criteria, or pathological evidence is considered diagnostic of fibromyalgia or chronic fatigue syndrome.  When a patient presents with the classical myriad of symptoms, diagnostic tests are performed to rule in or rule out certain diseases or conditions.  With the chronic fatigue or fibromyalgia patient, laboratory tests are often proved normal, physiological function is generally within normal limits, and no underlying cause supporting the reported symptoms can be found.  No correlation between documented examination results, laboratory tests and the patient’s complaint can be found.  Exhausting the list of potential differential diagnoses, the diagnosis of chronic fatigue syndrome or fibromyalgia syndrome is put forth by the medical doctor.  Both chronic fatigue syndrome and fibromyalgia are a diagnosis of exclusion, offered purely on the basis of patient history and subjective symptomatic complaints.

The vast number and nature of the symptoms reported by chronic fatigue syndrome and fibromyalgia sufferers introduce other concerns that must be addressed.  Specifically, the question arises of which symptoms are related directly to the condition and which symptoms appear later because of the changed lifestyle and decreased physical activity of the patient.  The longer a chronic disease of any type is left untreated, the longer the list of symptoms and complaints gets.  Assuming that the sufferers of a particular chronic disease will all follow a similar path in both lifestyle changes and symptoms experienced is not unreasonable.  Further complicating the matter is the fact that most chronic diseases have symptoms of an insidious onset, meaning they are slow to occur.  By the time the chronic disease or syndrome is diagnosed, the disease has usually progressed to the level that multiple symptoms are present.  Many of these symptoms are likely due to other factors, such as a modified lifestyle, a changed diet, and decreased activity levels.

Chronic fatigue syndrome and fibromyalgia go hand in hand.  The sufferers of one disorder have, at least to some degree, some symptoms of the other disorder.  This would lead us to believe that chronic fatigue syndrome and fibromyalgia are really both the same disorder, or at least have the same basis.  Medicine, however, has divided this disorder into two distinctly named syndromes.  Recall that a syndrome is really defined by symptoms common to sufferers of some disorder.  In the case of chronic fatigue syndrome and fibromyalgia, the predominant symptom is used to name the syndrome.  Oddly, each syndrome is given a name, which, in fact, simply renames the predominant symptom.  This is analogous to giving the name “pain syndrome” to any disease that causes pain, or “sleepy head syndrome” to any disorder that causes sleepiness.  On the surface, naming a syndrome “sleepy head syndrome” sounds, to be frank, quite stupid.  Why, then, would we accept any medical diagnosis that likewise simply renames the symptom?  Logic would dictate that more exists to the disease process than symptoms appearing for no apparent reason.

If we examine the concept of a syndrome, we have what is nothing more than a collection of casually related symptoms.  In assigning a name to a collection of symptoms, we have done nothing more than bring a Chupacabra into the health care system.  To claim that the symptoms are casually related is nothing more than an admission that the cause has not been found.  The problem arises when we believe a casual relation exists.  The specific symptoms are not casually related at all.  Symptoms are very specific, and complaints offered by patients reflect this high specificity with great reliability.  Logic will not allow us to conclude that we have a syndrome in which a collection of separate but distinct symptoms are developing independently for no reason at all.  These specific symptoms, which have been defined to be casually related, were, in fact, really all parts of the same disorder.

If the concept of fibromyalgia and chronic fatigue syndrome were discarded, and the symptoms experienced by the patient were examined in an objective manner, the true cause might actually become apparent.  Once we have identified a cause, the cure also becomes evident.  We can then work on reversing the causative factors that allowed the issues of fibromyalgia and chronic fatigue syndrome to manifest.  The other choice is to wait for some miraculous cure, but that is simply not going to happen.