Is it Fibromyalgia or Chronic Fatigue? Plus, more on Gray Matter and Dopamine

Is it Fibromyalgia, or Chronic Fatigue?


How do you tell whether you have fibromyalgia, chronic fatigue syndrome (also known as "Myalgic Encephalopathy" or "ME") or both? Are they completely unrelated disorders, sister illnesses that share similar symptoms, or one disease with two different names?

Although there is still some disagreement among experts, most believe they are two distinct disorders that have a number of symptoms in common. However, distinguishing one from the other can be difficult. Further complicating the situation is the fact that approximately 70 percent of people who have one also have the other.

SIMILARITIES:

Some of the most common symptoms that may be found in both FM and ME/CFS are debilitating fatigue, muscle and/or joint pain, difficulty with memory, concentration and cognitive functioning, depression, headaches, sleep disturbances, dry eyes and mouth, morning stiffness, and numbness or tingling.

There are also clinical similarities:

-Reduced blood flow in the cerebral cortex and midbrain
-Hypothalamic pituitary axis (HPA) suppression
-Disturbed Stage 4 sleep
-Lower than normal serotonin levels
-Reduced levels of growth hormone
-Evidence of a genetic component

DIFFERENCES:

A simplified explanation of the difference between fibromyalgia and chronic fatigue syndrome is that pain is the most predominant symptom of fibromyalgia, but fatigue is the most predominant symptom of ME/CFS. More specifically, fibromyalgia is identified by 18 distinct tender points (designated points on the body that are painful when four kilograms of pressure are applied), while chronic fatigue syndrome / ME is distinguished by a post-exertional malaise (deep fatigue and exhaustion following physical exertion, which lasts more than 24 hours).

Additional differences include:

-Substance P (a neurotransmitter that sends pain signals) is elevated in FM but not in ME/CFS.
-RNaseL (a cellular antiviral enzyme) is frequently elevated in chronic fatigue syndrome but not in fibromyalgia.
-ME/CFS is often triggered by an infectious or flu-like illness, while FM is usually triggered by a severe physical or emotional trauma (for example, injury, illness, surgery, prolonged stress).

DETERMINING a DIAGNOSIS:

Getting an accurate diagnosis of either illness can be challenging and frustrating. And rarely will you be diagnosed with both at the same time or by the same doctor. Although fibromyalgia and chronic fatigue syndrome / myalgic encephalopathy each has its own set of diagnostic criteria, the diagnosis you receive is sometimes determined more by which doctor you go to than by the specific criteria for each. A rheumatologist may be more apt to diagnose fibromyalgia while an infectious disease specialist is more likely to diagnose ME/CFS. Because general practitioners and family practice physicians have to learn about and treat an overwhelming number of different conditions, it may be a matter of which illness your doctor is more familiar with.

To learn more about the specific diagnostic criteria for each, see:

Fibromyalgia Diagnosis
Chronic Fatigue





MOLECULE TO TREAT CHRONIC PAIN DISCOVERED

BOSTON, Aug. 27 (UPI) -- U.S. scientists say they have created a synthetic molecule that could be used to treat chronic pain in patients with diseases such as diabetes or shingles.

Northeastern University Professor Alexandros Makriyannis, Associate Professor Torjjorn Jarbe and former University of Connecticut researchers Chen Li and Qian Liu said their new molecule, AM1346, mimics, but is more powerful than, anandamide, an endogenous cannabinoid neurotransmitter found prominently in the brains of humans and animals. Anandamide is a naturally occurring part of the endocannabinoid system that regulates pain, controls heart rate and blood pressure, and modulates mood and appetite, the scientists said.

"AM1346 is a more potent and stable synthetic compound than anandamide", Makriyannis said. "It will serve as a test compound to study and understand more completely the endocannabinoid system and could have potential therapeutic implications as a topically applied pain killer."

The findings were published in a recent issue of the journal Psychopharmacology; United Press International.




MILNACIPRAN FINALLY APPROVED

THURSDAY, Jan. 15, 2009 (HealthDay News) -- 'Savella' (brand name for Milnacipran Hydrochloride) has been approved by the U.S. Food and Drug Administration to treat fibromyalgia, a chronic condition characterized by restricted movement and widespread pain, makers Forest Labs and Cypress Bioscience announced.

The safety and effectiveness of the drug, a selective serotonin and norepinephrine dual reuptake inhibitor, were established in clinical trials involving 2,084 patients. In a news release, the drug's makers said it's not known exactly how Savella improves symptoms of fibromyalgia, which some scientists believe is related to abnormalities in certain brain neurotransmitters.

As many as 6 million Americans have fibromyalgia, making it the second-most common condition diagnosed in rheumatology clinics behind osteoarthritis, the companies said. There is no cure.

'Savella' is expected in pharmacies by March.

ABOUT MILNACIPRAN

Milnacipran is a unique dual-reuptake inhibitor that preferentially blocks the reuptake of norepinephrine with higher potency than serotonin, two neurotransmitters known to play an essential role in regulating pain and mood. It has been approved for a non-pain condition in over 50 countries, with real-world commercial experience outside the U.S. for 10 years. Milnacipran is jointly being developed for fibromyalgia in the United States market by Forest and its licensor, Cypress Bioscience, Inc. Milnacipran was originally developed by and is sold outside of the U.S. by Pierre Fabre Medicament. Fibromyalgia is defined by widespread chronic pain, as well as a broad spectrum of related symptoms including fatigue, cognitive dysfunction, and reduced physical function.

What are the Side Effects of Milnacipran?

In clinical studies, the vast majority of participants exhibited no side effects, (including NO WEIGHT GAIN!), even when receiving the highest possible dose of Milnacipran. Those that did suffer side effects primarily experienced mild and temporary nausea, limited to the early stages of the trial. Other rare but possible side effects include:

itching
sweating and chills
vertigo
difficulty urinating (Dysuria)

We now have a third FDA-approved option for treating fibromyalgia.

For MORE on MILNACIPRAN, please see:

FDA Information
Manufacturer's Insert
Past Articles




NEW FIBROMYALGIA STUDY RESULTS:


The study entitled "Self-Assessed Physical Function Levels Of Women with Fibromyalgia - A National Survey" was published in the September-October 2008 issue of the journal Women's Health Issues. The objective of the study was to determine the self-reported physical function level of women with fibromyalgia. The subjects included 1, 735 women, ranging in age from 31 to 78, who reported being diagnosed with FM.

The results of the study showed that:

1. More than 25% of women reported having difficulty taking care of personal needs and bathing.

2. More than 60% reported difficulty doing light household tasks, going up/down one flight of stairs, walking half a mile, and lifting or carrying 10 lbs.

3. More than 90% of women reported having difficulty doing heavy household tasks, lifting or carrying 25 lbs, and doing strenuous activities.

Women with lower functional ability reported higher levels of fatigue, pain, spasticity, depression, restless legs, balance problems, dizziness, fear of falling, and bladder problems.

The study concluded that the average woman in this sample reported having less functional ability related to activities of daily living and instrumental activities of daily living than the average community-dwelling woman in her 80s.

Data was gathered from an Internet-based survey posted on the
National Fibromyalgia Association website.




A New Era for the University of Nevada School of Medicine at RENO - THE WHITTEMORE PETERSON INSTITUTE:

Annette and Harvey Whittemore recently delivered $1 million to the University of Nevada as part of a $5 million pledge to augment the funding of construction of the Whittemore Peterson Institute for Neuro-Immune Disease within the University of Nevada School of Medicine's Center for Molecular Medicine in Reno. This institute is the first of its kind to combine basic research with evidenced-based patient care in a fully translational program.

The Institute was first conceived when a group of dedicated citizens and clinicians proposed the concept of a medical institute in Nevada for the millions of patients in the United States suffering from neuro-immune diseases such as myalgic encephalomyelitis/chronic fatigue syndrome, fibromyalgia, atypical multiple sclerosis, autism and other related illnesses. Although the number of Americans suffering from these disorders is growing, federally funded research has been sparse. Despite the seriousness of these illnesses, there are still no treatments or diagnostic tools that bring significant relief to patients. Scientists and clinicians at the Whittemore Peterson Institute hope to change that by building a bridge from the patient to the science, and back to the patient.

The Whittemore Peterson Institute for Neuro-Immune Disease exists to bring discovery, knowledge, and effective treatments to patients with illnesses that are caused by acquired dysregulation of both the immune system and the nervous system, often resulting in life long disease and disability.

Its first goal is to work towards developing a better understanding of the natural history of these diseases, thereby diagnosing and treating patients accurately and efficiently. Generating and sustaining a blood and tissue repository and a clinical database for ME/CFS and ultimately for other neuro-immune diseases is a primary focus of the Institute.

Other goals include:

To facilitate and advance patient care.

Research the pathophysiology of neuro-immune diseases such as ME/CFS, fibromyalgia, atypical MS, and autism.

Develop therapeutics, diagnostics and prevention strategies for this spectrum of diseases.

To advance and support medical education and physician training.

When it opens in 2010, the Whittemore Peterson Institute for Neuro-Immune Disease will occupy 19,000 sq. ft. in the Center for Molecular Medicine on the University of Nevada's Medical Campus in Reno, Nevada. It will be a place where ME/CFS patients can be diagnosed and participate in clinical trials, where novel research will be conducted, and where medical students can learn about this disease.

It has attracted substantial interest and support from patients, other foundations, and a host of international researchers who are already affiliated with it. It is the first Institute of its kind in the world.

Upcoming Event: September 12, 2009 - I Hope You Dance Fundraising Gala, Reno, Nevada

To read more about WPI, please go to:
Annette Whittemore and the Making of the Whittemore Peterson Institute
The Whittemore Peterson Institute website




FIBROMYALGIA PAIN MAY CAUSE MEMORY BLIPS

By Quinn Phillips in Medicine & Health / Research (PhysOrg.com)


The chronic pain from Fibromyalgia is devastating, but the suffering doesn't end there. According to a new study by the University of Alberta's Bruce Dick, people with the disease may have disruption in their memory because of the pain.

Dick, a professor in anesthesiology and pain medicine, compared 30 women with Fibromyalgia with 30 healthy women. In the first test, Dick and his colleagues had his subjects perform simple tasks such as reading a map or using a phone book. They got the bulk of their results in the second test when researchers looked at how much information the subjects could handle and whether multi-tasking was particularly difficult.

"We found that the Fibromyalgia sufferers had difficulty focusing on specific bits of information," said Dick. "The working memory was impaired and [as tasks] became more difficult mentally, people's performance dropped off quite dramatically if they had pain related to Fibromyalgia."

There are other factors that can cause cognitive disruption, including sleep problems and depression. Even with taking those factors into consideration, Dick found in his study that the subjects still had a slip in their working memory.

Dick believes his findings contribute to what Fibromyalgia sufferers call "fibro fog." They describe it as having trouble concentrating, suffering short-term memory loss and having general cognitive slowing.

The U of A researcher says he made another interesting and surprising discovery. Those patients that were on narcotics or opiates had much better memories.

"The drugs that are really controversial actually seemed to help them be much more functional," said Dick, who adds he wants medical professionals to consider his findings when they are prescribing something for pain.

"I think it is safe to say in the context of what we know in the research literature that when properly screened and supervised the benefits do outweigh the risks overall in using these medications."

Dick wants to further study the controversial treatments in order to address the best ways chronic pain sufferers can improve their memory skills.

"We need to more systematically study the drugs themselves and what they seem to do in different groups of people and even in different classes of drugs."

Provided by University of Alberta



AMINO ACIDS to treat chronic fatigue: See final link below!
More new information from February 2009:

Thursday, February 19, 2009: ADA Amendment Could Help Employees With Fibromyalgia & Chronic Fatigue Syndrome

Wednesday February 18, 2009: Objective Measurement of Fibromyalgia Pain?
and Fibromyalgia Pain: New Guidelines for Opiates

Tuesday February 17, 2009: Are CBT/Physical Activity Effective Treatments for Chronic Fatigue Syndrome?

For these latest developments, and more, please see full articles posted at About.com.



Finding Affordable Meds


Your doctor may also be able to help you enroll in a prescription drug aid program like the one sponsored by the Partnership for Prescription Assistance (see below for link) , a coalition of pharmaceutical companies and health-care advocates, says Cheryl Fish-Parcham, the deputy director of health policy at Families USA, another consumer advocacy group. Another good source for help with finding affordable prescriptions (and all types of medical financial assistance) is MedlinePlus.

PPARX.org

MedlinePlus



Fibromyalgia? What Brand do You Have??

So many are suffering, often needlessly, with fibromyalgia, a seriously growing problem in our modern population. This is a widespread pain and muscular aching disorder that is chronic and accompanied by other symptomatic problems, usually including fatigue and loss of energy. There is more drug free help than most think. We are accustomed to good successful outcomes through the process of narrowing down the type of fibromyalgia you have. If you've been told you have fibromyalgia or think you may have it, read on!

Knowing what "Brand of Fibromyalgia" © you have can make all the difference in actually getting life changing help for your condition. Trying to just cover up the symptoms, without knowing your "Fibromyalgia Brand" ©, usually leads to poor outcomes. Fibromyalgia is a serious disorder that impairs many women's lives, switching their life energy from centeredness around their family, their career, their loved ones, and favorite interests, and instead puts them on a course of fighting for their daily survival for a "normal" life, preoccupied with barely getting through the day, or worse yet, varieties of incapacitation, fatigue, pain, despair, and often even depression from dealing with this condition with no real solutions%u2026so far.

A sampling of the 10 or more varieties of fibromyalgia, or the "Brands of Fibromyalgia"©, includes perhaps the most common, Adrenal Fibromyalgia ©, as well as "Inflammatory Fibromyalgia" ©, "Glandular Fibromyalgia" ©, "Dysglycemic Fibromyalgia" © also referred to as "Blood Sugar-Handling Fibromyalgia", and "Gastro-Intestinal Based Fibromyalgia" ©.

Each type of fibromyalgia has unique characteristics in the history of onset of the disorder, as well as unique factors in the diagnostic workup components, and in the types of treatment protocols.

Diagnostic workup should include careful attention to the events of the several or more years prior to the early onset of the first related complaints, as this is often where the first clues as to the foundational causation will be located, in addition to special attention to history, a set of several hundred questions in a "Metabolic Survey Questionnaire", looks for a clustering of clues of "functional problems", predominately not the usual kinds of standard medical disease questions. This is an aid in focusing the physical and laboratory based evaluations.

A unique physical exam, including a "viscero-somatic reflex" exam (VSR), can be a crucial component to identifying your "Fibromyalgia Brand"©! This exam offers insight as to which nerves from which organ systems are "on overload", and are "short-circuiting" as they desperately try to repeatedly warn the brain about the internal distress inside of you. Practitioners trained and experienced in Applied Kinesiology (AK) and Sacro Occipital Technique (SOT) are well equipped to do a viscero-somatic reflex examination, and this offers an important vantage point to the determination of your "Fibromyalgia Brand".

Lastly, a thorough "functional-medicine" based blood and urine laboratory testing protocol must be included to objectively appreciate the origins and recovery solutions to your Fibromyalgia Brand, so that you can reasonably expect a recovery of the life you used to have before fibromyalgia. This workup may include often left out testing such as the "4-point cortisol" exam with DHEA. This measures your major stress hormone called cortisol, at 7AM, 11AM, 3PM and 7PM as well as a measurement of the adrenal "backup" hormone, DHEA, with 7AM and 3PM measurements. This gives vital information, which when graphed out, often gives the crucial clues to guiding successful treatment.

Many other important lab tests, such as "inflammation indices", including high-sensitivity C-Reactive protein should be done for all fibromyalgia patients. History and physical findings may point to the need for food and environmental sensitivity and allergy blood test panels, organic acids panels, strategically timed female hormone measurements, and sometimes fasting insulin measurements. Testing is highly individualized to each person, and yet a "wide net" needs to be cast in the laboratory evaluation so as not to miss important clues to your "Brand of Fibromyalgia"©. There are thousands of blood tests - Have you had the ones your really need?

Knowing what's really wrong, down at the root level of the cause of your particular "Brand of Fibromyalgia" can make all the difference, leading to highly successful outcomes!

You may contact the author at his office:

Pain Relief Center, PA
Dr. Daniel P. Hillis, DC
239-597-3929
NaplesPainRelief.com



MAY 12th is FIBRO Awareness Day!


The National Fibromyalgia Association's theme for the 2009 National Fibromyalgia Awareness Day campaign is "Fibromyalgia Affects Everyone" and will focus on the far-reaching effects of this disorder-from broken lives to the economic costs to patients and society.

The NFA's Walk of FAME (Fibromyalgia Awareness Means Everything) event is a major component of this important campaign. This year's walk will move away from the traditional 5K event, which in the past has drawn hundreds of people to a single location, to an expanded program that will increase participation and maximize outreach efforts.

The second annual Walk of FAME will consist of hundreds of buddy-type walks in local communities nationally and worldwide. On or around May 12, teams of three or more, patients, family and friends -wearing Walk of FAME T-shirts and equipped with information cards-will walk at an array of popular destinations, including shopping malls, the perimeter of Disneyland and high profile college campuses.

CLICK HERE for more info!


NOTE: May 12th is also CFS Awareness Day, due to it being Florence Nightingale's birthday. She was thought to have been bedridden by Chronic Fatigue.

To read more about her, go to this page on Wikipedia.



Inexpensive treatment for Fibro and CFS

A group of 10 women with fibromyalgia took part in a small pilot study at Stanford over a 14-week period to test the new use of a low dose of a drug called naltrexone for the treatment of chronic pain. The drug, which has been used clinically for more than 30 years to treat opioid addiction, was found to reduce symptoms of pain and fatigue an average of 30 percent over placebo, according to the results of the study published April 17 online in the journal "Pain Medicine".

"Patients' reactions were really quite profound," said senior author Sean Mackey, MD, PhD, associate professor of anesthesia and chief of the pain management division at Stanford University Medical Center. "Some people decided to come off other medications. Some people went back to work really improving their quality of life."

Still, Mackey and his colleagues remain cautious about recommending the drug this early on in the research process. "People need to understand that while we're excited about preliminary results, they are still preliminary, and we need to do longer studies with more patients. There is still a significant amount of work to be done." The researchers are moving ahead with a second, longer-term trial of 30 patients who will be tested during a 16-week period.

The drug is particularly promising, the study states, because of the few treatment options available for fibromyalgia patients, its low cost of about $40 a month and its limited side effects. Vivid dreams were reported by a few participants.

Still considered a controversial diagnosis, fibromyalgia is a disorder classified by chronic widespread pain, debilitating fatigue, sleep disturbance and joint disorder. Advocates and doctors who treat the disorder, estimate it affects as much as 4 percent of the population. "The symptoms of fibromyalgia are commonly seen in a number of other diseases, and there is no well-established and objective blood test to confirm the diagnosis," said Jarred Younger, PhD, the study's lead author and an instructor in anesthesia and pain management at Stanford. "In the meantime, new treatments that work particularly well for fibromyalgia go a long way toward validating the usefulness of the diagnosis."

The idea to explore the use of a low-dose of naltrexone as a treatment for fibromyalgia began about two years ago when Younger began searching for relief for patients with the disorder. "I was asking patients, 'Does anything work for you?'" he recalled. "A lot of people in support groups were saying, 'Yeah, I tried naltrexone and it works for me.' It just kept coming up."

The use of naltrexone to treat pain at first seems counterintuitive, Younger said, because at normal doses the drug actually blocks the body's pain relief systems. However, naltrexone appears to have the opposite effect when given at a lower dose. Naltrexone, at these lower doses, is thought to work by modulating glial cells in the nervous system, Mackey said. Glial cells provide support and protection for neurons and act as a link between the neuronal and inflammatory systems.

"We're learning more and more that maybe by modulating these glial cells we can impact the abnormal processing of pain in these patients," Mackey said.

During the study, the women used a handheld electronic device to capture their symptoms on a daily basis. They took a placebo for two weeks and then the drug for eight weeks, but they weren't told when they were taking the drug or the placebo.

Some of the women have continued to take the drug after the end of the study because the results were so positive, Younger said.



Will Social Security Disability send you to rehab to train you to do other work?

No. The two disability programs operated by the social security administration (Title II benefits which are social security disability and Title 16 benefits which are SSI, or supplemental security income) have only one purpose: to determine if an applicant for benefits has a physical or mental condition that satisfies the definition of disability used by social security.

The SSA definition of disability, of course, stipulates that an applicant must have a severe impairment (this is a fuzzy concept, but most can agree that a sprained wrist or a pregnancy will not qualify for disability and will be labeled as an NSI, or non-severe impairment), that the impairment or combination of impairments must result in functional limitations (for example, reduced ability to stand, sit, remember, or concentrate) that rule out the ability to engage in work activity while earning a substantial and gainful income, and that the disabling condition must last, or be expected to last, for at least a year.

By the same token, the social security administration offers zero assistance with utilities, housing maintenance costs, and medications while a disability application is pending (by contrast, a pending disability-medicaid application that is filed with a local department of social services may, in some states, make the applicant temporarily eligible for medication vouchers).

More at www.disabilitysecrets.com.



COMMONLY ASKED QUESTIONS ABOUT MYOFASCIAL PAIN SYNDROME

What is myofascial pain syndrome?

Myofascial pain syndrome is thought to be a form of muscle pain. It may result from a single significant trauma or repetitive minor trauma. There are no laboratory, radiographic or other diagnostic tests for myofascial pain syndrome, so it is considered a subjective diagnosis. There is a tendency for development of trigger or tender points, which may be felt as "knots" of tissue under the skin. Generally, it requires an experienced clinician to determine whether painful regions are indicative of myofascial pain syndrome. However, when trigger points are present and active, they can lead to discomfort in nearby muscles.

Is there a difference between myofascial pain syndrome and fibromyalgia?

Simply put - yes. Although often used interchangeably by patients and physicians, they are different. Fibromyalgia is considered part systemic disease and part syndrome. Fibromyalgia has more clearly defined criteria for diagnosis, including pain for more than 3 months, sleep disturbance, and a minimum number of specific tender points. Fibromyalgia may also be associated with irritable bowel syndrome, chronic fatigue syndrome, mitral valve prolapse as well as a possible family association.

Myofascial pain syndrome and fibromyalgia are similar in that there are no laboratory or radiographic tests to prove that a patient has either one, and the diagnosis is made when other diseases have been ruled out.

What are the symptoms of myofascial pain syndrome?

Symptoms usually involve the muscle itself or the muscle near a painful joint. Over time, this pain may spread to involve other muscles. Stress, poor sleep, and deconditioning have a significant effect on worsening the symptoms.

What are the treatment options?

An individualized program of regular stretching and cardiovascular exercise is the mainstay of treatment. To prevent deconditioning, the patient with myofascial pain should be involved in activities such as brisk walking, swimming, or bicycling.

Chronic pain stress management counseling may be valuable in teaching a patient how to deal with the social impact of long-term pain, as well as techniques on how to function despite the discomfort.

Medications are rarely needed. However, during intense flare-ups a short course of anti-inflammatory medication may be helpful. Occasionally, trigger point injections can be performed in an office setting to decrease muscle spasm. If an individual suffers from sleep disturbance, medications such as cyclobenzaprine, Doxepin, trazodone or amitriptyline may be used to promote a more normal sleep / wake cycle.

Tobacco use and caffeinated beverages should be discontinued. Caffeine and nicotine are stimulants, and have been found to irritate the muscles, thereby perpetuating myofascial pain.

Is surgery an option for myofascial pain syndrome?

There is no indication for surgery in patients with myofascial pain syndrome.

See more at Buffalo Spine

Gray Matter and Dopamine Levels in Fibromyalgia Patients

The Louisiana State University Health Sciences Center in Shreveport conducted a study on gray matter, dopamine and fibromyalgia. The lead researcher, Patrick B. Wood, and his colleagues found some interesting information: dopamine levels affect gray matter levels in fibromyalgia patients.

Gray matter (also known as 'grey matter') is an element of the central nervous system. Its function is to route sensory stimulus to create a response by chemical synapse activity. Dopamine is a neurotransmitter that carries signals between neurons and cells. While previous research had linked dopamine and gray matter, the cause for the link was unknown.

This recent study conducted MRIs on the brains of 20 healthy women and 30 women with fibromyalgia. The women were all the same age. They found that fibromyalgia patients had significant reductions in gray matter, and they also found that the areas of the brain where dopamine controls neurological activity had a strong correlation of gray matter density and dopamine metabolism levels.

Researchers are excited about these findings and hope that the new information will help them get closer to understanding many of the brain abnormalities that can sometimes be found in fibromyalgia patients.