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Is it Fibromyalgia or Chronic Fatigue? Fibromyalgia as a Complication of Injuries

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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

Fibromyalgia's Role in back Pain and Some Tips to Provide Relief

Fibromyalgia is a term that is used to diagnose individuals who suffer from chronic muscular irritation. Individuals who suffer from fibromyalgia experience very tender muscular points that cause intense pain. There are other symptoms as well that they suffer such as, extreme fatigue, irritable bowl syndrome, headaches, insomnia, and depression. Fibromyalgia can be debilitating to those who suffer from it. The onset of fibromyalgia is often seen in individuals who have gone through an extreme emotional or physical trauma. It appears that those who have been diagnosed with this disease also do not enter into deep sleep cycles and when this happens, the muscles do not have a chance to rest and recover properly. Back pain is increased when a person does not get adequate rest. Individuals who experience this disease may also suffer from other forms of muscle problems such as tendonitis, bursitis, muscle strain, cramping, and spasms.

Along with the many symptoms of fibromyalgia, back pain is often a primary complaint among those who suffer with the disease. Whether the pain is in the upper or lower portion of the back, there is extreme discomfort. Many times, it is impossible to sit or stand for extended periods. Here are some methods of back pain relief for those who suffer from fibromyalgia.

Heat is an exceptional therapy for the majority of muscle aches and pains, and it works especially well for the upper and lower back. Heat works to loosen up the muscles and stimulate circulation, allowing your body to heal itself. Different types of heat therapies include:

Heat wraps: Many heat wraps today are made to wrap around portions of your lower back or any section of your back that is in pain. They can be warmed in a microwave or in a sink of warm water. Many of these wraps are designed so that you can wear them during the night and up to eight hours.

Heating pad: These are great and simple to use. You can place them on the back of your chair or whatever surfaces you may be lying on. They are excellent at targeting specific areas of pain in your back.

Warm baths: Besides being a great stress reliever, they are excellent for relieving back pain associated with fibromyalgia.

Back supports are an excellent tool to help alleviate back pain (upper and lower). They are excellent if you have to sit for extended periods in front of a computer or desk. When purchasing a back support look for one that has a curve that will fit into the lower back region. It should have a high back that will ensure that your neck and shoulders are also in alignment and that it has an adjustable back (this way you can use it with a variety of different chairs).

You may want to consider exercises that are designed to eliminate (or at least minimize) back pain. Back exercises will help to strengthen your back muscles and helping to bring your spine into alignment. Be careful and only do these according to your level of comfort.

Curl up: Curls strengthen the abdominal and lower back muscles.

Upper body extension: These extensions strengthen the muscles in your upper back

Arm-leg Extension: This exercise will help keep your spine in alignment, which will relieve the pressure on your lower back.

Electric stimulation is effective pain relief for those suffering back pain from fibromyalgia. The electric stimulation is used to block the pain receptors that cause the nerves to become irritated. This micro-current stimulates healing to the area of tissue that is injured. It can also be used to charge the muscles to contract. If you want to try this method, find a practitioner who is licensed with this type of therapy treatment. You may want to look into alternative treatments for both your back pain and fibromyalgia. Many therapies available help to relieve muscle soreness while at the same time increasing circulation, which will enhance muscle repair. Always look for a qualified practitioner before beginning any type of alternative therapy treatments. Some other alternative treatments to consider include acupuncture, massage therapy, and hydrotherapy.

There are many forms of treatment available for those who suffer from back pain due to fibromyalgia. Always consult with your medical professional and they can help you on your journey to experiencing less pain in your life.

Read more at BackTwinge.com

Applying for Social Security Disability Benefits when you have Chronic Pain

This information is intended to shed some light on the SSDI/SSI disability evaluation process as it relates to claimants with chronic pain. Regardless of a claimant's condition, understanding how the Social Security Disability system works can make the difference between winning a disability claim or losing.

Chronic pain can be defined in a number of different ways: as pain that cannot be removed by standard medical treatment, as pain that persists beyond the point of injury or illness, and as pain for which no origin can be determined.

SSA has two disability benefit programs (social security disability insurance, or SSDI, and supplemental security income, commonly known as SSI) and in the administration of both programs the subject of "pain" receives very little consideration (despite the fact that social security has been sued in the past for failing to properly acknowledge the limitations brought on by pain).

Part of the problem that a claimant with chronic pain may face when filing for disability benefits is the fact that disability examiners (examiners make decisions on initial claims) and administrative law judges look for objective signs of residual functional capacity ("residual functional capacity" is what you can still do even with your condition). Pain, of course, tends to be subjective and difficult to measure.

Can you be approved for social security disability or SSI benefits if you have chronic pain? Yes, but probably not on the basis of having chronic pain alone. There is no listing in the blue book (this is the manual that lists the approval criteria for certain physical and mental conditions) for chronic pain. For this reason, a person with chronic pain would need to be approved on the basis of a medical vocational allowance. With a "med-voc" allowance, an applicant for benefits can be approved if it is found that their condition (or conditions) prevents them from returning to their past work or engaging in suitable forms of other work.

As with most applicants for social security disability or SSI disability, an individual with chronic pain would probably have a number of conditions to list on a disability application. And each of these, of course, would add to the total picture of a claimant's infirmity and influence an examiner or judge's evaluation as to the physical or mental limitations a claimant has.

An individual with chronic pain may have one or more physical impairments, the limitations of which would need to be considered. However, the effects of pain may also receive consideration by evaluating how pain may affect a disability applicant's ability to: 1. work under supervision, 2. work alongside co-workers, 3. maintain attention and concentration, and 4. learn and retain new information. These, of course, are the kinds of factors that would receive consideration in a psychological evaluation. For those who aren't aware, disability examiners perform physical impairment and mental impairment write-ups when necessary. These writeups are reviewed by medical and psychological consultants (M.D.s and PH.D.s) who provide consultation and oversight for disability examiners.

For any individual with a disabling impairment, medical record documentation will be of the utmost importance. However, an individual with chronic pain whose ability to work is impaired in the ways mentioned above may be sent to a psychological evaluation if:

1. A claimant alleges difficulty in one these areas (e.g. by indicating poor concentration on a disability application).

2. References to difficulty in one of these areas is found in a claimant's medical records (it's fairly common for a claimant to be sent to a psychological examination when it's been discovered that their family doctor has made mention of "depression" or "memory problems" in his or her notes).

3. There is no existing documentation (one's own medical records) to sufficiently indicate to what extent and severity these limitations actually exist.

Read more at Disability Secrets.

NATIONAL FIBROMYALGIA AWARENESS WEEK

It's National Fibromyalgia Awareness Week (September 6 - September 12). Fibromyalgia affects more women than men, but it is REAL. You may have it, or know someone who does. Please support your friends and family, with prayer, kindness, and understanding. This is a devastating disease that affects EVERY SINGLE part of a FMS patient's life. Be aware, share, support, encourage! We all need it and each other.

Here's where we can do that:

National Fibromyalgia Association

Facebook Fibromyalgia Patients Unite

Chronic Pain can make you feel decades older

People who suffer chronic pain tend to have general physical capabilities similar to those decades older, a new study finds.

Scientists re-examined data from a 2004 study of 18,531 people age 50 and over. As one example, among participants age 50 to 59 who had no chronic pain, 37 percent could jog a mile and 91 percent could walk several blocks with no trouble. Among those with chronic pain, only 9 percent could jog the mile and only half managed the walking task.

"We found that the abilities of those aged 50 to 59 with pain were far more comparable to subjects aged 80 to 89 without pain, of whom 4 percent were able to jog 1 mile and 55 percent were able to walk several blocks, making pain sufferers appear 20 to 30 years older than non-pain sufferers," said study leader Kenneth Covinsky of the Division of Geriatrics at the University of California, San Francisco.

Chronic pain is a huge problem for middle-aged and older adults. In fact 24 percent of the people in the study suffered from moderate to severe pain most of the time. About 75 million U.S. residents endure chronic or recurrent pain, other studies have found. Migraines plague 25 million of us. One in six suffer arthritis.

While pain is poorly understood, many experts now recommend physical exercise to combat many types of chronic pain, in addition to medication in some cases.

"Our study cannot determine whether pain causes disability or whether disability causes pain," Covinsky said. "We think it is likely that both are true and that pain and disability probably can act together in ways that make both problems worsen in a downward spiral."

The findings, announced today, are detailed in the Journal of the American Geriatric Society.

The research suggests pain and disability may often be part of the same underlying process. "Patients may be better served if pain and disability are evaluated and treated jointly rather than treated as separate issues," Covinsky said.

Read more in article by LiveScience.com.

Fibromyalgia as a Complication of Injuries
by Dr. Mark J. Pellegrino, MD

The pain started after the car accident, and it has never gone away. Before the accident I was perfectly healthy, and now I hurt all over and nothing has helped."

This is a typical story I hear from patients who have chronic pain after a whiplash injury. Some of the treatments may have helped reduce the pain, but it didn't disappear. Many times, the pain is localized at first to the neck, shoulders and upper back areas, but over time, other areas of the body begin to hurt just as bad. Eventually, the person may say the classic four-word sentence that practically epitomizes Fibromyalgia: "I hurt all over."

Fibromyalgia caused by trauma is called Post-Traumatic Fibromyalgia (PTF).

Trauma to the body causes tissue damage. Whereas healing is the expected outcome for trauma, it doesn't always happen and PTF can develop. PTF does not occur immediately after an injury; it takes time to evolve and fully develop the characteristic tender points in distinct locations.

Just as trauma other than motor vehicle accidents can cause whiplash-type injuries, trauma other than whiplash-related ones can lead to PTF. Lifting injuries, falls, work injuries, sports injuries, and repetitive-type injuries are examples of other kinds of non-whiplash trauma.

The medical literature has numerous examples of persistent pain following trauma. Since fibromyalgia criteria were established by the American College of Rheumatology study published in 1990, various articles have appeared in the medical literature about PTF.

Dr. T.J. Romano wrote in 1990 about patients with PTF who continued to require treatment for their condition years after settlement of litigation. ("Clinical experiences with post-traumatic Fibromyalgia syndrome." )

In 1992 Dr. S. Greenfield published a paper describing reactive Fibromyalgia syndrome in patients who report trauma as a precipitating event. ("Reactive Fibromyalgia Syndrome.")

Dr. G.W. Waylonis published a paper entitled "Post-traumatic Fibromyalgia, A Long Term Follow-Up" in 1994 that described a follow-up of 176 patients with PTF.

Dr. F. Wolfe wrote a paper, "Post-traumatic Fibromyalgia: A Case Report Narrated by the Patient" in 1994.

Dr. D. Buskila's 1997 study showed a higher rate (about 22%) of fibromyalgia following trauma to the cervical spine (neck). ("Increased rates of fibromyalgia following cervical spine injury: A controlled study of 161 cases of traumatic injury.")

A study by Dr. H.R. Walen (Journal of Musculoskeletal Pain, 2001) showed a remarkably high prevalence of over 90% of patients reporting at least one traumatic event prior to the onset of fibromyalgia symptoms. More and more researchers seem to be reporting on the importance of physical trauma as a factor in the development of fibromyalgia.

Among doctors in private practice, many (including me) have reported over half of fibromyalgia patients attribute the onset of their symptoms to a traumatic event. In my own private practice, about 65% of patients report a traumatic injury as the cause of their fibromyalgia%u2026.

DIAGNOSING PTF

Trauma-related fibromyalgia, or PTF, is a specific medical condition that exists regardless of individual physician's beliefs or opinions. This diagnosis is never assumed before a patient is seen, or from the patient's history alone. In order for a physician to diagnose PTF, information from the overall clinical evaluation needs to be analyzed. This evaluation includes the patient's history and physical exam, supplemented by any diagnostic testing and review of any previous medical records. The final diagnosis of PTF is made if the total clinical picture "fits."

PTF can be diagnosed if these features are present:

No previous pain complaints before the trauma similar to those experienced since the trauma. That is, the person didn't already have a pre-existing fibromyalgia diagnosis or fibromyalgia-like symptoms before the trauma.

History of a trauma that led to the pain.

Pain resulting from the trauma that has persisted ever since the trauma. I call this the "unbroken chain of pain."

Widespread pain persisting for at least 6 months after the injury, well beyond the usual soft tissue healing time.

The presence of characteristic painful tender points as defined by the American College of Rheumatology criteria; i.e., at least 11 of 18 positive tender points. If consistent reproducible tender points are present only in an injured region and not widespread, a subset of fibromyalgia - post-traumatic regional fibromyalgia - may be considered.

A person can be diagnosed with PTF after one evaluation with an experienced physician. The physician does not have to order specific tests first, or reevaluate the patient over time, to conclude PTF is present. The tender points are the key findings on exam, but muscle spasms and trigger points may be helpful to the physician to clarify the diagnosis. The physician's exam will provide clues if something other than fibromyalgia (e.g., inflammation, or neurological disorder) or in addition to fibromyalgia is present.

Conditions in addition to PTF are often present.

They can include, but are not limited to, post-concussive syndrome, disc disease, facet dysfunction, and reflex sympathetic dystrophy.

After the initial diagnosis of PTF, the patient may visit the physician for subsequent evaluations to review the condition and effects of any treatment. Re-demonstrating the initial tender points upon follow-up examination is a reliable and supportive physical finding of PTF. The exam abnormalities are expected to persist over time in PTF, and the physician can confirm this expectation upon re-evaluation at a later date.

The ability to diagnose PTF is not dependent upon the person being seen immediately after the trauma. PTF takes time to develop, and once it does, it leaves telltale puzzle clues. If the pieces of the puzzle fit and form the "big picture," a diagnosis of PTF can be made...

MECHANISMS OF PTF

There is a difference between cause and mechanism. The cause is WHY something developed. Trauma is the cause of PTF. The mechanism is HOW something developed, or the pathological events that led to the problem. If you fall on the ground and break your hip, trauma is the cause of the broken hip (WHY you have a hip fracture). The pathological mechanism of injury (the HOW) is that high amounts of compressive forces (momentum) impacted the hip and resulted in a fracture.

Many times it is difficult to determine if an abnormal research finding is part of the cause or the mechanism of fibromyalgia. Changes occur after fibromyalgia has developed, so an abnormality can be one of the consequences of fibromyalgia.

It's like asking the famous question, "What came first, the chicken or the egg?"

INJURY PAIN MECHANISMS

Damage to body tissues from an injury can occur from muscle strains, ligament sprains, disc tear or herniation, joint impaction, direct nerve trauma, swelling and inflammation. A combination of injuries activates the normal pain cascades from multiple locations, bombarding the spinal cord and brain with pain signals.

Dr. Rajesh Munglani recently published a good review article on the neurobiologic mechanisms that can occur with whiplash injuries (Journal of Musculoskeletal Pain, 2000 - "Neurobiological Mechanisms Underlying Chronic Whiplash Associated Pain"). His descriptions help explain how some people develop chronic pain and others do not.

The road to PTF travels first through acute pain, and then chronic pain. As noted, PTF does not happen immediately after the accident. It takes time to fully evolve.

Presently, we have no way to determine which injured people will get PTF and which ones will heal and not develop chronic pain.

Complete healing without residual pain is attempted in all with injuries, and expected in most. If chronic pain persists several months after an injury, complete healing is not likely to occur, and the risk for getting PTF increases.

Let's review the neurobiological mechanisms that lead to fibromyalgia after an injury.

Nerve injuries, tissue inflammation, soft tissue damage and scarring activate the nociceptors (specialized nerve endings where pain originates) and signal pain. Localized injuries to the muscle components (spindles, intrafusal fibers, calcium pumps) can create biochemical, hormonal, and red blood cell changes that interfere with cells' ability to receive oxygen, glucose, and other nutrients.

Blood flow, energy formation, and bioelectrical harmony are all disrupted. In those who ultimately develop PTF, the nociceptors probably remain "faulty" and continue to signal pain. Like faulty electrical short-circuits, the nociceptors continue to release pain-producing neurotransmitters.

Hypersensitization of the nociceptors also occurs, so they respond more dramatically to any stimulation (called allodynia). The nerves cannot "turn off" these continuous painful signals and undergo profound functional changes. Pain arises spontaneously from the nerves, causing the person to hurt "for no obvious reason." Instead of waiting to be signaled from outside sources such as trauma, pressure, touch, or temperature changes, the nerves signal spontaneous pain without any outside help.

Furthermore, permanent nerve changes cause outside sensory signals to be misinterpreted as pain. Instead of feeling ordinary touch, movement, or pressure, one feels painful touch, throbbing movement, and stabbing pressure. This exaggerated painful interpretation of ordinarily non-painful sensations is known as allodynia.

[For a detailed plain-language explanation of the mechanisms by which trauma and tissue injury may trigger persistent activation step-by-step throughout the pain pathway from nociceptors to brain, see Dr. Pellegrino's article "Fibromyalgia - Ultimately a Disease of Amplified Pain".]

PERSISTENT TRIGGERS

Ongoing peripheral input that feeds into the centrally sensitized "fibromyalgia pain cascade" comes from different injured tissues. These areas are known as "triggers" or "pain generators" and can occur wherever there is residual damager or instability from injury. A number of pain generators exist and include:

Muscle triggers. Ongoing muscle spasms and restrictive muscle scars are examples of persistent triggers that can exist in muscles. Muscle bundles may go into protective spasms whenever there is inflammation or potential irritation in the region. For example, someone with a low back disc herniation may have spasms in the low back muscles as an involuntary attempt to protect, or guard from movements of the back. Any back movement could cause further damage or inflammation from the already damaged disc.

In PTF, muscles have a double whammy effect on the pain-generating cascade. The injury itself caused muscle damage and persistent localized spasms, causing ongoing pain signals. But the muscles may be forced to work harder because tother tissues (e.g., discs, facets, ligaments) were permanently damaged and cannot do their jobs of stabilizing the spine. Hence, the muscles tighten and spasm up to assist in the stabilization, and more persistent pain signals are sent%u2026the double whammy effect.

Facet joint dysfunctions. Australian researcher Nikolai Bogduk and his colleagues have demonstrated how the cervical facet joints (joints in the vertebra of the neck) especially are a major trigger of chronic pain. The facet joints may be unstable because the capsular ligaments were damaged or overstretched from the whiplash. Loose ligaments cannot hold the joints together as tightly as needed to stabilize them, and any "extra" movement in the facet joints triggers pain. The facet joints may be too restricted or tight, leading to instability. Muscle spasms can tighten or restrict the facet joints, causing pain from immobility.

Intervertebral discs. These areas can become chronic pain generators if the whiplash trauma caused tears or defects in the disc's annular ligament. Dr. Bogduk's work noted up to 50% of chronic whiplash patients have problems with these discs.

Nerve injuries. Direct injuries to nerves can result in chronic pain generation, as opposed to indirectly signaling chronic pain through normal uninjured nerves. Nerve roots, brachial plexus, and sympathetic nerves can all be bruised, stretched or damaged from the whiplash trauma and never heal properly, causing chronic pain signals.

All of the above sources can feed into the sensitized central nervous system (spinal cord and brain) and maintain, aggravate, and permanently worsen the PTF's chronic pain state.

TREATMENT OF POST-TRAUMATIC FIBROMYALGIA (PTF)

Just as in nontraumatic fibromyalgia, no one single treatment eliminates the symptoms of PTF. Currently there is no cure for this disorder. However, various treatments can help those with PTF even if the condition is not cured. Each person's treatment program needs to be individualized, and what works for some may not work for others. Hopefully each patient will find some treatment that helps to deal with the chronic pain.

[Other chapters on medications, therapeutic injections, and physical medicine treatments] review in detail the various treatments for fibromyalgia. The treatments for PTF are really the same, since fibromyalgia is fibromyalgia regardless of the cause!

TREATMENT GOALS

Overall, six main treatment goals can be identified for each person with PTF:

Decrease pain. The ideal goal is to eliminate pain altogether, but this rarely happens because PTF has no known cure at this time. Many treatments can reduce the pain, however, even if it is still present. Sometimes a remission occurs where the pain is hardly noticed although painful tender points are still palpable on exam.

Improve function. The ability to perform everyday activities such as dressing oneself, driving, moving about, and eating is the basis for "quality of life" issues. If pain interferes with basic daily activities, the patient with PTF usually reports a poorer quality of life. Pain can interfere with work abilities, especially if the job requires a lot of reaching, bending, or lifting. Optimizing job functions is an important treatment goal.

Promote healing of any residual injuries. If residual damage to tissues is still present and contributing to pain, instability, ongoing irritation or inflammation, then treatments to promote healing of this damage should help.

Prevent worsening or complications. If residual damage to tissues is present and cannot be healed, then the goal becomes avoiding further damage or complications.

Decrease the risk of re-injury or flare-up. If PTF is chronic and permanent, than a goal is to keep it at a stable baseline, or a level where the pain can be successfully managed. A stable baseline free from annoying flare-ups may sound boring, but is exactly what is hoped for.

Find a successful home program to control symptoms. This goal is the ultimate prize. One hopes the therapy program works, and learns to do the program on his/her own to maintain a stable baseline.

In PTF, various types of treatments are prescribed in order to achieve as many individual treatment goals as possible. Some treatments may work better than others, and usually the combination of all the different treatments can lead to overall improvement.

Since WHEN did "Disability" become a dirty word?

Over the last 10 years, I have painfully discovered that there are NO 'breaks' in the U.S. for former professionals who were forced to leave the workforce due to the discovery and development of a disabling disease. Also, the American public just doesn't understand that being 'disabled' does NOT mean one is completely UNable to do ANYthing; the definition includes those experiencing a decrease in functioning AS COMPARED to one's past capabilities. For example, if you were able to work in a six-figure income career and now cannot even concentrate enough to flip burgers for half a day, you CAN be considered 'disabled'.

To make it worse, if you are single with little or no support system, as often 'highly-functional' people are since they were also seen as extremely self-sufficient, there is really NO supportive social services either available to, or appropriate for, you, either. In essence, you're now sick, AND ABANDONED. The American public either doesn't realize this, or doesn't WANT to accept, that this population exists.

People with Chronic Fatigue, Fibromyalgia, and many other disabling conditions, for that matter, don't often 'look' sick. They are often 'bullied', or ignored, by the very people who are supposed to (or are assumed will) help them: social workers, therapists, doctors, social security employees, friends, even family. I know this because I have experienced it.

I've gotten to the point where I don't even try to get help anymore. I spend most of my days lying in bed, at home. When I DO feel well enough go out (or because I HAVE to get something done), I have lots of anxiety of being around people. Sad, but true. I find myself rushing to get home and crawling back into my 'hole'.

So, if you know of someone with Chronic Fatigue, Fibromyaliga, or some other disabling condition, and they are either single and/or live alone, REACH OUT! GO KNOCK on their DOOR! Take time to stop and say 'hello'.

If you're one of those highly-functional, work-hard-play-hard people who never stops to smell the roses? I have some advice: DON'T allow yourself to get caught up in the vicious rat race of life by trying to live up to others expectations, or be accepted. Most of society lives a very unhealthy pace of life.

FOR YOU FELLOW CHRONIC FATIGUE and FIBRO SUFFERERS: Keep life simple; enjoy the simple things. Do what makes YOU feel good, even if you have to do it alone, and even if it's extremely difficult to kick yourself in the butt to get up and out. You feel better once you do.

Now please browse through the links below, or leave your feedback at the bottom of the page. And do whatever it takes to stay healthy! JULIE follow JulieC3 on Twitter

Is it Fibromyalgia or Chronic Fatigue? Fibromyalgia as a Complication of Injuries

Since WHEN did "Disability" become a dirty word?

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