For years after I started practicing medicine I was frustrated by not being able to help the many patients who came through my door with complaints of fatigue with painful muscles.
It’s not that I didn’t believe them…how could I not. I firmly believe that most people have better things to do (like life!) than come to the doctor over and over again for the same thing. But there was obviously something missing in my many years of diligent training. The “aha” moment came for me when I found myself sliding into a “mystery disease” of my own.
Fibromyalgia is technically defined as widespread pain lasting more than three months along with tender points. Chronic fatigue syndrome is similar but with predominant fatigue, variable pain and other symptoms. Patients often describe foggy thinking, poor sleep, numbness, irritable bowel syndrome, TMJ, rashes, headaches or muscular twitching. There is no known single cause or treatment for fibromyalgia or chronic fatigue that we know of. But we are developing more and more ideas about it. It may, in fact be due to a variety of things at once and may differ from person to person. One key seems to be sleep. We know that improving sleep improves fibromyalgia. Various approaches have been used in general, from antidepressants to seizure medications such as gabepentin to guafenesin to acupuncture. Another possibility is overgrowth of bacteria in the small bowel. Some studies have shown a correlation between small bowel bacterial overgrowth, irritable bowel syndrome and fibromyalgia symptoms. Furthermore, the symptoms seem to improve by treating the bacterial overgrowth.
The best approach is to search for things that have gone wrong in the body system that are manifesting as the symptom complex of fibromyalgia or chronic fatigue. This may be different from person to person. Sometimes there has been an event that preceded the onset of fibromyalgia such as trauma. Other times, there might have been a preceding infection or a particularly stressful time period. Other times, there may be a picture of mitochondrial energy production challenges or toxicity issues.
The usual approaches to fibromyalgia and its related conditions can produce incomplete relief despite everyone’s best efforts. The vague and variable symptoms make people with fibromyalgia and chronic fatigue good candidates for a whole person approach to diagnosis and management. Conventional testing often shows no detectable abnormalities. Functional medical testing is often much more useful.
Whatever the cause, there is hope for reducing the symptoms of fibromyalgia.