We have found that it is increasingly common to find doctors diagnosing people as suffering both Fibromyalgia and Chronic Fatigue Syndrome. That is not unusual as most specialists now consider that both have a common underlying cause and simply lie at different points on the same spectrum. This is why newer tags such as ‘central sensitisation’, are being used in order to emphasise their similarities and common underlying mechanisms.
What do doctors mean by ‘Fibromyalgia’?
In a nutshell, the term ‘fibromyalgia’ is little more than a useful shorthand for doctors.
Symptoms are what patients report to their doctors. A particular symptom usually suggests several diagnoses to the doctor. The signs observed may narrow these down, but the doctor may require further investigations to identify the actual cause. Patients commonly report to doctors symptoms that have no explanation, but these are often mild, do not warrant further investigation and eventually disappear.
However, some patients persistently report intrusive, unexplained symptoms. Although one particular symptom is often reported as being dominant, further questioning usually reveals a wider range of symptoms. The most common are pain, fatigue, poor memory, poor concentration and sleep disturbance. Pain reported may be widespread or limited to a particular area.
Over the years, each medical speciality has applied their own ‘tag’ to those patients: gastroenterologists see irritable bowel syndrome; cardiologists see Da Costa’s syndrome; orthopaedic surgeons see coccydynia and rheumatologists see musculoskeletal pain (fibromyalgia), fatigue (chronic fatigue syndrome) and myalgic encephalomyelitis (or ME – multiple symptoms often with no one symptom predominating).
Doctors now recognise that these patients all belong to the same group with a shared underlying cause. To that extent, the various ‘tags’ are now considered unhelpful because their use suggests the existence of different conditions.
New, more general, names have now been coined to help address the confusion, but have yet to be widely accepted or used; most commonly ‘central sensitisation syndrome’ or ‘bodily distress syndrome’.
Unlike in the past, these conditions are now accepted by most doctors as genuine and a broad consensus agrees they are associated with abnormalities of neural processing within the central nervous system resulting in normal bodily sensations being perceived as unpleasant and distressing. Chemical, electrical, physical and functional changes have been identified in the brains of sufferers. In other words, objective signs have been recognised. A number of factors are thought to be involved, including genetics.
Psychological issues are accepted as an important factor in these conditions and there is a clear overlap with psychiatric ‘somatisation disorders’. In particular there is an association with depression, anxiety and adverse early life events.
Whilst there is a wide spectrum, doctors believe that in a ‘typical’ case there will be a history of early life stressors (bereavement, bullying, mental, physical or sexual abuse); onset of depression or anxiety during adolescence (when it appears that the brain is becoming hard-wired) and during adolescence and early adult life, the sufferer repeatedly reports unexplained medical symptoms that become intrusive.
The frequency of occurrence of these conditions depends on the definition but are remarkably high, with studies on the general population suggesting that up to 10% of people may suffer from them. However, the great majority of those people have mild symptoms and don’t ever seek medical help.