Fibromyalgia syndrome (FMS), chronic fatigue syndrome (CFS), multiple chemical sensitivity syndrome (MCS), myofascial pain syndrome (MPS), and other conditions form a family of overlapping syndromes. In fact, more than one syndrome. Thus, FMS and CFS as being part of a larger spectrum of conditions, which he called Dysregulation Spectrum Syndrome or DSS (see diagram below). A new term (dysregulation) means biophysiological abnormalities, possibly in the body's neurological, hormonal and chemical systems.

It is always important to keep these overlapping syndromes in mind because the presence of one or more syndromes could impact your treatment.

Most practicing physicians and researchers alike will tell you that the chronic pain diagnosis a person first receives is often colored by their chief symptom complaint. For example, widespread muscular pain is often diagnosed by rheumatologists as fibromyalgia syndrome. A person who is overcome by extreme fatigue and flu-like symptoms might consult an infectious disease expert and receive the diagnosis of chronic fatigue syndrome. A person who has severe jaw pain might see a dentist and be told that they have temporomandibular joint dysfunction (TMJD). People who appear to have allergic-type symptoms to a number of chemicals, foods, or odors may be informed by an allergist that they have MCS. Similar situations occur with the other conditions in the family of Dysregulation Spectrum Syndrome.

Criteria for Diagnosis
If you are devastated by symptoms of severe widespread pain and daytime exhaustion, yet your blood tests are normal, you may have fibromyalgia syndrome or chronic fatigue syndrome. Both are serious chronic illnesses that have specific criteria for diagnosis, but may be overlooked. Also, you should be aware that the distinction between fibromyalgia and chronic fatigue syndrome is "very fuzzy rather than sharp," and up to 70% of fibromyalgia patients meet the diagnosis for chronic fatigue syndrome.*

Fibromyalgia Syndrome (FMS)
Routine lab tests do not detect the widespread pain of fibromyalgia. Instead, the diagnosis is made by a physical exam that takes about five minutes. When light pressure is applied to the surface of the muscles throughout the body, patients with fibromyalgia find this painful, especially at the tender points used for diagnosis.

To meet the fibromyalgia criteria for diagnosis, patients must have:
A. Widespread pain in all four quadrants of their body for a minimum of three months

B. At least 11 of the 18 specified tender points (see diagram**)

The 18 sites used for the fibromyalgia diagnosis cluster around the neck, shoulder, chest, hip, knee, and elbow regions. The finger pressure that must be applied to these areas during a "palpation" exam is roughly equivalent to the amount that causes the finger nail bed to blanch or start to become white. Over 75 other tender points have been found to exist, but are not used for diagnostic purposes.

While many chronic pain syndromes display symptoms that overlap with fibromyalgia, the 1990 American College of Rheumatology (ACR) multi-center criteria study (published in the February 1990 issue of Arthritis and Rheumatism) evaluated a total of 558 patients, of which 265 were classified as controls. These control individuals weren't your typical healthy "normals." They were age and sex matched patients with neck pain syndrome, low back pain, local tendonitis, trauma-related pain syndromes, rheumatoid arthritis, lupus, osteoarthritis of the knee or hand, and other painful disorders. These patients all had some symptoms that mimic fibromyalgia, but the trained examiners were not foiled—they hand-picked the fibromyalgia patients out of the "chronically ill" melting pot with an accuracy of 88%. Fibromyalgia is not a wastebasket diagnosis!

Although the above diagnosis focuses on tender point count, a consensus of 35 fibromyalgia experts published a report in 1996 saying that a person does not need to have the required 11 tender points to be diagnosed and treated for fibromyalgia (Wolfe F, et al. J Rheumatology 23(3):534-9, 1996). This criteria was created for research purposes and many people may still have fibromyalgia with less than 11 of the required tender points as long as they have widespread pain and many of the commonly associated symptoms below.

fatigue
irritable bowel (e.g., diarrhea, constipation, etc.)
sleep disorder (or sleep that is unrefreshing)
chronic headaches (tension-type or migraines)
jaw pain (including TMJ dysfunction)
cognitive or memory impairment
post-exertional malaise and muscle pain
morning stiffness (waking up stiff and achy)
menstrual cramping
numbness and tingling sensations
dizziness or lightheadedness
skin and chemical sensitivities

Do you meet the diagnosis for fibromyalgia?
If you meet the diagnosis for fibromyalgia, learn how to remain optimistic despite setbacks or difficulties relating to others who cannot see your pain. Join the Fibromyalgia Network to learn the latest in research, treatment, and coping news. Member benefits include:ad-free, patient-focused quarterly Fibromyalgia Network Journal , monthly eNews Alerts, physician and support group referral , toll-free support phone number, and much more.

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Chronic Fatigue Syndrome (CFS)
If you struggle with daily fatigue, you are not alone. Ask your doctor about other diagnoses that could be producing your energy drain because additional tests and treatments may be warranted. Fibromyalgia patients tend to battle more fatigue than any other rheumatic disease diagnosis and should be routinely evaluated for chronic fatigue syndrome, sleep disorders, and common overlapping conditions. Click here to learn more about the diagnosis of chronic fatigue syndrome. For information on sleep disorders and conditions that overlap with fibromyalgia

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Sleep Disorders in Fibromyalgia
Two common sleep disorders that may be present in fibromyalgia patients are: restless leg syndrome (RLS) and periodic limb movement during sleep (PLMS). According to sleep researcher Harvey Moldofsky, M.D., of the University of Toronto, RLS has been described as someone playing soccer all night long. The patient’s arms and legs just cannot stay still. PLMS may feel like a startling response that occurs when you think you have reached the last step going down a flight of stairs and you fling your limbs to catch your balance as you discover that there is one step remaining. Both RLS and PLMS can cause continuous arousal movements during sleep and impede your ability to wake up feeling rested.

Referring to the specific sleep disorders of RLS and PLMS, Dr. Yunus comments that a sleep study might be helpful if a physician suspects either condition. First of all, it may offer an objective test finding that is lacking for most fibromyalgia patients. Secondly, the treatment for RLS or PLMS is a benzodiazepine with anti-seizure properties such as Klonopin (clonazepam), or a dopamine-like drug such as Mirapex or Requip. The most commonly used medications for fibromyalgia, such as tricyclics like Elavil and trazodone, can actually make this subgroup (30%) of patients worse. Therefore, it is important that you assist your physician by providing accurate symptom information regarding your sleep to help identify related syndromes. This can aid in the development of appropriate treatment strategies.

Could fibromyalgia be part of a newly discovered sleep disorder?
Novel findings are continuing to shape the direction of research and theories about the cause of these overlapping syndromes. In the October 2004 issue of the Fibromyalgia Network Journal, a recently identified sleep disorder was found in 27 of 28 fibromyalgia patients tested. Is this just a fluke or could a disruption of sleep truly be the origin of your symptoms? Jed Black, M.D., Medical Director of Stanford's Sleep Clinic addresses this topic in the January 2006 issue of the Fibromyalgia Network Journal. To read about answers to new and intriguing questions, become a Member of Fibromyalgia Network. As new research discoveries are presented by scientists in the field, you can rely upon Fibromyalgia Network to cover them! To join, call (800) 853-2929.

Call to set up a nutritional consultation so that tests can be performed and a comprehensive strategy of lifestyle, dietary modification and nutrient supplementation can be implemented to aid you in reversing this debilitating disorder and begin to live again.

For an appointment with Dr. Rispoli, contact our office at: 818 707-3126 and visit our web site www.completehealthinstitute.com go to lab tests and click on appropriate test for more information about these Functional Laboratory Tests.