A summary of research suggesting fibromyalgia & ME/CFS are distinct illnesses

Is chronic fatigue syndrome the same illness as fibromyalgia: Evaluating the ‘single syndrome’ hypothesis
– Source: QJM (Quarterly Journal of Medicine), Aug 26, 2012

By Bhavna Abbi, Benjamin H Natelson

[Note: Dr. Benjamin Natelson, MD, is head of the Pain & Fatigue Study Center at Beth Israel Medical Center in New York, and one of the world’s most respected medical experts on ME/CFS and FM. As an expert in neurology as well as the infectious & immunological causes of pain and fatigue, Dr. Natelson has worked for years on projects to better characterize and classify these often co-existing syndromes.

In this detailed review article, he and Bhavna Abbi at the War Related Illness and Injury Study Center in East Orange, NJ, lay out the evidence to date suggesting that the underlying pathophysiology of fibromyalgia may be different than that of ME/CFS.

Although the full text of the article (abstract below) is fee-based, Dr. Natelson indicates the identified differences fall into these categories:

General (e.g., age of onset patterns);

Hormone and neurotransmitter dynamics (e.g., regarding somatomedin/growth hormone, melatonin, cortisol, spinal fluid substance P);

Genetic profiles, and gene expression (e.g., gene upregulation patterns after exertion)

Mechanisms of autonomic function;

Muscle biochemistry;

Sleep disruption patterns/factors;

Comorbidities (e.g., PTSD rates). 

And the work continues. Dr. Natelson has extended a request to our site visitors, asking for ME/CFS and fibromyalgia volunteers to take part in several current studies designed to fill in further pieces of the puzzle. (See “Dr. Natelson recruiting for CFS & FM studies in NYC.”)

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Chronic fatigue syndrome (CFS) and fibromyalgia (FM) are medically unexplained syndromes that can and often do co-occur. For this reason, some have posited that the two are part of the same somatic syndrome-examples of symptom amplification.

This hypothesis would suggest that few differences exist between the two syndromes.

To evaluate this interpretation, we have searched the literature for articles comparing CFS to FM, reviewing only those articles which report differences between the two.

This review presents data showing differences across a number of parameters – implying that the underlying pathophysiology in CFS may differ from that of FM.

We hope that our review encourages other groups to look for additional differences between CFS and FM.

By continuing to preserve the unique illness definitions of the two syndromes, clinicians will be able to better identify, understand and provide treatment for these individuals.

Source: QJM (Quarterly Journal of Medicine), Aug 26, 2012. PMID: 22927538, by Abbi B, Natelson BH. War Related Illness and Injury Study Center, DVA Medical Center, East Orange, NJ (Abbi); Pain and Fatigue Study Center, Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York, NY (Natelson), USA. [Email: bnatelson@chpnet.org]

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