Are Fibromyalgia and Other Chronic Conditions Associated?

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By ImmuneSupport Staff

An article by Muhammad Yunus, MD, Professor of Medicine at the College of Medicine at Peoria, looks at how fibromyalgia (FM) and several other chronic conditions, such as chronic fatigue syndrome (CFS), myofascial pain syndrome, headaches, irritable bowel syndrome (IBS), Gulf War syndrome, etc., may possibly be similar conditions.

Dr. Yunus cites various studies that have shown how these syndromes are associated and how not just one, but several of these syndromes, can be present in the same patient. In addition, studies have proposed that these syndromes have overlapping features and are linked by common characteristics.

Researchers have come up with a common name for this occurrence – Central Sensitivity Syndromes (or CSS). CSS is related to the central nervous system’s ability to vary in developmental pattern or behavior according to varying environmental conditions on cellular, molecular, membrane, and neurochemical levels in response to outside stimulus.

These CSS syndromes share several characteristics – pain, hyperalgesia, poor sleep, and fatigue. In fact, as a group these CSS syndromes are likely to be the most common conditions that a patient consults a physician about.


By Muhammad B. Yunus, MD

It has become increasingly clear that fibromyalgia (FMS) and several other chronic conditions, such as chronic fatigue syndrome, myofascial pain syndrome, headaches, irritable bowel syndrome, restless legs syndrome, primary dysmenorrhea, temporomandibular pain and dysfunction syndrome and female urethral syndrome are similar conditions. Gulf war syndrome is quite similar to FMS, and chemical sensitivity has not been well defined. A number of controlled studies show that these syndromes are associated with each other, and many of them are present in the same patient. In 1984, we had proposed that these syndromes have overlapping features and are unified by a common pathophysiologic mechanism which was not well understood at that time (Yunus MB, Comprehensive Therapy 1984; 10:21-28). Subsequently it became evident that the binding glue for these common conditions is a neuroendocrine aberration that is generally different from those found in psychiatric conditions (Yunus MB, Bailtieres Clin Rheum 1994; 8: 811-37). Recent research suggest, as well reviewed by Bennett (Bennett RM, Mayo Clin Proc 1999; 74:385-98), that more specified neuroendocrine abnorn1ality may well be central sensitization which is likely to be the common biopathophysiological binder of these overlapping illnesses.

Although some members of the above mentioned overlapping group of syndromes may indeed show central sensitization in response to a peripheral afferent input, it is equally possible that the central nervous system is intrinsically sensitive, even in the absence of a noxious stimulus in the peripheral tissues, in these conditions. An appropriate nomenclature for this group of syndromes has therefore been suggested to be “Central sensitivity syndromes” or CSS (Yunus MB, Journal of Indian Rheum Association, in press). The concept of central sensitization/central sensitivity and the available evidence for central sensitivity for several members of CSS will be discussed.

Central sensitization is related to central nervous system (CNS) neuroplasticity, which involves transsynaptic, cellular, molecular, membrane, and neurochemical changes in the central neurons of the spinal dorsal horn and supraspinal structures, in response to a peripheral stimulus. Such changes lead to central sensitivity with an exaggerated and prolonged response to a painful stimulus, increased receptive field, wind-up or summation effect and painful response to an otherwise non-noxious stimulus (such as touch). Central sensitization/ sensitivity is determined by other CNS factors, e.g., neurohormonal interactions and cerebral cognition.

Central sensitivity and related neurohormonal aberrations in FMS are suggested by persistence and spread of dysesthesia following a non-noxious electric stimulation, hyperexcitability with temporal summation to repeated electric stimulation, increased amplitude of cerebral event- related potential evoked by CO21aser stimulation, a decreased regional blood flow to thalamus and caudate nucleus, and an aberrant HPA axis. In chronic fatigue syndrome, there is widespread lower pain threshold in muscles by electric stimulation, as compared with normal controls. HPA axis abnormalities as well as brain neuroimaging studies also support that CFS is a disease of CNS.

Patients with irritable bowel syndrome (IBS) have multiple tender points as well as heightened visceral sensitivity with amplification and spread of pain in response to noxious stimuli. Cerebral neuroimaging in IBS also suggest a central dysfunction of nociception. Central sensitivity in tension-type headaches is evidenced by a widespread distribution of pain as well as a qualitative difference in pain following a peripheral noxious stimulus. The role of central mechanisms in migraine is suggested by an involvement of hypothalamus, serotonin, excitatory amino acids, central trigeminal pathways and cerebral events. Nicolodi et al examined existing data and concluded that hyperalgesia related to CNS neuroplastic changes are crucial for both migraine and FMS (Niclodi et al, Cephalgia 1998; 18 (suppI21): 41-4). With regards to myofascial pain syndrome, Bendtsen et al have demonstrated qualitatively altered nociception in this condition, suggesting aberrant central pain mechanism (Bendtsen et al, Pain 1996; 65 :259-64 ).

Several characteristics are shared by the CSS members, e.g., pain, hyperalgesia, poor sleep, fatigue, a response to a centrally acting drug, and an absence structural pathology in the tissues. The usual laboratory tests or X-rays which are useful for detecting classic pathology are normal in CSS. However, neurohormonal and newer brain imaging studies are abnormal in CSS diseases, but these abnormalities are generally different from those seen in psychiatric conditions. Thus CSS does not fit the traditional dichotomy of structural pathology or psychiatry, but a third” paradigm of central sensitivity/ neurohormonal dysfunction. It is, however, important to recognize that the boundaries between these three paradigms are not rigid and that there are some overlaps between them. For example, subgroups of rheumatoid arthritis as well as FMS have a psychological/psychiatric component, and FMS may be associated with, or triggered by, diseases of structural pathology, such as RA and systemic lupus erythematosus, as well as trauma. The diseases of these three chronic disease paradigms can be satisfactorily explained only by a biopsychosocial model. The boundaries between the so-called organic and functional disorders are more artificial than real. For this reason, I often use the tenus ‘disease’ and ‘illness’ synonymously.

The CSS members are probably the commonest conditions as a group for which a patient consults a physician for their immense suffering. Greater academic and clinical interest as well as an increased level of research funding are strongly warranted for these real illnesses.

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8 thoughts on “Are Fibromyalgia and Other Chronic Conditions Associated?”

  1. brebka says:

    I was diagnosed with fibromyalgia and cutanious lupus in 06 after aleast 5 yrs of failing health, i have flare ups on the fibro that can last months with muscle ands joint pain and constant fatigue. i also was told that some of my joint pain was from osteo. when i have the skin flare ups from the cutanious lupus, it’s like having someone peel back layers of your skin and pour gasoline and light a match and then lay your skin cover over the flames and feeling like it burns down to the nerve endings. the discomfort is unbelievable. they have to use predinsone to stop the burning. they tried me on plaquenel but i was alergic to it and developed another skin problem called lichen planus. after the plaquenel was stoped, the lichen planus went away. they don’t want to try me on any other ammune supressant drugs and so my flare ups ar at random, in which seem to happen when i’m under alot of emotional and physical stress.I have been denied ssdi and ssi and have been fighting this claim for 3 yrs now. what can i do?? can anyone talk to me about this? thank you, brebka

  2. brebka says:

    I would like to know if any of the readers of this prohealth site either have or no someone with cutanious lupus and talk to me about treatment that keeps it under control. I was put on plaquenel but was allergic to it and my DR’S have decided to leave it untreated which leaves me with flare ups at random and then it is treated with prednisone as the flare ups occur. I have a chronic inflamation condition and most always have a sed rate of around 40. can any one offer any advice? thank you, brebka5

  3. laney2 says:

    I was surprised to see the list of common sydromes you presented. I fit nearly every one. It is so uncommon that anyone relates all of the syndromes to fibromyalgia, chronic fatigue, irritable bowel syndrome, restless legs syndrome, etc. This gives me hope that someone will find a way to relieve this mess. I have all of the above and would sure like to find relief from all of these. Laney2

  4. says:

    i have had fibro since 2001.My first sign something was wrong,I got up out of bed to go to the bathroom, when my feet hit the floor, it felt like i had stepped in hot coal’s !!never had I expierened anything like that !! I finally made it to the bathroom,and got back in bed, but could not go back to sleep !! Wondering what had just happened to me !! Then my right leg at hip joint,began to give out so I had to start using a stick till I could get a cane ! Then I got Chronic fatigue syndrome, When My husband would leave I would hit the bed!! When I heard him pull up in drive, I would jump up and act like I was being useful!then the pain started, migraines,bronchites,! I could no longer hide it,I could not stand to be touched, to shake hands with some one,would bring me to my knee’s !! Went to many Dr.’s had so many test’s,every test there is for artherits ! Irratable bowl syndrome!One Dr. I went to was determined to find out what was wrong with me. She put me thru every test imaginable,so when I went to get my results,she said, well,I have good news, and bad!! All my vital organs she checked were very good,the bad news is I can’t find what is causing you so much pain!I told her it was good to know I was healthy,but what can I do, I can’t live like this,it did destroy my marrige, I did not tell my husband,too much, he had no patience for sick people,perhaps if I had opened up,we could have saved the marrige , and he would stick by me, but because I tried to avoid physical contact, he found some one who would !!We had a nasty divorce, and the stress and trama, plus he was an abuser,so I fell totally apart!! I could only get to the court, and back home to bed !! I could hardly move!i wanted to get out with my friends and have some fun!! I lost 65lbs.Even my ex. commented on how bad I looked !! After a year or more, I went to the Mescalero Indian clinic.He looked at all my recors from various Dr’s so he tested me for fibromyalga and of the 19 points they go by,I had 18 ! He gave me vicadin,for pain, and zanez for my panic atacks,celexa for depression,so I could sleep.I had stomach problems!I hard a very severe case of the desease. After all these years no end in sight for me !!I had diverticulosis,Dr. said I had had it for a very long time,it was very big,so he took out 2-3inches out of my large colon. do you have fibro fog ? You go to do something, and go blank? Lack of concentration?? In 2005,my precious daughter was taken from us !!She left 2 beautiful children.Her Daugher had gotten married, I got custody of her son, her such a dog !We are not supposed to outlive our children,She would be with me when I went to the dr’s !! She said I know you Mom,you won’t tell them everything !! HAHA she hovered over me made me go places with her and the kids, I’m so glad she did,I had quality time with her and my grandkids !! There is nothing more painful,I had lost my little brother 5 months before her.So without my zanex and pain meds.I see no relief in my future,that’s why i don’t see getting better, without meds.i can’t survive ! She was my precious,and if i run out of meds.I can’t get her out of my mind,She was loved by everyone who knew her,she is remembered by her beautiful smile, and hugged everyone she met,she loved life,her kids, her family!!Well,I got off the track a little,I learned a lot,to count my meds. when I get them !! I take 3 vicadin a day, and 3 zanex,I need more. If I run out I am in so much pain,can’t walk,with my meds. I can function pretty well.I hope I helped some one !! Bless all who have this hidious illness !! paperrozy

  5. sanchez5247 says:

    have had this bad thing for 12 years and was able to cope with it all this time, until last year 2009. now I know why so many people out there with this is in so much pain. no one can know how bad we feel unless they have it. fibromyalgia is terrible. didn’t really know what to exspect with it and now I am beginning to find out thanks to all of you. Im not crazy after all. I thought I was looseing it. I go to see my DR. and I think something bad is taking place with my body and he tells me its my fibromyagia. I guess I didn’t really know what this thing I have was about but you all say what I am feeling so at least Im better prepared for what is going on. I hurt really bad but what gets to me worse is my moods I get so mad or I think every one is out to get me ect.ect.the fog they talk about is with me a lot and I don’t like the way my mind is. I had to think for a few moment what my own name was. now how much worse can that be. most of you talk about the pain is there any one else out there that can relate to the way my mind feels?

  6. Mustangnv says:

    getting on ssd with fibro is difficult. i got lucky it only too little over 3 years but i had physical problems with my legs as well. i had to go all the way to the hearing and then it was just a rubber stamp. they told my lawyer even before they called me into the hearing that they were going to give it to me. there is only one thing i would have done differently and that was get a lawyer before i even filed the first time. as it was i got a lawyer the day i got my first denial. i am ex military and i know how the government works. i really think that the ssd board doesn’t even look at the medical history before they send back the first denial. they just stamp denied and hope you will give up. best thing i did is that i gave them enough paperwork that it was at least 4x what the others i saw in the hearing had given. it was in a small box it was so much. i gave them everything from the day i got to korea which is where i manifested, to the day i went to the hearing. i would go get my med records every few months and submit them to both the va, for my unemployablity and to ssd. that was about 6 or 7 years ago. the best advice i can give you is to keep at it. bombard them with information. as they say the squeaky wheel gets the oil. don’t let them win because they want you to give up. that is really why they take so long. but what ever you give them make sure you have at least one if not two copies in different places so that if they lose it, and they will, you can replace it easily. good luck

  7. autoharp15 says:

    I am so sorry for your loss. You are right a mother should not out live her children but unfortunately this does happen. I was diagnosed with Fibro in 2002. At first my stepdaughter tried to convince my spouse that I was mentally ill. Thankfully he met some one he worked out with that also had fibro and did not think I was nuts. I also made him come to the Doctor with me so he could get it straight from my doctor. So not only was I in terrible pain but I was being looked at as though it was all in my head. Strangely enough I started nursing school in 2004 and that imaginary illness was in my text books. It was a start. I still hesitate to tell anyone I have this illness due to the negative reactions I get. Now thru the media and education Fibro is accepted by most as a true disease. There are no support groups in my area for people with Fibro so I still feel pretty isolated. I have had a bad flare this week and its been pretty bad. And I guess it doesn’t help that I keep telling my spouse I am ok for fine when he knows thats a lie. I just get so mad at myself for not being able to do what I need to do. I have already cut my working hours to just 2 days a week. And sometimes thats more than I can handle. I am a nurse at a Long term facility and its really hard work. But I love all of my patients and I just can’t give it up. I am currently on Elavil and Lyrica. The Elavil helps me sleep and the Lyrica helped at first but is not helping anymore. I have tried Cymbalta which gave me terrible headaches. I am at a loss as to what to do next. I am so exhausted and in so much pain I don’t know what to do. Sorry to dump on you but I needed someone to talk to that would understand where I am coming from. Thanks for listening.

  8. Mtnflower says:

    I have fibromyalgia, subcutaneous lupus, diverticulosis, restless leg, osteoarthritis, scoliosis, irritable bowel. I wanted to answer the person with subcutaneous lupus.
    I am sorry you are allergic to medications but I do have a suggestion that helps with the burning pain associated with the eruption of the sores. My dermatologist had prescribed Halobetasol Prop.0.05 (Ultravate). You might ask your doctor about it. It seems to help with the healing into plaques.

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