Q: I was diagnosed with CFS in 1994, and fibro in 1998. Was CFS an onset to fibromyalgia? What is the difference?
A: A long time ago I wrote a book, and in it I described “lumpers” and “splitters”. A lumper is one who gathers all similar vegetables in one basket and carries it to the house. A splitter separates the squash from the eggplant and carries them to the house in two separate baskets. I have always been a lumper, although I recognize the need for the splitters at times.
Take for example the question of Down’s Syndrome. When I was in training, Down’s Syndrome was known as trisomy 21, that is an extra chromosome 21 present first described by John Langdon Down in 1866. It caused a specific abnormalities in facial appearance, cognitive issues, growth and other areas. It was thought to be very specific and unique to this extra chromosome 21.
Now, however, we know that the same syndrome can exist with pieces of chromosome 21 in excess, or in the attachment of the long arm of chromosome 21 to another chromosome, a process called translocation. A lumper would call these variations irrelevant as the clinical disease is basically the same. A splitter would say that they are different genetic diseases.
I feel that ME/CFS is the same basic illness as fibromyalgia, and I hope no one has a stroke because I have said this. It is well known that FM is very common in ME/CFS, and I published a paper saying that in kids, 75% of those with ME/CFS also have fibromyalgia. Depending upon the criteria used, this figure would be different. In one family I saw in Lyndonville, several kids became ill. One had very little pain, clearly a case of ME/CFS. In a sibling, pain was by far the most severe symptom, but because they both became ill from the same family, they must have had the same illness.
Another point that is important is that at the beginning of whatever illness this is, fatigue and viral symptoms predominate. After several years, the muscle and joint pain becomes more of a problem. So in your question about two diagnoses separated by several years, I see this as the natural history of the disease, not the presence of two separate illnesses. Best of luck. David Bell, MD