By Teresa Clarke, M.D.
Fibromyalgia (FM) and Chronic Fatigue Syndrome (CFS), also known as myalgic encephalomyelitis (ME), are similar conditions that affect an estimated 3% of all adults and cause significant disability and loss of quality of life. I have seen hundreds of patients in my practice with these two diagnoses and their symptoms seem to overlap; most patients with FM also have fatigue and most patients with the diagnosis of CFS also have some muscle aches.
In addition to muscle aches or fatigue, both groups have multiple symptoms in common such as irritable bowel, brain fog, poor sleep, headaches, reduced stress tolerance, anxiety, depression, allergies, sensitivities to light/sound/odors, bladder weakness, pre-menstrual syndrome, cold intolerances, numbness or tingling and immune system problems. Regardless of the diagnosis of either FM or CFS, both groups can benefit from supportive group therapy. I have facilitated group programs for FM and CFS for the past five years and have witnessed amazing transformations in the health of many participants.
Most of my group participants have been referred to me by their rheumatologist or family doctor and have a confirmed diagnosis of FM or CFS. I see them initially in a private consultation to review their history, symptoms and treatments tried. Almost all have been on a variety of medications such as antidepressants, muscle relaxants, sleeping medications, painkillers, etc., with limited improvement. Some have explored complementary therapies such as massage, chiropractic, acupuncture or naturopathic medicine with varying results. Most have been ill for a number of years and have almost lost hope that they could ever feel well again. After a few weeks of participating in a structured group program, they start to see signs of progress, and by the end of the program, the average improvement is a 50% reduction in severity of symptoms reported (assessed by questionnaires). How does a group program help people who have been ill for years in spite of numerous medical treatments?
First, we need to understand some of the complexities of FM/CFS. Common precipitating causes are car accidents, surgery, injury, severe prolonged stress, an emotionally traumatic event, pregnancy, severe respiratory or gastrointestinal infection and recurrent respiratory infections. Other contributing factors are poor diet, exposure to toxins, cigarette smoking, sleep deprivation and overwork. The causes are extremely varied. There is no single specific cause and that is why medical treatments often fail. Medical science excels at finding treatments for specific causes of disease such as antibiotics for an infection or insulin for diabetes. As FM/CFS has no specific cause there is no curative medical treatment. Prescriptions [medications] can only help alleviate symptoms. Sometimes prescription medications result in side effects that even reduce quality of life.
I believe that FM/CFS is a neuroendocrine dysfunction that happens to people with sensitive nervous systems. Each of us has biochemical individuality and unique coping resources. Some of us are at high risk of coming down with FM or CFS after experiencing one or more of the causes and factors described above.
The neuroendocrine disorder happens at the metabolic level causing widespread symptoms in many of the body’s systems at an invisible level such that we do not appear to be ill and standard medical tests are negative. The main location of dysfunction is the mid-brain which is a key relay station in the brain. It is the site of our emotional brain as opposed to the higher brain, which controls our intellectual functioning. Pain signals from the body coming up the spinal cord pass through the mid-brain before reaching the higher brain and we become aware of the severity of the pain.
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A dysfunction in the mid-brain may result in pain signals becoming magnified from anywhere in the body. Normal sensations such as light touch or pressure may be magnified into severe pain (the tender points of FM). The mid-brain also affects our autonomic nervous system, the nerves that serve as the automatic pilot of our internal organs going to our lungs, heart, bowels, bladder, uterus and the blood vessels of our circulatory system controlling blood pressure and circulation to our hands and feet. Dysfunction of the mid-brain can affect this system resulting in many of the associated symptoms of FM/CFS.
The mid-brain is also the emotional center of the brain and any weakness would result in emotional difficulties of anxiety, depression and poor stress tolerance. The tiredness of the brain spreads from the emotional areas to the cognitive or thinking brain causing “brain fog.” The mid-brain also contains the master endocrine gland of the body, the pituitary, which controls other glands such as the thyroid or adrenals with key stimulating hormones. This control system may not be functioning at optimal levels in spite of lab tests within normal range.
Thus you can see how a shock to the brain from any cause could have such widespread effects on multiple systems in the body. Instead of focusing on just helping symptoms as they arise we need to learn how to help the brain heal and bring the neuroendocrine dysfunction back to healthy balance. We need to look at the whole picture and have the courage to look at all aspects of our lives and all the contributing factors that made us sick or stop us from healing. Supportive group therapy works because the support of the group members gives us the motivation and encouragement to work on all aspects of our lives to promote healing and recovery.
My group program includes education on self-care, group sharing and practicing relaxation exercises or guided imagery to support healing. It starts with the basics of nutrition and making lifestyle changes such as exercising and stopping coffee, alcohol and smoking. Nutrition and good lifestyle habits provide the building blocks for regeneration of healthy mid-brain function. We then learn how to improve sleep, manage pain and stress, and learn how to cultivate positive thoughts and attitudes that will support mid-brain recovery.
We continue to encourage mid-brain recovery by exploring meaning and purpose in our lives and learning how to balance our lives in all areas – physical, mental, emotional and spiritual. Finally, we “spark” the mid-brain by inspiring the spirit and deeply connecting to our hearts. Our brain is not just a cluster of chemicals and molecules; it can respond positively to inspiration, love, sharing, art and music, etc. There is wisdom in the brain/body that facilitates the chemicals and molecules to adjust and respond positively to a wide variety of human experiences; this is the art of medicine. FM/CFS is an excellent example in which the science of medicine is insufficient. We may never discover the single chemical or drug to cure FM/CFS because there is a whole complex orchestra playing out of tune. It is time we explored the art of medicine to learn to conduct the orchestra to create the symphony of balanced health.
Participants in my programs have learned how to help themselves heal rather than looking endlessly for the chemical cure. They have learned how to create their lives as a work of art, integrating body, mind and spirit. The midbrain is stimulated back to healthy function and symptoms improve. I would like to encourage everyone living with FM or CFS to get involved in a group in your community, a group that follows a structured educational program that will allow you to learn how to help yourself heal in body, mind and spirit. Ask your doctor or your local FM or CFS society for programs in your community.
Each day is precious and the sooner we get on the road to recovery the sooner we return to health and improving our quality of life not just for ourselves but for our families and our communities.
May you be blessed with peace, joy, and love on your journey toward optimum health.
Dr. Teresa Clarke is the author of “Fibromyalgia 12 Week Recovery Program – a guide to healing and recovery for people with symptoms of fibromyalgia or chronic fatigue” and the companion CDs of guided imagery visualizations. Further information is available at: www.fmrecovery.com.