FATIGUE: What is FM and CFS?

  • October

    Fatigue is reported in 25% of general medical visits with widespread chronic pain at 10-12% (Jason et al., 1999). Chronic fatigue syndrome (CFS) and fibromyalgia syndrome (FMS) contribute to 3% and 2-6% of the reported population, respectively (Bested andLogan, 2008). This percentage is most likely an under-representation of actual cases due to under-reporting and misdiagnoses.


    Fibromyalgia (FM) is a complex, multi-faceted disease with many hypothesized causations and no true etiology. The American College of Rheumatology has recently replaced the classic “11 of 18 tender point” criteria with identifying the Widespread Index of Pain in 19 specific regions and the Symptom Severity Scale (0-12 total score) (Wolfe, 2010).

    11 of 18 Tender Point criteria

    11 of 18 Tender Point criteria

    Criteria for Diagnosis of Fibromyalgia
    (Crofford, 2012; Wolfe, 2010)

    1. Pain and symptoms over the past week, based on the total:

    Number of painful areas out of 18 parts of the body plus level of severity of these symptoms (0-3 scale for each symptom):

    a. Fatigue
    b. Waking unrefreshed
    c. Cognitive (memory or thought) problems

    Plus number of other general physical symptoms (0-3):

    • Numbness, dizziness, nausea, irritable bowel syndrome or depression.

    2. Symptoms lasting at least three months at a similar level

    3. No other health problem that would explain the pain and other symptoms

    Since there is no one etiology for Fibromyalgia, there are various theories including;

    • Genetic predispositions and abnormalities,
    • Mitochondrial dysfunction,
    • Abnormal vitamin and mineral levels,
    • Thyroid dysfunction,
    • Autoimmune diseases,
    • Adrenal disorders,
    • Cerebellar tonsil herniation ,
    • Immune dysfunction,
    • Infections,
    • Side effects of vaccinations,
    • Anaemia,
    • Toxic exposure,
    • Cancer,
    • Psychological disorders,
    • Physical and mental trauma,
    • Excessive stress

    Chronic Fatigue Syndrome/ Myalgic Encephalomyelitis

    Chronic Fatigue Syndrome (CFS) is also known as Myalgic Encephalomyelitis (ME) and is a debilitating condition with marked fatigue lasting over 6 month (Prousky, 2008). The Journal of Chronic Fatigue Syndrome states that in order to be diagnosed with CFS, a patient must contain the following:

    Criteria for Diagnosis of Chronic Fatigue Syndrome
    (Carruthers et al., 2003; Bested and Logan, 2008)

    1. Fatigue: new onset, unexplained recurrent physical and mental fatigue that significantly alters activity level.

    2. Post-Exertional Fatigue: after physical activity there is an increase in symptoms and/or an extended recovery period usually lasting a day or more.

    3. Sleep Dysfunction: There is unrefreshed sleep and/or difficulty getting to or maintaining sleep.

    4. Pain: There is a significant degree of muscle pain. Pain can also be experienced in the joints and is often widespread and changes location. Often there is a new onset of headaches post-illness. Headaches may be of a different quality and in a different location than in the past.

    5. Two or more Neurological/ Cognitive Manifestations:

    • Confusion;
    • Impairment of concentration and short-term memory;
    • Disorientation;
    • Difficulty with information processing, categorizing, and word retrieval;
    • Perceptual and sensory disturbances.

    The Expert Panel describes overload phenomena, cognitive and sensory—ie. heightened sensitivity to lights and noises—and/or emotional overload, which may lead to “crash” periods and/or emotional symptoms.

    6. At least one symptom from two of the following categories:

    a. Autonomic Manifestations:
    • blood pressure abnormalities (particularly when rising from lying or seated position, often called delayed postural hypotension or orthostatic hypotension);
    • light-headedness;
    • nausea and irritable bowel syndrome;
    • urinary frequency and bladder dysfunction;
    • heart palpitations;
    • shortness of breath with physical activity.

    b. Neuroendocrine Manifestations:
    • “Thermostat” regulation is lost, presenting as lowered body temperature with significant daily fluctuation, sweating episodes, recurrent feelings of feverishness and cold extremities;
    • intolerance of extremes of heat and cold;
    • significant weight change—lack of or abnormal appetite;
    • worsening of symptoms with stress

    c. Immune Manifestations:
    • tender lymph nodes;
    • recurrent sore throat;
    • recurrent flulike symptoms;
    • general malaise;
    • new sensitivities to food, medications, and/or chemicals.

    7. The illness is chronic and lasts for at least six months in adults, three months in children. It usually has a distinct onset, although it may be gradual.

    Chronic Fatigue Syndrome is thought to have multi-factorial pathogeneses, but it is believed that viral infections are the initial trigger (Prousky, 2008). Therefore, CFS often develops from a post-viral infection that causes fatigue for more than 6 months. There have been studies correlating post-viral fatigue to SARS disease, XMRV infection, Epstein-Barr virus (Mononucleosis), Coxiella burnetii virus (Q-fever), Ross River virus, Borrelia burgdorferi (Lyme disease), Brucellosis, and Campylobacter gastroenteritis.

    For more information about condition diagnoses, relevant laboratory testing and potential treatment plans please book an appointment at the Robert Schad Naturopathic Clinic (RSNC) in Toronto, ON.

    The Fibromyalgia and Chronic Fatigue Syndrome specialty shift at the RSNC is supervised by Dr. Louise McCrindle, ND.

    Keep up-to-date on the latest research for Fibromyalgia and Chronic Fatigue Syndrome by read other related topics:

    Here are my FM/CFS book recommendations from fellow medical colleagues:

This website is NOT to be used as a diagnostic or treatment tool. Always consult with your Conventional Medical Doctor or Naturopathic Doctor for specific concerns. In cases of medical emergencies visit your nearest hospital or call 9-1-1.