Etiology and Laboratory Testing of Chronic Fatigue Syndrome and Fibromyalgia
In the past, CFS and FM have been diagnosed on exclusion of similar appearing conditions. Due to the widespread symptoms experienced by a patient it is common to observe multiple dysfunctions within the same person contributing to their debilitated state. Such common conditions to rule out include the following: Addison’s disease, Cushing’s syndrome, hypothyroidism, hyperthyroidism, iron deficiency, iron overload syndrome, anemia of various types, diabetes mellitus, cancer, treatable sleep disorders (ie. apnoea), neurological and auto-immune disorders (ie. multiple sclerosis, Parkinson’s disease, myasthenia gravis, B12 deficiency); infectious diseases (ie. AIDS, hepatitis, tuberculosis, Lyme disease), Celiac disease, primary psychiatric disorders and substance abuse (Bested and Logan, 2008).
In order to rule out the above conditions, laboratory testing and imaging is necessary. Below is a thorough but not exclusive list of testing that is commonly performed with CFS and FM patients in order to rule out other pathophysiology or co-morbid conditions:
Blood tests: CBC, ESR, serum electrolytes, glucose, Calcium, RBC Mg, phosphorous, TSH, T3, protein electrophoresis screen, CRP, Ferritin, Creatinine, Rf, ANA, CPK, Liver function tests, Urinalysis.
Brain/ cervical imaging: SPECTS scan (blood flow, glucose uptake), MRI (white/ grey matter, Chiari Malformation, phospholipis, abnormal pain processing areas).
Neuroendocrine studies: HPA, CRH, ACTH, Cortisol 4 point salivary test.
Neuropsychological investigation and testing: cognition, brain fog, slowed processing speed, impaired working memory, inability to multitask, poor leaning of information, depression.
Other: Functional testing; food intolerances and allergies; oxidative stress; heavy metal toxicity, genetic testing, sleep studies.
Additional testing depending on personal and family history: STI, hepatitis B and C, tuberculosis, HIV, cancer.