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Chronic Fatigue Syndrome Vs. Fibromyalgia: Symptoms To Look For And How To Tell The Difference

Wednesday, December 27, 2023 2:28AM

Fibromyalgia and chronic fatigue syndrome are two mysterious and debilitating conditions - and they're often confused with each other.

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LOS ANGELES (KABC) -- Fibromyalgia and chronic fatigue syndrome are two mysterious and debilitating conditions - and they're often confused with each other.

Tiredness, pain, trouble concentrating and sleeping difficulties - these are symptoms of both fibromyalgia and chronic fatigue syndrome. How can you tell the two conditions apart?

First, recognize that while signs may overlap, the signature symptom of fibromyalgia is pain.

"The pain is often described as an ache or a burning type of sensation," said Erik Hiester, a doctor of osteopathic medicine at Concierge Medicine.

People with fibromyalgia commonly experience discomfort in areas of the body called tender points.

"Tender points are typically located on both sides of the body, oftentimes at the head, the neck, shoulders, elbows, lower extremities and upper extremities," Hiester says.

When it comes to chronic fatigue syndrome, fatigue is a key symptom that sets it apart. Typically, people with this condition report fatigue that worsens with activity and doesn't improve after resting.

For both fibromyalgia and chronic fatigue, it's important to get a correct diagnosis so you can start on the proper treatments. There are three FDA-approved drugs for fibromyalgia and none for chronic fatigue syndrome, although some meds are used off-label to treat symptoms of chronic fatigue.

With both conditions, it's important to maintain a healthy lifestyle and stay active. Finding a doctor who specializes in treating these illnesses can also be beneficial.

There are no widely accepted lab tests or imaging studies used to diagnose fibromyalgia or chronic fatigue. So doctors rely on a clinical approach of ruling out other diseases and listening to patients describe their symptoms.

Chronic Fatigue Syndrome Affects 3.3 Million Americans, The CDC Estimates. Here's What To Know About Symptoms And Treatment.

About 3.3 million U.S. Adults have chronic fatigue syndrome, according to new data from the Centers for Disease Control and Prevention.

The number is the first nationally representative estimate of how many Americans have the condition — and it's more than previous studies have suggested, likely boosted by some patients with long COVID, the Associated Press reports,

The CDC report, released Friday, is based on a survey of 57,000 U.S. Adults in 2021 and 2022. Participants were asked if a health professional had ever told them they had chronic fatigue syndrome and whether they still have it. About 1.3% said yes to both questions, which translated to about 3.3 million U.S. Adults, CDC officials said.

The condition clearly "is not a rare illness," said the CDC's Dr. Elizabeth Unger, one of the report's co-authors.

They found cases were more common in women than men, and rates were higher in people ages 50-69, but people in all age, sex and racial and ethnic groups can be affected.

Chronic fatigue syndrome, also known as myalgic encephalomyelitis, or ME/CFS, is a "complex, multisystem illness characterized by activity-limiting fatigue," the report notes.

Symptoms of chronic fatigue syndrome

Chronic fatigue syndrome is more than just tiredness.

"Symptoms are extreme exhaustion after physical exercise and mental effort, unrefreshing sleep, trouble with memory, weight changes, extreme emotional stress, headaches and muscle pain," explains Dr. Eric Ascher, family medicine physician at Northwell Lenox Hill Hospital in New York. "Because symptoms mirror many other syndromes, it may be hard to diagnose."

Three primary or "core" symptoms are required for diagnosis, according to the CDC:

Six months or longer of fatigue coupled with a greatly lowered ability to do activities that were usual before.

Worsening of symptoms after physical or mental activity — known as post-exertional malaise, or PEM. Patients often describe this as a "crash" or "collapse" that can leave them bedridden for days after an activity as simple as going to the store or taking a shower.

Sleep problems, including not feeling less tired even after a full night of sleep.

In addition to those core symptoms, the CDC says in order to qualify for the diagnosis patients must also experience either problems with thinking and memory — sometimes described as "brain fog" — or worsening of symptoms while standing or sitting, which may include dizziness, lightheadedness or fainting.

What causes chronic fatigue syndrome?

Researchers have not yet found an exact cause for ME/CFS, but it can occur after "viral or bacterial infections, can be due to genetics, chronic illness (or) autoimmune disease and physical or emotional trauma," Ascher said.

Cases can develop following infections with a number of different viruses including herpes simplex, dengue and Epstein-Barr virus, says Dr. Hector Bonilla, clinical associate professor of infectious diseases at Stanford.

"Now we see similar cases after coronavirus infections such as SARS, MERS, and SARS-CoV-2," Bonilla said.

And despite the diagnosis guidelines, it can be difficult for doctors to pin down, since there are no blood tests or scans to specifically diagnose ME/CFS. Plus there can be a lack of familiarity and education about the condition among medical professionals.

Experts believe only a fraction of the people with chronic fatigue syndrome actually get diagnosed, Dr. Daniel Clauw, director of the University of Michigan's Chronic Pain and Fatigue Research Center, told the AP.

"It's never, in the U.S., become a clinically popular diagnosis to give because there's no drugs approved for it. There's no treatment guidelines for it," Clauw said.

Chronic fatigue syndrome treatment

While this is currently no cure for ME/CFS, there are options to manage or treat certain symptoms of the condition.

For example, doctors may suggest medication or other therapies to help with pain and sleeping problems. For post-exertional malaise, it can help to develop an activity management or pacing plan to reduce flare-ups. The right balance of activity and rest may vary for each individual.

"Treatment is usually to manage symptoms and is multidisciplinary, including movement (yoga and stretching), gentle massages, hydration, a healthy, anti-inflammatory diet (meaning less processed and prepackaged foods) and therapy (both behavioral and physical)," Ascher noted. He said the goal is to reduce stress and anxiety and promote a state of healing and mindfulness.

"Sometimes medications are used as well if these other treatment options do not provide relief," he adds. "Many patients may be turned off when offered an antidepressant, but these medications have shown to improve symptoms and allow suffering patients to live a more fulfilling life."

Fatigue? Unexplained Weight Gain And Dry Skin? Could It Be Hashimoto's Disease?

Maybe you feel worn out. Perhaps you're also having trouble losing weight. Generally, you just don't feel 100%.

Could it be Hashimoto's disease? This common autoimmune thyroid disorder is when your immune system (which fights off viruses and bacteria), mistakenly attacks a part of your body. In this case, it's your thyroid—a gland located at the base of your neck—and can cause low thyroid hormone levels (hypothyroidism).

Hypothyroidism affects one in 33 Australians and Hashimoto's is one of the most common thyroid conditions in first-world countries.

While symptoms can be subtle, untreated Hashimoto's can cause long-term problems with your heart, memory, and fertility. Here is what you need to know.

What happens when you have Hashimoto's?

Your thyroid gland is a butterfly-shaped gland in the neck. It is essential in regulating things like muscle function, digestion, metabolism, the heart, and lungs. In children, thyroid hormones are also needed for normal growth and development.

Hashimoto's thyroid disease, named after the Japanese doctor who discovered it in 1912, is also known as Hashimoto's thyroiditis or chronic lymphocytic thyroiditis. The disease can cause the immune system to mistakenly produce proteins called antibodies (thyroid peroxidase and thyroglobulin). These can cause inflammation and long-term damage to the thyroid gland. Over time, as thyroid tissue is inflamed and/or destroyed, there can be a decrease in the production of thyroid hormones (hypothyroidism).

Hashimoto's can present subtly at first. If you only have antibodies with no change in thyroid levels, it is likely you won't have any symptoms.

However, as the disease progresses, you may experience fatigue, weight gain (or difficulty losing weight), increased sensitivity to the cold, constipation, dry skin, muscle aches, irregular or heavy menstrual cycles, enlarged thyroid (goiter), and occasionally hair loss, including at the ends of your eyebrows.

What causes Hashimoto's thyroid disease?

Several risk factors can contribute to the development of Hashimoto's including:

What are the long-term risks?

Long-term, untreated Hashimoto's thyroiditis can cause heart issues, higher cholesterol levels, nerve damage (peripheral neuropathy), reduced cognition and infertility.

In pregnancy, Hashimoto's has a higher risk of pre-eclampsia (high blood pressure affecting several organs), premature birth, placental abruption (when the placenta separates from the inner wall of the uterus before birth) and, in severe cases, pregnancy loss.

The disease has also been linked with an increased risk (but low incidence) of the lymphocytes of the thyroid turning into cancer cells to cause thyroid lymphoma.

How is Hashimoto's diagnosed?

Diagnosis can be confirmed with a blood test to check thyroid levels and antibodies.

Thyroid peroxidase antibodies are commonly present but about 5% of patients test antibody-negative. In those people, diagnosis depends on the thyroid levels, clinical presentation and ultrasound appearance of general inflammation. An ultrasound may not be required though, especially if the diagnosis is obvious.

Three hormone levels are tested to determine if you have Hashimoto's.

Thyroid stimulating hormone (TSH) is produced by the brain to speak to the thyroid, telling it to produce two types of thyroid hormones—T3 and T4.

If you have either relative or absolute thyroid hormone deficiency, a test will show the stimulating hormones as high because the brain is trying to get the thyroid to work harder.

Can it be treated?

The management of Hashimoto's depends on the severity of the thyroid levels. Up to 20% of the population can have antibodies but normal thyroid levels. This is still Hashimoto's thyroid disease, but it is very mild and does not require treatment. There is no current treatment to reduce antibody levels alone.

Because thyroid peroxidase antibodies increase the risk of abnormal thyroid levels in the future, regular thyroid testing is recommended.

When the thyroid stimulating hormone is high with normal thyroid hormone levels it is termed "subclinical hypothyroidism". When it is paired with low hormone levels it is called "overt hypothyroidism". The first is a mild form of the disease and treatment depends on the degree of stimulating hormone elevation.

Overt hypothyroidism warrants treatment. The main form of this is thyroid hormone replacement therapy (levothyroxine) with the dose of the drug adjusted until thyroid levels are within the normal range. This is usually a lifelong treatment but, once the dose is optimized, hormone levels usually remain relatively stable.

In some people with very enlarged thyroid glands causing compressive symptoms (such as difficulty swallowing or breathing), thyroidectomy (surgical removal of the thyroid) is considered.

Hashimoto's thyroiditis is a common condition caused by your body's immune system incorrectly damaging to your thyroid and can go undetected. Long-term, untreated, it can cause issues with your heart, cognition, and fertility. It can be diagnosed with a simple blood test. Speak to your doctor if you have any concerns as early diagnosis and treatment can help prevent complications.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Citation: Fatigue? Unexplained weight gain and dry skin? Could it be Hashimoto's disease? (2023, December 21) retrieved 30 December 2023 from https://medicalxpress.Com/news/2023-12-fatigue-unexplained-weight-gain-dry.Html

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