Welcome to These Three

By Celeste Cooper

I am a retired registered nurse with all three disorders, fibromyalgia (FM), chronic fatigue immunodysfunction (CFID), and chronic myofascial pain (CMP). My son developed this website so we could share valuable information on how to cope with the many aspects of one, two, or all three of these chronic illnesses. If you are here, you are seeking answers to questions like:

• What is fibromyalgia (FM)?
• What's the difference between fibromyalgia and chronic fatigue syndrome (CFID)?
• How is the body-wide pain of fibromyalgia different from the painful trigger points found in chronic myofascial pain?
• What is a tender point and how does it differ from a trigger point?

Fibromyalgia (FM) and chronic myofascial pain (CMP) are often interpreted as interchangeable terms, as are fibromyalgia and chronic fatigue immunodysfunction. Even though these disorders can and do often co-exist in the same patient, they are not the same disorder. Understanding the differences is paramount to proper diagnosis and successful treatment.

The diagnostic criteria for each disorder are separate and distinct. It makes my teeth chatter when I hear remarks that suggest throwing them all into one blender and pouring them out as one textbook cocktail. They are more like Neapolitan, its all ice cream, but each has its own color and flavor.

There is scientific proof that these disorders are real. New studies on fibromyalgia (FM) show scientific evidence of a disruption in the pain pathway of the central nervous system, and is documented using the functional MRI (fMRI). Central processing, believed to be disrupted in chronic fatigue immunodysfunction (CFID), has been identified through brain mapping and sleep studies. According to the National Institute of Health, fibromyalgia and chronic fatigue immunodysfunction are closely related. Some believe that both fibromyalgia and chronic fatigue immunodysfunction are caused by a disruption in the chemical messaging system between the body and the brain; however the disruption is not the same between the two. Substance P, one of the two key chemicals of neurotransmission is elevated in the spinal fluid of fibromyalgia patients studied; however, this is not seen in chronic fatigue immunodysfunction patients. Chronic myofascial pain (CMP) has been scientifically documented by abnormal muscle biopsy and electro-physical abnormalities of trigger points. Fibromyalgia, diagnosed by the presence of tender points and chronic myofascial pain from trigger points may coexist in the same patient. Some scientific studies do show overlapping between fibromyalgia and chronic fatigue immunodysfunction; however, the symptoms and diagnostic criteria set the two apart.

Understanding the similarities and differences between fibromyalgia, chronic fatigue immunodysfunction, and chronic myofascial pain from trigger points is important in order to define the appropriate treatment plan. A diagnosis of fibromyalgia is made according to a "tender point" count. (See information on fibromyalgia on this website). This is not so with chronic fatigue immunodysfunction or chronic myofascial pain. Unlike the tender points of fibromyalgia, chronic myofascial pain manifests in a taut band of muscle fiber that is usually felt easily by you or by someone else. (See the information on chronic myofascial pain on this website). The lumps and bumps found as a result of untreated "trigger points" cause restriction of motion and pain, and have specific pain referral patterns. This is not, I repeat, "is not," present in fibromyalgia or chronic fatigue immunodysfunction. Yes, you can develop a sore throat, one of the diagnostic criteria for chronic fatigue immunodysfunction, from untreated "trigger points" found in those taut bands of muscle fiber, but if the pain is from the trigger points of chronic myofascial pain, it will go away when the affecting trigger point(s) is treated. Chronic fatigue immunodysfunction is not part of fibromyalgia. Yes, you can and often do have fatigue with fibromyalgia, but unless you also meet the Center for Disease Control (CDC) diagnostic criteria for chronic fatigue immunodysfunction (chronic fatigue syndrome), you do not have chronic fatigue immunodysfunction just because you have fibromyalgia.

Fibromyalgia, chronic fatigue immunodysfunction, and chronic myofascial pain from trigger points can make strange bedfellows. When they do coexist together, the diagnostic water turns murky, making it difficult and frustrating for you and your healthcare provider. Understanding all the parameters and how to make a differential diagnosis is necessary. You can help your physician by keeping a record of your symptoms. When our book is published, you will find many tools to guide you and help you provide information to your physician. It is a must that (s)he has a clear picture of what it is like in the day of a body riddled with fibromyalgia, chronic fatigue immunodysfunction, or chronic myofascial pain.

Why, you ask, is it so important to know if I have one, two, or all three disorders? Because knowing the difference will determine how successful your treatment plan is. Some treatments differ for all three disorders. Trigger point treatment for chronic myofascial pain can flare symptoms of fibromyalgia or chronic fatigue immunodysfunction if you have them as a coexisting disorder. As a patient with all three, I can attest to the release of toxins from trigger point therapies, or from the stretching required to treat the "glued together" restrictive tissue of fibromyalgia. The treatments for fibromyalgia and chronic myofascial pain not only aggravate each other they also cause a flare of chronic fatigue immunodysfunction symptoms. There are helpful treatments, such as biofeedback and meditation, which have an impact on the "side effects" of all three disorders, either directly or indirectly. It is important to learn what treatments aggravate your many symptoms. It is equally important to learn about helpful treatment options for your fibromyalgia, chronic fatigue immunodysfunction, chronic myofascial pain, or any combination. Identifying your needs may require a day-by-day or moment-by-moment assessment.

Awareness of fibromyalgia, chronic fatigue immunodysfunction, and chronic myofascial pain, is essential to research and education in the medical community. We understand that chronic pain disorders are not limited to fibromyalgia (FM), chronic fatigue immunodysfunction (CFID), or chronic myofascial pain (CMP), but "these three" are the focus of this website. Understanding the source of our pain can have a significant impact on our overall well-being.

You should not feel alone, isolated, or without resources. Chronic pain and fatigue affects you physically, mentally, emotionally, and spiritually. Learning to deal with the psychological issues that evolve with any chronic illness can have a profound impact on your relationships and the balance in your life. The human mind is a complex organ, and healthy processing of information is as important as a gentle breeze is to a butterfly. Maybe we are fearful of sharing underlying concerns with others because we are apprehensive and fear the consequence. However, there should be no reason for us to hide in a closet cloaked in despair. Reach out to someone you can trust, the sun is shinning and the breath of life is waiting for you.

Through the various web-links, you will find helpful tools for dealing with pain, exhaustion and fatigue, healthcare providers, family, friends, co-workers, self-esteem, depression, anxiety, stress, and the system. I hope you utilize them to meet your needs.

With our help, we can contribute to the benefit of society by vocalizing and participating in the march against chronic pain and fatigue of fibromyalgia, chronic fatigue immunodysfunction, and chronic myofascial pain from trigger points. Widespread pain, fatigue, muscle tenderness, restriction of joint motion, radiating pain, generalized swelling, sore throat, swollen lymph nodes, memory difficulties, or any of the many other symptoms that accompany, each or all of "these three" on a constant basis is not normal. The general population experiences any one of our symptoms intermittently, but the question is "would anyone of those people enjoy all the symptoms together all the time?" It is doubtful. That is why the plight of chronic pain patients, like us, is to persevere. Don't give in, join in.

Wishing you balance in the four directions, and as we say in the world of fibromyalgia, "gentle hugs" and warm wishes to all of you.