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  • Q&A with Australian Health Practitioners

    What is the link between chronic pain, fibromyalgia and chronic fatigue syndrome?

    My sister had a bad case of glandular fever a few years back and since then has suffered from chronic fatigue syndrome. She now has unexplained pain in her body which has been diagnosed as fibromyalgia. Is there a link between chronic fatigue syndrome and fibromyalgia/chronic pain?
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    Joanna Sochan

    Naturopath, Nutritionist, Western Herbal Medicine Practitioner

    Joanna is a Natural Medicine Practitioner (Naturopath, Herbalist and Nutritionist) who offers an integrative and holistic approach to health and wellbeing. She applies a number … View Profile

    It is not uncommon for one person to have a combination of any two or all three of the above conditions; however, they appear to have different causes and need different solutions. CFS is a viral condition with a significant inflammatory response and thus involvement of the immune system. The type of pain experienced in CFS is associated with muscle aches similar to what you get during the flu. Also, not everyone with CFS experiences pain.

    Fibromyalgia (FM) is a chronic pain disorder characterised by wide spread pain, and its causes are only partially understood at present. FM is linked to different types of pain such as hyperalgesia (pain amplification) and allodynia (pain from a typically non-painful source). According to current studies, FM is likely caused by abnormalities in the nervous system. Research suggests that the central nervous system (CNS) pain processing signals are dysfunctional in FM causing abnormal signaling and altered pain perceptions (see the study summary here). This mechanism appears to be a feature of FM and many other chronic pain syndromes including migraines, irritable bowel syndrome, and low back pain. Simply put the brain processing of pain is altered turning relatively “small” pain input signals (such as emotional stress, fatigue and muscle use in exercise) into “large” pain output signals resulting in exaggerated pain response beyond reasonable cause(s).

    According to the researchers, excessive neurotransmitter called substance P (which transmits pain signals) is the source of this abnormal signaling. There is a chronic stress response in FM and this constant strain on the body activates and causes hyperactivity of substance P. Healing and rejuvenating the nerves and decreasing substance P on a regular basis are important strategies to reduce pain. Lowering substance P over time will help the pain system to cool down from its overheated state. Notably, substance P appears to be normal in people with CFS.

    Some of the helpful supplements to lower substance P include high doses of magnesium, quercetin (for inflammation) and acetyl-l-carnitine (for the nervous system), among others. A Mayo Clinic study also suggested that adequate levels of vitamin D help with chronic pain (see the study link here). So make sure that you know your vitamin D levels and correct them if needed. Also important are adequate sleep (substance P is ‘discharged’ during sleep), consistent moderate exercise and stress reduction.

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    Nathan Butler

    Exercise Physiologist

    Nathan Butler is an exercise physiologist and founder of the multi-disciplinary Active Health Clinic whom specialise in chronic health especially Chronic Fatigue Syndrome, orthostatic intolerance … View Profile

    There is often an overlap between other chronic conditions, such as fibromyalgia, irritable bowel syndrome, orthostatic intolerance, postural orthostatic tachycardia syndrome, anxiety or depression.
    These are not the cause of chronic fatigue syndrome. If you have chronic fatigue syndrome, the primary symptom is fatigue and not pain or any other symptom.
    It is not directly related to other conditions with a definite diagnosis, such as cancer or Multiple Sclerosis.

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