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At our Clinics in London and Bristol we treat patients who have Fibromyalgia (FM) and ME (also known as Chronic Fatigue Syndrome or CFS). These syndromes can be characterised by a set of symptoms that overlap by around 70% and Dr Muhammad Yunus, a leading FM Researcher for decades who was amongst the group of doctors who stated that FM was real, believes that Myofascial Pain Syndrome is present in roughly 50% of FM and CFS diagnosed patients. Many of the therapies or approaches that are used to treat FM are also used to treat ME /CFS, and vice versa. Many doctors would consider that the link between all of these conditions is that they all show Central Sensitization (CS) - a hypersensitive Central Nervous System that produces enhanced sensitivity throughout the body.
Both FM and CFS/ME present the following characteristics, all-over body pain, post-exertional fatigue/malaise, problems with temperature control or cold intolerance, disrupted sleep, sensitivity to many stimuli including bright lights and noise, irritable bowel and bladder symptoms, headaches, brainfog, alcohol and medicine intolerance, dizziness, Neurally Mediated Hypotension, reduced cerebral blood flow in cortex and midbrain, reduced serum and/or CSF serotonin, often there is a family hereditary and there are abnormal neuroimaging (i.e. MRI and Spect Scans).
Dr. Debra Buchwald (who conducted a large USA research project to evaluate the symptoms commonly reported by each condition and determine the degree to which they may or may not be related) writes that “what she found was that CFS and FM are characterised by greater similarities than differences. The distinction between CFS/FM to be sub-classified according to severity of various symptoms. For patients and their physicians, there is substantial value in the findings in both the CFS and FM literature opening up research channels of communication between both camps will benefit patients with either diagnosis”.1
Drs Wood, Russell and Olafsson are renowned world experts and use various diagnostic methods including Brain Imaging; these have shown up changes in brain chemicals resulting in central sensitisation, or Fibromyalgia.
Professor Davies has developed a variety of treatments to help patients with these disabling conditions, based upon the latest medical research from around the Medical world and years of clinical experience. Prof. Davies clinical experience has been that are various medicines, which when added to other treatments that have been shown to reduce FMS and/or Myofascial Pain Syndrome and this forms the basis of our plan of care.
There have been many articles and reports on the value of graded exercise programs in ME/CFS and Fibromyalgia. However, Professor Davies is firmly of the opinion that Pacing oneself, including prolonged periods of REST for both the body and mind are essential. This opinion has been confirmed by a scientific study 2 and in a review of previous studies that question the generally-held view that aerobic exercise programmes are a major useful treatment for ME/CFS and FM. It is Professor Davies experience that patients generally do best if they rest completely in the early stages of these conditions, then as their health and muscles improve with treatment they can first increase their activities and later on if appropriate introduce exercise. The key is to establish a good sleep routine and to avoid a ‘boom and bust’ cycle.
Pain relief is an area of much development recently and Professor Davies is using new medicines that have been shown to significantly reduce pain and also improve the sleep of these conditions (it is important to use medicines that will not disrupt deep or stage four sleep further). Upper Airway Resistance Syndrome (or UARS) is something that has recently become a major area of research for FM/CFS/ME and is a condition that affects the majority of patients with these illnesses.3 Fortunately, there are several treatments that can significantly improve UARS.4 Additionally, many patients must also be screened for Obstructive Sleep Apnea as this condition if untreated can make FM/CFS worse by disrupting deep sleep and this adversely effects healing or recovery.
Trigger point injections have been used since the late 1940’s in France and the 1950’s in America for a variety of soft tissue musculo-skeletal problems. Anecdotal literature abounds with success stories of patients who have suffered for considerable lengths of time with musculo-skeletal pains which have not responded to conservative therapies but did respond to trigger point injections. In a study published in the Journal of Orthopaedic Medicine 2001, treatment by trigger point injections were given to patients with Fibromyalgia. 9 of the 11 patients reported worthwhile symptomatic improvement after treatment. These injections help release the tension in the tightened and shortened muscles of FM/ME and should reduce the pain in these muscle areas.
Our medicine-sensitive patients will be pleased to hear that there are few, if any, side-effects from these injections. Prof. Davies has over 20 years experience injecting these painful areas and comments that most patients find these injections useful for their pain.
By: Daniel Austen, BSc, Clinic Manager. Medically reviewed by Professor John E. Davies.
1) Dr Charles Lapp, et al. Fibromyalgia Network. April 2003 CFS Conference, the merging of two syndromes pp4-10.
2) C Ramsey, J Moreland et al, ‘An observer-blinded comparision of supervised and unsupervised aerobic exercise regimes in Fibromyalgia’ J of Rheumatology Vol 39 No 5 (2000).
3) Timothy J Craig, D.O., S. Kakumanu. American Family Physician. Volume 65, Number 6/ March 15, 2002. pp1088. Further references pp 1090, Number’s 31, 32, 33, 34 & 35.
4) Fibromyalgia Network. Edition 67 pp12-14 and edition 68 pp9-15.