Chronic Fatigue and Fibromyalgia Awareness Day
Posted Sunday, May 12, 2024 by . Filed under Conditions
These two conditions are quite poorly understood by both the general public and many in the healthcare community as well. May 12th is both Chronic Fatigue Syndrome (CFS) / Myalgic Encephalomyelitis (ME) and Fibromyalgia awareness day, so let’s discuss these conditions in depth…
CFS / MEONSET / TRIGGER
Can be triggered by;
- infections,
- trauma, or
- other stressors
with a sudden or gradual onset
FIBROMYALGIAONSET / TRIGGER
Often begins after;
- physical trauma,
- surgery,
- infection, or
significant psychological stress
CFS / MEPRIMARY SYMPTOM
Post Exertional Malaise
- described as a general feeling of discomfort, illness, or unease following either physical or mental activity
Any exertion can lead to a worsening of symptoms.
FIBROMYALGIAPRIMARY SYMPTOM
Widespread musculoskeletal pain and tenderness.
CFS / MEASSOCIATED SYMPTOMS
- fatigue,
- cognitive difficulties,
- headaches,
- unrefreshing sleep, and
- sleep disturbances.
FIBROMYALGIAASSOCIATED SYMPTOMS
- fatigue,
- sleep disturbances,
- cognitive difficulties (often referred to as "fibro fog"),
- sensitivity to chemicals,
- restless legs,
- depression and/or anxiety, and
- irritable bowel syndrome.
CFS / MEDIAGNOSTIC CRITERIA
Diagnosed primarily on case history;
- An individual with a new onset of severe fatigue that has lasted for more than 6 consecutive months
- That is not exertion-related, and
- Is not significantly relieved by rest
and exclusion of other causes of fatigue.
FIBROMYALGIADIAGNOSTIC CRITERIA
Early diagnostic criteria focused on a “tender point count”, assessing the number of sore points in specific areas across the body.
It’s now recognised that this criterion does not account for the broader spectrum or fluctuating nature of fibro symptoms.
New diagnostic criteria from the American College of Rheumatology now utilize a scale to assess;
- Chronic musculoskeletal pain
- Fatigue
- Cognitive dysfunction
- Sleep disturbances
Nervous System Dysfunction
It’s clear that there is LOTS of cross over between the two conditions. This is because both are believed to involve dysregulation of the nervous system.
The central nervous system (brain and spinal cord) can undergo changes either structural, functional or chemical in nature that result in an increased sensitivity to stimuli (inputs from the outside world). They call this “central sensitization”.
The most common form of central sensitisation is an amplification of nociceptive information. Nociception is our body’s very natural, healthy detection of danger or the potential for danger, which produces pain in order to warn us.
The nervous systems of CFS and Fibromyalgia patients are like a helicopter parent…
Hypervigilant and overprotective… So worried about your safety that it becomes problematic (and in this case painful and exhausting).
Regulating the Nervous system
Managing CFS/ME and Fibromyalgia
Understanding the state of the nervous system in these conditions is crucial for developing effective management strategies.
Firstly, a helicopter parent is not going to be easily convinced to relax/stop being over-protective. The same applies here.
The nervous system has to be shown slowly, with conviction and repetition that it is not in danger.
Reinforcing the message that you are safe and capable both physically and mentally can re-wire the nervous systems hyper-protective tendencies.
Strategies for nervous system regulation
Mind body Techniques
Mindfulness and Meditation
- Practices that promote mindfulness can help regulate the autonomic nervous system, promoting relaxation, reducing stress and improving cognitive function.
Breathwork:
- Controlled and deep breathing can activate the parasympathetic nervous system, promoting a calming effect.
Vagus nerve stimulation:
- The vagus nerve is the primary nerve involved in the parasympathetic portion of your autonomic nervous system, meaning its in charge of “rest and digest”, feelings of calm and safety.
- Stimulating the vagus nerve can help to improving vagal tone, meaning you return to a state of calm quicker after stressful events (which are normal and happen every day).
Physical Activity
- Gentle movements like tai chi and yin yoga can positively impact the autonomic nervous system and contribute to overall improvements in quality of life.
- Overexertion is a problem however in both conditions.
As a result, a Graded Exposure program is key
- Gradually introducing exercise at a pace that suits your body is key to reinforcing the message of safety and capability within the nervous system.
- Any movement plan should consider the person’s individual limitations and should be flexible to accommodate for both good and bad days.
As the Nervous system becomes less protective/hypervigilant
- Physical activity can slowly be adapted to this new capacity, becoming more frequent and more challenging
Managing Sleep Hygiene
Establishing healthy sleep practices can positively influence the autonomic nervous system. This includes;
- maintaining a regular sleep schedule/routine,
- creating a comfortable and calming sleep environment,
- avoiding stimulation in the hour before sleep
Incorporating sunlight viewing into your daily routine (viewing the sunrise and/or sunset) can also help with setting your circadian rhythm. This is your body’s innate sleep/wake cycle. Programming your circadian rhythm in this way can help you;
- fall asleep easier
- wake more refreshed
- sleep more solidly
The role of Manual Therapy
It’s important to note that there are extra considerations with ME/CFS and fibromyalgia patients, but manual therapy can be a key part of the comprehensive care for these conditions.
A manual therapist will consider the following;
- History; previous experiences with manual therapy are a great way to guide the practitioner’s choices.
- Technique type: Due to the heightened sensitivity and risk of exacerbating symptoms, manual therapy generally starts with a focus on gentle and non-invasive techniques. This may change as the therapist gets to know your body’s limitations.
- Current Capacity/Tolerance; both conditions fluctuate day to day, therefore treatment may need to be modified to suit that current tolerance.
An open dialogue before, during and after each session is important to ensure that treatment is tailored to your needs and limits.
References
https://www.racgp.org.au/afp/2013/october/fibromylagia
https://www.racgp.org.au/getattachment/33a724c5-fcaa-4ab6-9f9e-d1e9b172e142/attachment.aspx
https://www.ccjm.org/content/90/4/245#:~:text=Central%20sensitization%2C%20a%20pathophysiologic%20process,have%20unexplained%20pain%20and%20fatigue.
https://www.racgp.org.au/clinical-resources/clinical-guidelines/handi/handi-interventions/exercise/incremental-physical-activity-for-cfs-me#:~:text=Center%20for%20Disease%20Control%20(CDC,result%20of%20other%20medical%20conditions.
https://www.racgp.org.au/getattachment/2587cac6-95cd-44ad-a1fe-44deedc79990/Chronic-fatigue-syndrome.aspx
https://www.racgp.org.au/getattachment/33a724c5-fcaa-4ab6-9f9e-d1e9b172e142/attachment.aspx
https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2020.01792/full
https://karger.com/nim/article/30/1/167/853624
Dr Cloe graduated from RMIT with a Bachelor of Health Science and Bachelor of Applied Science (Osteopathy)