Are You Always Tired and Achy?

When to suspect fibromyalgia or chronic fatigue
Chronic Fatigue & Pain

Do you find that chronic pain, fatigue, disruptive sleep and anxiety make you want to stay in bed some days? There are many possible causes. Among them are mysterious, debilitating conditions: fibromyalgia and chronic fatigue syndrome.

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People who have either condition may experience many of the same symptoms.

So how do you know which one you have? And how does the specific diagnosis affect your treatment?

Doctors diagnose these diseases through a process of elimination rather than with a blood test or scan. They rely on one main difference between the two, says pain management specialist Robert Bolash, MD.

“While fibromyalgia can cause fatigue, the dominant symptom is pain.”

“For people with chronic fatigue syndrome, however, the dominant symptom is fatigue,” he says.

What do we know about fibromyalgia?

Of the two, more information is available about fibromyalgia, or FM. It affects about 10 million Americans, mostly women.

Many patients get their diagnosis between the ages of 20 and 50. But the incidence increases with age. By age 80, about 8 percent of adults have fibromyalgia, according to statistics from the National Fibromyalgia Association.

The cause of fibromyalgia is unknown. Genetics, trauma or an infection may play a role, Dr. Bolash says.

Symptoms include:

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  • Diffuse pain
  • Headaches
  • Stiffness
  • Joint swelling
  • Fatigue and morning stiffness

Fibromyalgia sufferers say it feels like having the flu all the time.

What do we know about chronic fatigue syndrome?

Those who have chronic fatigue syndrome, also called myalgic encephalomyelitis, or ME/CFS, report fatigue that is worsened with activity and not relieved by rest. Other symptoms, which may come and go, include dizziness, and trouble with concentration, sitting and standing.

The Centers for Disease Control and Prevention estimates that 836,000 to 2.5 million Americans suffer from ME/CFS, but most cases are undiagnosed.

“Both diagnoses are sometimes called into question as to not being ‘real’ diseases,” Dr. Bolash says. But the chronic pain and fatigue are real enough — and often debilitating — for those who have it.

How do doctors treat the two disorders?

People with either disorder can often get some relief with a variety of therapies. And this is where a proper diagnosis is most useful, Dr. Bolash says.

“Medical options are just the tip of the iceberg for both conditions,” he says. “But when we use medications, we need to ensure that we are targeting pain without excess sedation.”

When it comes to non-pharmacological help, doctors use a variety of tools.

Dr. Bolash talks to patients about how important it is to stay active, but pace themselves. His advice? “Set a structured activity program that avoids overexertion.”

On a good day, a patient may decide to walk four miles, then require two to three days to recover. Try to walk one mile a day so you are active every day, he tells them.

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He also recommends swimming, yoga and biking.

How your family can help

Support from your family can make your condition easier to bear. “I try to make family members a partner in treatment,” Dr. Bolash says.

When you just want to spend the day in bed watching TV because of fatigue and/or pain, a family member can encourage simple, fun activities to help get you moving.

Your family can also help by spending time with you on good days as well as bad ones. “We have to understand the psychological part of the diseases as well,” Dr. Bolash says.

Whether your diagnosis is chronic fatigue or fibromyalgia, a doctor’s role in treating the disease small.

“A doctor is there as the coach and can help you with the first 10 to 15 percent of improvement; a patient has to help themselves manage the remaining 85 to 90 percent,” he says.

If you’re suffering with chronic pain and/or fatigue, talk to your doctor. A diagnosis can put you in a better position to manage your symptoms — even if there are still some mysteries surrounding your disease.

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