Lately we’ve seen what appears to be a great deal of similarity in muscle issues in Chronic Fatigue Syndrome and Fibromyalgia. We know that Dr. Bateman and others believe ME/CFS and Fibromyalgia occur on a fatigue-pain continuum – that they are similar disorders that differ in the amount of fatigue and pain present. They both predominantly affect women, and similar medications are used in both.
Both Dr. Natelson and the Lights, however, have found differences in ME/CFS + FM vs ME/CFS patients alone, and Natelson argues that they’re quite different disorders.
ME/CFS and FM appear to be very similar but some important differences have shown up
Now a recent study demonstrates an important way that this is so.
Reduced levels of BDNF – described as a nerve repair agent – were recently found in Chronic Fatigue Syndrome and multiple sclerosis. The levels found – less 25% of normal – were stunningly low, and this suggested that neuron functioning was taking a real hit in both these disorders. Given the nerve damage found in MS, that result was expected for MS – but not in ME/CFS.
A recent Fibromyalgia BDNF study seems to portray a very different disorder. It examined BDNF and a marker of central sensitization (S100B) in the blood of fifty-six FM patients and then determined if this correlated with pain pressure thresholds (the threshold at which pressure starts producing pain). The lower the pain threshold, the more pain a person is in. The study did not involve healthy controls and thus did not, strictly speaking, determine if BDNF levels were higher or lower than normal in FM.
Microglia Activation and Central Sensitization
Before we get to the findings, let’s look at S100B. S100B is such an intriguing factor that it’s surprising it hasn’t been studied before in FM or in any other pain disorders. S100B upregulates two key cytokines, IL-1b and TNF-a, both of which may be involved in FM and ME/CFS. It also activates the nuclear transcription factor which Maes proposes underlies the inflammatory milieu in ME/CFS and depression. It is also considered a surrogate for microglial activation.
Study Findings
This study found that increased BDNF and S100B levels were associated with increased pain sensitivity in FM. Other studies have found increased BDNF levels in FM as well. These FM findings contrast sharply with the decreased BDNF levels found in ME/CFS.
With regards to BDNF, ME/CFS looks more like multiple sclerosis than it does Fibromyalgia.
High Levels of Excitation vs Low Levels of Nerve Repair?
Is one disorder more excitatory?
While high levels of BDNF in FM look like they’re enhancing the activity of excitatory pain pathways in FM, low levels of BDNF in ME/CFS look like they may be impeding neuron repair and slowing down nerve transmission. Could FM be a disorder of brain excitation while ME/CFS is a disorder of brain loss and slowed functioning? Could it be that simple?
A quick look at the research findings in ME/CFS and Fibromyalgia indicate more overlaps than dissimilarities. Both are characterized by sympathetic nervous system activation, reduced aerobic capacity, increased lactate levels (in one place or another), reduced brain blood flow, decreased cortisol, and decreased grey matter in the brainstem.
Similarities between the ME/CFS and Fibromyalgia
- Reduced heart rate variability – sympathetic nervous system activation – FM and ME/CFS
- Reduced aerobic capacity – FM / Reduced aerobic capacity – ME/CFS
- Increased lactate – muscles – FM / Problems with lactate metabolism – FM / Increased lactate brain – ME/CFS
- Homocysteine increased in spinal fluid – both disorders
- Reduced brain blood flow – FM / Reduced brain blood flow – ME/CFS
- Neuropeptide Y increased – FM / Neuropeptide Y increased – ME/CFS
- COMT Polymorphism Implicated– FM /COMT Polymorphism – ME/CFS
- Reduced salivary awakening response cortisol – ME/CFS / FM
- IL-6 increased – FM / IL-6 increased ME/CFS
- Decreased grey matter – brainstem – FM / Decreased brain matter – brainstem – ME/CFS
Differences between the ME/CFS and Fibromyalgia
- Substance P increased in FM / Reduced in ME/CFS
- BDNF increased in FM / Reduced in ME/CFS
- IL-8 increased FM / IL-8 decreased ME/CFS
- Leptin reduced – FM / Leptin increased – ME/CFS
Central Sensitization – the Key?
It’s intriguing that the two major differences between the two disorders, increased substance P and BDNF in FM, are associated with central nervous system activation.
Given the high amount of pain and problems with stimulus overload, we’ve assumed ME/CFS is also a central sensitization disorder. Yet two markers associated with central sensitization that are elevated in FM, BDNF and substance P, are not elevated–or are actually lowered–in ME/CFS.
The excitatory neurotransmitter glutamate is also clearly increased in some parts of FM patients’ brains, but a CDC gene expression study suggested decreased glutamate uptake may be present in ME/CFS. At the Stanford Symposium Dr. Zinn described an ME/CFS brain characterized by substantial ‘slowing’. It was a brain that seemed to be more asleep than awake.
On the other hand, Jason has proposed that limbic kindling produces a kind of ‘seizure activity’ in parts of the brain in ME/CFS, and high levels of neuropeptide Y and reduced heart rate variability indicate the sympathetic nervous system is activated in both disorders. Klonopin (clonazepam), a nervous system inhibitor, is used in treating both disorders.
In the end it may be that, like the immune system in ME/CFS, parts of the brain are over- and under-activated in both disorders.
Conclusion
Increased levels of BDNF and S100B levels are associated with increased pain sensitivity in Fibromyalgia. They join a variety of other markers of central sensitization markers found in FM.
Differing levels of BDNF and substance P in Chronic Fatigue Syndrome and Fibromyalgia suggest that the two disorders differ in important ways. However, the two disorders share many more commonalities than differences. The central nervous system could be, however, where the two disorders diverge.
Pain is common in ME/CFS, but it appears that the pain is, at least in part, being produced in different ways than it is in Fibromyalgia.
I, like many others with ME/CFS, have signs and symptoms of both diseases. Any thoughts about how that shakes out in the CNS?
You could have positive results on all the tests I suppose. Then again both diseases are very heterogeneous – so it’s really an individual thing.
I have symptoms of both, as well. Appreciate a reply.
Thanks for looking for some similarities and differences, Cort. I find it hard to keep track.
I have little faith in any CDC studies that use the empiric criteria, such as the one you referenced regarding glutamate.
I have big doubts about the empirical criteria as well. However some studies that have used the empirical criteria have had results similar to those using the Fukuda criteria, – which has, of course, been the main criteria used for research studies.
It may be that the Empirical criteria can pick up basic aspects of ME/CFS but misses in the more fine-tuned areas in the same way that the Fukuda definition may be doing with with the Canadian Criteria.
As a sufferer of both conditions, I see this article a very positive step forward in identifying differences with Fibromyalgia and ME/CFS.
I have often said to others that I know the difference between my symptoms and which symptom belongs to which condition.
I really appreciate the science and exploration others around the world are doing. Working towards the understanding of Fibromyalgia and ME/CFS. It give me hope for a positive future if not for me and my generation of sufferers but for the next generation and the generations to come of sufferers with these two disabling conditions. Thank you kindly!
Thanks Shass
Well said!
hi you wrotte this years ago…but just in case..my doctors jumo from cfs to fibro..they dont know what i might have..would you mind to explain me the key differences in clinical symptoms of both??i experience mainly pain(alrthalgia but also burning pain and postural pain)i also get pain in my back when sitting down.other sensations include bubbly pulsating feeling on my legs mainly..some tingly in my hands sometimes…some days tho i am extremely fatigue to the point of getting dizzy to words. im very sensitive to noise..and have huge stomach issues..they trigger headeches and malaise.i also get migraines..and probably many more thingd
Thank you for the good info and findings. I too feel I have both CFS & FMS, but cannot find a local doctor to confirm the CFS. I was officially diagnosed with FMS over 12 years ago, but believe I have fought it since I was a small child. My standard lab work has been all over the charts, and my GP doesn’t seem too concerned and won’t refer me to a specialist unless I request it. I have been going to see a Rheumatologist lately and being given steroidal w/pain meds shots in the most painful & tender spots, such as hips & shoulders. It has not worked… if anything made my symptoms worse to where I can barely work at all during those times. That doctor seems to think I have acute Bursitis. I can’t seem to get him looking into other areas and other options for treatment. The shots are excruciatingly painful . How does one get diagnosed with CFS?
I have been receiving your blogs & newsletters and appreciate that someone does care about getting not only answers but treatment suggestions too.
Thank you so much!
~Corrine Carter
Hi Corrine,
Here’s my suggestion regarding getting a diagnosis of CFS (or ruling it out as the cause of your symptoms/limitations in addition to the FM). Print out a copy of the “Myalgic Encephalomyelitis International Consensus Primer for Medical Practitioners” and take it to your physician. It is available at various locations on the internet, but the website that showed up first on my search is: http://www.mecfs-vic.org.au. The document is found under the “Medical Practitioner Information” tab.
The link will take you to the 2012 document. I had the privilege of seeing the lead author of the consensus criteria twice during the early 1990’s — Doctor Bruce Carruthers. Out of all the physicians I’ve seen or heard lecture, his presentation of the severe version of the illness most closely matches my experience. If I didn’t know otherwise, I’d think he has it himself (maybe a close family member does).
The consensus criteria was updated this year, but I much prefer the format of the 2012 document. Of particular interest to your physician (assuming he/she is receptive) may be the section near the end of the document titled: PERSONALIZED CLINICAL ASSESSMENT & DIAGNOSTIC WORKSHEET FOR ME. Regardless of your physician’s response, I’m sure you’ll find the information regarding treatment and lifestyle interventions helpful.
Good luck in your search for answers and support.
Karen
I this primer very different than the one the IACFS developed in the last few years?
Linda
Hi Linda,
I’m not familiar with the primer developed by the IACFS, so can’t say for sure how similar they are. But, since the “International Consensus Primer” I mentioned is freely available on the internet, it’s definitely worth a look. It is described as having been “developed by an international panel of ME experts who have collectively more than 500 years of ME clinical experience and worked with over 50,000 patients with ME”.
Karen
I have had FM since I was born (runs on my mother’s side of the family, 4 generations that we know of). I got ME/CFIDS in June of 1998. They are definitely two distinct disorders/diseases.
could you please help me differentiate?im currently suffering from pain,fatigue,dizziness,stomach issues,food sensitivities and adverse reactions,noise sensititycy, heart beat weirdness,tingly bubbly sensation in the legs..and so on
what I wouldn’t give to be a subject in these studies…
The problem I have with these studies is when they say they are studying fibromyalgia patients, unless they exclude those with comorbid ME/CFS, then you don’t know whether the results are for fibromyalgia or undiagnosed or not excluded ME/CFS patients. With rates of 30-70% overlap, you could end up with a cohort that has both, but only carry the label of fibromyalgia. And some fibromyalgia researchers and clinicians think all who have fibromyalgia have “chronic fatigue,” not even thinking that ME/CFS is a different disease. So you know they didn’t exclude them. And vice versa, as well.
I can tell the difference between the two in my symptoms, and thankfully, at this time, my fibromyalgia is so low that I wouldn’t fit any of the fibromyalgia criteria. I do get that fibromyalgia pain, but not in enough places and not bad enough to meet either criteria.
I associate other symptoms that diminished as my fibromyalgia pain diminished as being fibromyalgia symptoms. All the rest I still have are ME/CFS.
could you please tell me the key dofferences in both?i dont know if i have both or just one..and my doctors dont know either i have got different opinions
intermittent fasting is said to increase BDNF levels in mice suggesting that those whose primary symptom is fatigue might benefit from this, Exercise also increases BDNF suggesting why some of those diagnosed with CFS might benefit from it while those who have fibromyalgia might be made worse.
Don’t know about those with both.
Very interesting Cort. I still ponder, for someone like myself, dx with FM & ME/CFS…how the CNS adapts? I have wondered for decades, if FM/ME/CFS is related to MS. I thought in a recent article, that researchers were tossing out the idea of central sensitization?
Your site is top notch. Your old site is top notch. BUT………it always misses the point. There really is only ONE DISEASE. It is a DISEASE OF CIVILIZATION. Neolithic Civilization for 10,000 years and now made many times worse by this abomination called Modern Life. I had CFS/FM for twenty seven years. The day (MARCH 31, 2011) I realized it ALL had to do with Evolution, was the day I started to heal this nightmare. Kurt Harris, MD got me started. (Paleo Diet). Eight months later I started Cutler’s Mercury Chelation.Four months later I Started doingJack Kruse’s Cold Thermogenesis. A year later I started doing Jack Kruse’s EMF elimination. A year later I started Freddd’s Methylation Protocol. Three months later I started doingFreetheanimal.com’s Resistant Starch+probiotic protocol. Two months ago I started Rhonda Patrick’s Sauna Therapy. I am slowly , but steadily healing BOTH diseases. At the same time, I healed adrenal fatigue, hypothyroidism, depression, anxiety, Seasonal affective disorder, pollen allergies and gum disease. My hair is thicker and darker. My skin is much less dry. I’ve put on over twenty lbs. of muscle and lost over five lbs of fat. AND I’m 58 years old! How many actual diseases call one man heal? How many diseases can one man have had? The answer: only one The DISEASE OF. CIVILIZATION! The so-called Allopathic” Diseases” weren’t really diseases. They were just symptoms of a” poor schmuck” with lot’s of Methylation and non-Methylation SNP’s interacting with a toxic/poisonous/contaminated world. It was that simple. Keep up the excellent work, but really….. Start looking in the right place! Science is not going to get us anywhere. Evolution is. Evolution is everything…. Peace
….. P.S.. Thank you for bringing Freddd to me. He is one piece of work!
I have fibromyalgia and chronic fatigue syndrome plus a lower spine injury that was caused from a serious car accident. I am also a Chronic pain sufferer. I find this article interesting but when are GP’s actually going to take fibromyalgia seriously I always battle with my doctor until I saw a rheumatologist and got him to put it in writing so I could shove it in my docs face…..One day I really hope they find something to cure or help with these crippling illnesses x
Hi Maria, you may have functional neurological disorder, which is strongly associated with ME/CFS and fibromyalgia. Look at http://www.neurosymptoms.org. It is a benign condition in the sense that there is no damage to the nervous system and the symptoms can go away entirely. If you feel depressed or anxious you should deal with those first and the rest may improve. Hope this helps.