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This is about chronic fatigue, fibromyalgia syndrome (FMS) and chronic myofascial pain syndrome (MPS) and their relationship to pain and depression. 

Fatigue is a common health complaint, one of the hardest terms to define, and a symptom of many different conditions. Fatigue is a challenge. 

Fatigue (fatigue syndrome) is weariness or exhaustion from labor, exertion, or stress. Also known as tiredness, exhaustion or lethargy, fatigue is generally defined as a feeling of lack of energy. It is not the same as drowsiness, although the desire to sleep may accompany fatigue. Apathy is a feeling of indifference that may accompany fatigue or exist independently. (Another definition of fatigue is temporary loss of power to respond, induced in a sensory receptor or motor end organ by continued stimulation.) 

Fatigue is common. Around 20% of Americans report fatigue sufficiently intense to interfere with normal life. There are both physical causes and emotional causes. The challenge is how to tell what is causing one’s fatigue and whether it is serious enough to see a doctor. I say, if you have a doctor and you feel bad, consult her/him! 

Everyone has experienced fatigue, but it is difficult to define and measure because of the interplay among biologic, psychological, and social factors. And there’s that gap between patients’ organizations and those health professionals who contend that fatigue is all in patients’ heads. Ninety percent of fibromyalgia patients are women. [“Fatigue as a window to the brain.” Issues in Clinical and Cognitive Neuropsychology. Edited by John DeLuca. MIT Press, 2005.]  

Pain and fatigue are too often considered subjective discretional health complaints. But for many seniors, they are not arbitrary, and they are not the antithesis of objective! They are common in all societies. Pain has been extensively researched and pain clinics are numerous, but fatigue is still controversial. Scientific studies of fatigue are scarce, and fatigue clinics are nonexistent in most places. Acute fatigue due to extensive physical or mental work is a normal phenomenon; the treatment of choice is rest. Pathologic (relating to or caused by disease) fatigue remains after rest and can block normal life.  

There are many possible causes for fatigue. Techniques of combating and avoiding fatigue can be easier said than accomplished. Fatigue can be depressing, and depression can induce fatigue. 

Avoid: excess carbohydrates, overwork, emotional depression or suppression, clutter in your life, frustrations, sensory overload, pain, stress. 

Get exercise. Get adequate restorative sleep. Once things are changed to allow you to wake up feeling refreshed, fatigue may diminish. Get a pc (personal computer)… regular Internet use reduces the rate of depression among elderly Americans by 20%, according to a 2009 study by the Phoenix Center, a Washington, D.C. think tank. 

People with Fibromyalgia Syndrome (FMS) and Chronic Myofascial Pain Syndrome (CMP) are often oxygen-starved. (Lack of oxygen may also be caused by allergy, fluid retention, or microcirculation difficulties.) Fatigue can also stem from the constant effort to function in spite of pain. [“Fibromyalgia & Chronic Myofascial Pain Syndrome”: p 125, 338] 

What about complementary and alternative medicine (CAM) in the treatment of fibromyalgia, pain and fatigue? Acupuncture, ayurveda, biofeedback, chiropractic medicine, herbalism, heat application, homeopathy, hypnosis, massage therapy, meditation, naturopathy, nutritional-based therapies, physical therapy, T'ai Chi, traditional Chinese medicine, yoga…  

Research at the University of Maryland School of Medicine’s Complementary Medicine Program concluded that the limited amount of high-quality evidence suggests that “real acupuncture” is more effective than “sham acupuncture” (also referred to as “poor quality acupuncture”) for improving symptoms of patients with FMS. [“Is acupuncture effective in the treatment of fibromyalgia?” Berman BM, Ezzo J, Hadhazy V, Swyers JP. Journal of Family Practice. 1999 Mar;48(3):213-8] 

A 2009 article in the journal Academic Medicine that summarized research on alternative therapies reported acupuncture was not proven to help patients with problems other than pain or nausea. Chiropractic care of fibromyalgia lacks scientific evidence and was not recommended. [SmartMoney p77 September 2010] 

Fibromyalgia and Chronic Fatigue Syndrome (also known as myalgic encephalomyelitis) are both disorders characterized by widespread musculoskeletal aches, pain and stiffness, soft tissue tenderness, general fatigue, and sleep disturbances. Fibromyalgia is typically accompanied by fatigue, headache, and sleep disturbances. You may also hear fibromyalgia syndrome, fibromyositis. And controversy. I say, if you have a doctor and you feel bad, consult him/her!  

There are designated possible fibromyalgia tender or “trigger points,” although a person with the disorder may feel pain in other areas as well. During diagnosis, force is exerted at each of these 18 points. The patient must feel pain at 11 or more of these points for fibromyalgia to be considered. Four kilograms of force is about the amount of pressure required to blanch the thumbnail when applying pressure. 

I consulted my Redwood Gardens friend. Her fibromyalgia experience through years of courageous hanging in there is relevant and interesting. Sleep is her big problem. As a senior citizen, she considers herself lucky in terms of her fibromyalgia because now she doesn’t have to get up and go to work after an exhausting, sleepless night. Asked whether she was aware of those symptomatic pressure points: Yes! And of depression, which contributes to inability to lose weight. Fatigue is another big problem. Has she tried alternative approaches? Yes! Acupuncture (Alexander technique) and TaiChi. After years of “my miseries,” she takes only Aspirin. She has ups and downs, good and bad times. “Arthritis is a generic,” she reminds me. 

There are “questions” regarding the validity of Fibromyalgia as a clinical entity. It continues to be a disputed diagnosis. Many members of the medical community do not consider fibromyalgia a disease because of a lack of abnormalities on physical examination, and the absence of tests they consider objective and diagnostic. Again, I say, if you have a doctor and you feel bad, consult her/him! 

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Elders in the news:  

California Alliance for Retired Americans (CARA) is holding its 7th Annual Convention, “Taking Back the State in 2010”, October 12-13, in Oakland. Register online now. 

On September 27^th the Elder Justice Coalition announced that neither the House nor Senate Labor, Health and Human Services FY 2011 appropriation bills contain any money for the Elder Justice Act. Funding for the Elder Justice Act has been hindered by the fact that the bill passed as late as it did in the FY 2011 appropriation planning process combined with a more difficult fiscal environment. Congress is headed towards adopting a Continuing Resolution (CR) to begin the new fiscal year. The resolution would last until mid-November and until then; programs would continue to be funded at the FY 2010 level. New programs would not be funded. 

Wednesday, October 17, 10:30 AM-12 Noon: Lavender Seniors Presentation. Join the Emeryville Senior Center for this informational presentation which will focus on LGBT aging issues. 4321 Salem St. 94608. (510) 596-3737). The Coming Out Again Group meets at the North Berkeley Senior Center,1901 Hearst. (510) 981-5190 or check Berkeley’s website/Seniors for date(s) and time. 

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Attention, candidates… Running for election in the November election? You are invited to email to Senior Power (pen136@dslextreme.com) a statement of your “platform” in regard to senior citizens, e.g. housing, health, transportation. If you are running for re-election, please describe the h ighlights of your record on issues important to seniors. Deadline is October 13. 

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Editor’s note: Dr. Wheeler is not a physician and does not purport to provide medical advice. She is a senior advocate whose graduate degrees are from Columbia University and the University of Chicago.