Fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome.
Buskila, D · Current opinion in rheumatology · 2000 · DOI
Quick Summary
This review article examines the connections between fibromyalgia, chronic fatigue syndrome (ME/CFS), and myofascial pain syndrome. Researchers found that people with these conditions often have tender points in their muscles, hormonal imbalances affecting stress response, and possible immune system involvement. The study suggests that talking therapies like cognitive behavioral therapy may help manage chronic pain in these conditions, and that children and adolescents with these illnesses often improve over time.
Why It Matters
This review synthesizes evidence connecting neuroendocrine dysfunction, potential microbial triggers, and autonomic nervous system abnormalities across overlapping pain and fatigue syndromes. Understanding these shared biological mechanisms may help identify common pathways for ME/CFS and guide development of targeted interventions, while the reported favorable outcomes in children provide prognostic hope.
Observed Findings
Fibromyalgia and widespread pain were prevalent in Gulf War veterans with unexplained illness referred to rheumatology
Increased tenderness was demonstrated in the postmenstrual phase compared with intermenstrual phase in normally cycling women but not oral contraceptive users
Patients with fibromyalgia showed impaired HPA axis and sympathoadrenal system activation with reduced corticotropin and epinephrine response to hypoglycemia
Mycoplasma genus and M. fermentans were detected by PCR in ME/CFS patients
Favorable long-term outcomes were reported in children and adolescents with fibromyalgia and ME/CFS
Inferred Conclusions
Autonomic and neuroendocrine dysfunction play a role in symptom development and exacerbation in ME/CFS and fibromyalgia
Hormonal factors and potentially genetic factors (HLA region linkage) contribute to symptom presentation and susceptibility
Cognitive behavioral therapy and behavioral interventions are effective for managing chronic pain in these conditions
Pediatric cases of fibromyalgia and ME/CFS tend to have more favorable prognoses than adult cases
Remaining Questions
What is the mechanistic role of Mycoplasma species in ME/CFS, and is their presence directly causative or incidental?
What This Study Does Not Prove
This review does not prove causation for any proposed mechanism, nor does it establish that Mycoplasma infection causes ME/CFS (detection does not equal causation). The review also does not provide evidence from controlled clinical trials, and the broad scope examining three related but distinct conditions limits conclusions about ME/CFS specifically. Cross-study comparisons may reflect publication bias and varying case definitions.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →