Fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome.
Goldenberg, D L · Current opinion in rheumatology · 1997
Quick Summary
This review examines three related conditions—fibromyalgia, ME/CFS, and myofascial pain syndrome—and discusses ongoing challenges in diagnosing and treating them. The study found that psychiatric conditions are not a core feature of these diseases, but rather reflect that people with these conditions are more likely to seek medical help. The researchers identified that a blood pressure problem called neurally mediated hypotension may play a role in ME/CFS, and that treating patients in multidisciplinary groups (rather than in isolation) showed more promise than traditional individual treatments.
Why It Matters
This study addresses fundamental diagnostic and treatment questions that remain relevant for ME/CFS patients struggling with recognition and care. By challenging psychiatric-centric explanations for these diseases, it supports the biological basis of ME/CFS and validates patient experiences. The finding that multidisciplinary group treatment shows promise offers practical guidance for healthcare providers seeking more effective management strategies.
Observed Findings
Multiple lifetime psychiatric diagnoses in fibromyalgia and CFS patients correlate more strongly with healthcare-seeking behavior than with disease pathology
Neurally mediated hypotension may be associated with chronic fatigue syndrome
Multidisciplinary group intervention approaches showed more promising outcomes than standard individual treatments
Traditional treatment approaches for fibromyalgia and CFS had limited success rates
Inferred Conclusions
Psychiatric complexity in fibromyalgia and CFS reflects secondary responses to chronic illness rather than intrinsic psychiatric disease
Neurally mediated hypotension may represent an important pathophysiologic mechanism contributing to CFS symptoms
Multidisciplinary, group-based interventions warrant further investigation as a superior treatment model compared to monotherapy approaches
Diagnostic and treatment frameworks for these conditions require reorganization away from psychiatric-centered models
Remaining Questions
What are the specific mechanisms by which neurally mediated hypotension contributes to ME/CFS symptoms and how can this be therapeutically targeted?
Which components of multidisciplinary group intervention are most effective, and what are the optimal protocols for implementation?
What This Study Does Not Prove
This review does not establish causation between neurally mediated hypotension and ME/CFS—only an association. It does not prove that psychiatric comorbidity is entirely absent in these conditions, only that it may be secondary to medical illness and healthcare-seeking rather than primary. The review does not provide definitive treatment protocols or demonstrate that any specific intervention is curative.
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 →