Clinical overlap between fibromyalgia and myalgic encephalomyelitis. A systematic review and meta-analysis, 2022, Ramírez-Morales et al

Abstract

Myalgic encephalomyelitis is an illness characterized by profound malaise after mental or physical effort occurring in patients already suffering from constant fatigue. On the other hand, widespread pain and widespread allodynia are the core fibromyalgia clinical features. There is controversy on these two syndromes alikeness.

Through the years, different diagnostic and/or classification criteria have been put forward to appraise both fibromyalgia and myalgic encephalomyelitis. The epidemiology of these two illnesses, and their overlap, may vary accordingly to the used definition. The most recent Wolfe et al. 2016 fibromyalgia diagnostic criteria incorporates three myalgic encephalomyelitis features including fatigue, waking unrefreshed and dyscognition.

The objective of this meta-analysis was to define the clinical overlap between fibromyalgia and myalgic encephalomyelitis based on a systematic literature review.

Methods
PubMed, Embase, Lilacs, and Cochrane data bases were searched on January 25, 2021 linking the medical subject heading “Fibromyalgia” to the following terms “chronic fatigue syndrome”, “myalgic encephalomyelitis” and “systemic exertion intolerance disease”. Our review included all original articles in which the clinical overlap between fibromyalgia and myalgic encephalomyelitis could be quantified based on recognized diagnostic or classification criteria. Articles scrutiny and selection followed the PRISMA guidelines. Each study quality was assessed according to GRADE recommendations. The global clinical overlap was calculated using a fixed effect model with inverse variance-weighted average method.

Results
Twenty one publications were included in the meta-analysis. Reviewed studies were highly dissimilar in their design, objectives, sample size, diagnostic criteria, and/or outcomes yielding a 98% heterogeneity index. Nevertheless, the clinical overlap between fibromyalgia and myalgic encephalomyelitis was a well defined outcome that could be reliably calculated despite the high heterogeneity value. All reviewed publications had moderate GRADE evidence level. Most evaluated articles used the old 1990 Wolfe et al. fibromyalgia diagnostic criteria. Myalgic encephalomyelitis and fibromyalgia diagnoses overlapped in 47.3% (95% CI: 45.97–48.63) of the reported cases.

Conclusion
This meta-analysis found prominent clinical overlap between fibromyalgia and myalgic encephalomyelitis. It seems likely that this concordance would be even higher when using the most recent Wolfe et al. 2016 fibromyalgia diagnostic criteria.

Open access, https://www.sciencedirect.com/science/article/abs/pii/S1568997222000994

 

Amazing how out of two words it's so common to completely overlook what they mean. In a discussion of pain in myalgic encephalomyelitis, compared to FM, they don't even list pain in the ME symptoms because they don't think about it.

Myalgic encephalomyelitis
Myalgic encephalomyelitis
Myalgic
Myalgia

JFC, the lack of attention to details in this profession is so damn absurd. They can pay obsessive attention to trivial things while at the same time completely overlook the basic stuff. Probably because they use the term ME but are thinking only of "chronic fatigue" so they simply don't think about 90%+ of the damn illness, and pain is so often left out of the definitions, even though it's in the freaking name. What a mess.

 

Exercise reportedly helps people who have FM without ME but not people with both

 

My impression from a very small sample is that doctors in Mexico don't generally know anything at all about ME. Maybe that will change with somewhat growing awareness of Long Covid.

It looks like these authors all have experience with FM and work in rheumatology, and don't seem to have much experience with ME.

 

We have no molecular mechanisms identified for either illness to distinguish them.

In people with systemic autoimmune disease there is a lot of co-existing diagnosis and symptoms of FM. Does one cause the other, or are they related in molecular origins, are some of the symptoms too similar to distinguish one illness from the other?

At the moment, not the most pressing question, when the science isn't there.

 

Sure. But it's common. It definitely shouldn't be left out, especially not on a discussion over this issue. I frankly don't understand why it's so often left out of definitions, but that's my bias as someone experiencing it.

It's just silly how everything is made out out of "a primary symptom of" that completely ignores most of the disease. Of course no progress can be made given that, it's usually impossible to solve an issue without understanding it and it fully applies here. All this discussion over generic things that simply ignore real life.

 

Agreed

If I remember correctly, the presenter at CDC's recent community call for ME (who recommended graded exercise and CBT) stated that FM and ME are a continuum with FM - pain - on one end and ME - fatigue - on the other.

Can't make progress with such simplistic views

 

That makes no sense whatsoever. WTH?

But it really confirms my view that the biopsychosocial ideology can genuinely, and in full, be reduced to the love-and-fear pseudo-cult in Donnie Darko, or at least this makes up 90% of it, you can just swap some words and it's basically that: one-dimensional thinking, the smallest, shallowest possible level there is, can't even see what's right in front of their nose because it's out of the one-dimensional bounds.

I usually just post the picture and since many people probably haven't watched it, it's worth putting it here:

https://www.youtube.com/watch?v=vivEzQUGHOQ

That's how I feel about everything BPS, there really isn't anything more to it. "The lifeline is divided that way". "The relationship between the mind and the body is biopsychosocial".

"If you don't complete the assignment, you get a zero for the day" is basically the same as "Do CBT and GET or you get denied disability". Coercive compliance.

 

In the UK before Lake Tahoe the symptoms of ME were seen as being widespread, often devastating pain especially in the muscles, an abnormal response to exercise and neurological involvement. Fatigue was only mentioned in the sense that it is present when people are ill.

When the CDC in its wisdom decided that fatigue was the main symptom of CFS, the only symptom in the UK, people with the pain of ME were told they had fibromyalgia as well. All the confusion stems from that.

The deep, burning pain in ME is most likely from lactic acid build up from reliance on anaerobic cellular respiration. Some people may not experience that if they keep below their anaerobic threshold.

Fibromyalgia must have a completely different cause because if it was due to a low AT then it would be ME! It is possible to have both as with any 2 diseases and maybe continual damage from ME can lead to secondary FMS

Nowadays, the biopsycho people are using fibromyalgia to mean pain and CFS to mean fatigue. Diseases now reduced to symptoms... well that won't cause any confusion!