Treatment of Hypothalamic-Pituitary-Adrenal Axis Dysfunction in Patients with Chronic Fatigue Syndrome (CFS) and Fibromyalgia (FM)

Points addressed:

• A review of the literature regarding evidence of significant hypothalamic-pituitary-adrenal axis (HPA) dysfunction in CFS andFM.
• Indications and efficacy of treatment with physiological doses of cortisol
• Expected risks and benefits of such treatment

Abstract:

There is clear evidence that adrenal axis dysfunction is present in patients with chronic fatigue syndrome (CFS) and fibromyalgia (FM) 1-21,23-28 and that treatment with low physiologic doses of cortisol have been shown to be safe, appropriate and effective.8,9,10,23,30 It should be considered the standard of care to treat patients with CFS and FM who have baseline cortisol levels under 12 ug/ml.8,9,10,31,32,33

COMMENTARY: DIFFERENTIAL DIAGNOSIS OFFIBROMYALGIA SYNDROME: PROPOSAL OF A MODEL AND ALGORITHM FOR PATIENTS PRESENTING WITH THEPRIMARY SYMPTOM OF CHRONIC WIDESPREAD PAIN

By: Michael J. Schneider, DC, PhD,a David M. Brady, ND, DC,b and Stephen M. Perle, DC, MSc

Fibromyalgia syndrome (FMS) remains an elusive condition of unknown etiology, in which patients report chronic widespread pain (allodynia or hyperalgesia) and a variety of other complaints including fatigue, sleep disorders, cognitive deficit, irritable bowel and bladder syndrome, headache, Raynaud’s syndrome, bruxism, atypical patterns of sensory dysethesia, and other symptoms. Despite the name of the condition, fibromyoalgia, there are no data to support the hypothesis that FMS is a distinct pathologic disorder of the soft tissues. More recent data tend to support the notion that FMS is a disorder of the central nervous system pain processing pathways and not some type of primary auto-immune disorder of the peripheral tissues. It is quite possible that the term FMS is a poor choice of words, for it implies that patients with a variable symptom complex all have the same singular disease or disorder. The diagnosis of FMS has been burdened by a controversial and problematic history since its inception in 1990, with a disturbing trend toward overdiagnosis in recent years. A recent study provided some evidence of the seriousness of improper FMS diagnosis, when a cohort of patients referred to a specialty rheumatology clinic with a tentative diagnosis of FMS were prospectively followed and the FMS diagnosis could only be confirmed in 34% of these patients.1

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By: Alan C. Logan, ND, FRSH

Fibromyalgia (FM) is a rheumatic disorder characterized by chronic widespread musculoskeletal pain and tenderness in the absence of well-defined  musculoskeletal or rheumatic disease. The finding of tenderness in 11 of 18 specified soft-tissue points on digital palpation confirms this diagnosis. In addition to  pain and tenderness, patients often present with fatigue, insomnia, cognitive difficulty, and gastrointestinal complaints (Goldenberg, 1999). FM patients present with a wide range of symptom fluctuations and high levels of comorbidity and are met clinically with an absence of curative interventions (Friedberg & Jason, 2001).
FM is a commonly diagnosed rheumatic condition that affects more women than men. The prevalence of FM is approximately 3,400 women and 500 men per  100,000; in women, the prevalence increases with age to more than 7% between the ages of 60 and 79 (Wolfe, Ross, Anderson, Russell, & Hebert, 1995). Although considerable international investigation has been devoted to understanding FM, no single etiologic factor has yet been identified.

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Bacterial overgrowth and yeast infections are thought to be one of the triggers that cause fibromyalgia and chronic fatigue syndrome.   As the standard American diets (SAD) have grown increasingly focused on processed foods, sugars and refined grains, and our environment is full of chemicals and pollution, this has led to a substantial increase in harmful bacteria in the intestinal tract for many of us. 

By: Alan H. Pressman, DC

Note: The information on this website is not a substitute for the advice of & treatment by a qualified professional.

Alan H. Pressman, MS, DC, DACBN, CCSP, is past president of the Council on Nutrition of the American Chiropractic Association; former chairman, department of nutrition, New York Chiropractic College, and, associate professor of biology, University of Bridgeport, Connecticut.  He is currently the director of research, Institute of Rehabilitative Nutrition, and maintains an active practice in New York City.

In a recent paper published in the journal Seminars in Arthritis and Rheumatism, rheumatologists Bland and Cooper reviewed the possible reversibility of degenerative joint disease.¹ In this article they propose that the degeneration of hyaline cartilage occurs as a consequence of activation of monocytes, macrophages and neutrophils which re lease oxidants that in turn attack connective tissue and the joint lubricant substance hyaluronic acid. The activation of white cells that in turn release alarm substances and oxidants occurs as a consequence of an inflammatory cascade modulated through receptor sites on the surface of white cells which are stimulated by the presence of foreign molecules. These foreign molecules have been termed metabolic toxins and are from exogenous and endogenous sources.

Lifestyle Recommendations:

Studies show that poor cellular energy production due to poisoning of the energy-producing machinery of the cell (the mitochondria) is a common characteristic in both fibromyalgia and chronic fatigue syndrome.  In studies at the Abington Memorial Hospital in Pennsylvania, rheumatology researchers found that fibromyalgia patients suffer from a condition that could be described loosely as “muscle toxicity”, in which structures called mitochondria within muscle cells were inefficient in their production of energy.  In addition, fibromyalgia sufferers were found to have smaller than normal muscle fibers that exhibited misshapen mitochondria that were not found in normal subjects.