ABSTRACT
Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 407 Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 408 Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 410
Disordered Sleep (S) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 411 Hormonal Dysfunction (H) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 412
Thyroid Function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 413 Adrenal Insufficiency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 414 Dehydroepiandrosterone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 416 Low Estrogen and Testosterone . . . . . . . . . . . . . . . . . . . . . . . . . . . 416 Testosterone Deficiency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 417
Immune Dysfunction and Infections (I) . . . . . . . . . . . . . . . . . . . . . . . . 417 Nutritional Deficiencies (N) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 419 General Pain Relief . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 420 Autonomic Dysfunction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 420 Psychological Well-Being . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 421
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 421
Chronic fatigue syndrome (CFS) and fibromyalgia syndrome (FMS) are two common names for an overlapping spectrum of disabling syndromes. It is estimated that FMS alone affects 3 to 6 million Americans, causing more disability than rheumatoid arthritis.1 Myofacial pain syndrome (MPS) affects many millions more. Although we still have much to learn, effective treatment is now available for the large majority of patients with these illnesses.2,3
CFS/FMS/MPS represents a syndrome, a spectrum of processes with a common end point. Because the syndromes affect major control systems in the body, there are myriad symptoms that initially do not seem to be related. Recent research has implicated mitochondrial and hypothalamic and dysfunction as common denominators in these syndromes.4-7 Dysfunction of hormonal, sleep,
and autonomic control centers in the hypothalamus and energy production centers can explain the large number of symptoms and why most patients have a similar set of complaints.
