Among the abnormalities so-far found in the brains of many patients with FMS and CFS(ME) are reduced blood flow and energy production in key sites of the brain. While any such changes might themselves merely be symptoms of the syndrome it is thought by many researchers that the most important imbalance in these conditions probably lies in the brain and central nervous system itself.

New technologies for visualising the brain in a non-invasive manner (SPECT, BEAM, PET) show that there are few if any differences in the scans of patients with CFS(ME) and FMS.

What’s Going on in the FMS Patient’s Muscles? ^11,12,13
A host of stress related adaptations and changes are likely to have taken place in the muscles of someone with fibromyalgia resulting from overuse, misuse, abuse or disuse (postural, occupational, leisure activity, repetitive use, trauma etc) plus a number of additional factors.

1. A biochemical imbalance which may be the direct result of disturbed sleep leads to inadequate growth hormone production and poor repair of minor muscle damage.

2. Low levels of a serotonin in the blood and tissues lead to lowered pain thresholds because of the reduced effectiveness of the body’s natural endorphin painkillers, and the increased presence of ‘substance P’ which increases pain perception.

3. The sympathetic nervous system, which controls muscle tone can become disturbed leading to muscle ischemia (oxygen lack) resulting in greater ‘substance P’ release and increased sensitivity.

4. Duna proposes that these two elements are combined in fibromyalgia. Disordered sleep leading to reduced serotonin leading to reduced natural pain killing effects of endorphins, combined with a disturbed sympathetic nervous system which has resulted in muscle ischemia and increased pain sensitivity. Both disturbances involve reduced pain thresholds and activation of latent trigger points, with muscle pain as the end result.

5. ‘Micro-trauma’ (tiny amounts of damage) of muscles occurs in FMS patients ( genetic predisposition is a possible cause) leading to calcium leakage which increases muscle contraction, further reducing oxygen supply. This seems to be associated with a reduction in the muscle’s ability to produce energy , causing it to fatigueand to be unable to pump the excess calcium out of the cells. A similar mechanism is said by Travell and Simons to be involved in myofascial trigger point activity. ¹¹

6. James Daley MD has tested just what happens in the muscles of people with CFS(ME) when they exercise. Tests involving people with FMS (by Robert Bennett MD) gave similar results showing that muscles produced a great amount of lactic acid, adding to the discomfort. Some of the patients showed low carbon dioxide levels when resting, which is an indication of a hyperventilation tendency.

There is some evidence that progressive cardiovascular training (graduated training through exercise) improves muscle function and reduces pain in FMS but this is not thought desirable (and is often quite impossible anyway because of the degree of fatigue) in CFS(ME). ^12,13

The special features of fibromyalgia seem to involve a combination of circulatory and nerve imbalances which make the muscle changes even more pronounced and the symptoms more unpleasant.