Updated 7/8/2020 by Marc Woodard
Chronic Pain Syndrome (CPS) is a common problem that presents a major challenge to health-care providers because of its complex natural history, unclear etiology, and poor response to therapy. CPS is a poorly defined condition [Google 2020]. Whereas fibromyalgia has specific physical and hormonal markers that likely confirm the diagnosis and treatment can significantly alleviate chronic pain.
If you have no history of illness, disease or injury and have unexplainable and medically unsubstantiated pain, you may likely be diagnosed with fibromyalgia. What’s the difference between the two? Fibromyalgia is a neurosensory disorder where one feels widespread pain throughout the body, but most specifically; joint and muscle stiffness and pain with fatigue. CPS appears to manifest after ill-health, or injury has been treated and chronic pain continues on for years.
During the early years of fibromyalgia medical diagnosis, it was thought the pain originated from the brain; and the body’s oversensitivity to pain was somewhat of a mystery between the brain-body connections. Today, there appears to be medical consensus on likely cause of fibromyolgia pain. “Researchers believe repeated nerve stimulation causes the brains of people with fibromyalgia to change. This change involves an abnormal increase in levels of certain chemicals in the brain that signal pain (neurotransmitters). In addition, the brain’s pain receptors seem to develop a sort of memory of the pain and become more sensitive, meaning they can overreact to pain signals” [MayoClinic 1998-20].
It is now understood a cause of fibromyalgia stems from environmental factors, genetics, lifestyle, injury, illness and disease which influence the brain’s neurochemical balance and can become unbalanced. For some, these imbalances appear to be caused by environmental stressors, which triggers anxiety and depression. Mood changes, change brain chemicals… whereas brain chemical imbalances are known to cause bodily pain.
Unlike fibromyalgia which is becoming less of a mystery than it was 10 years ago… i.e., “Doctors don’t know exactly what causes CPS. It often starts with an injury or painful condition such as: Arthritis and other joint problems, Back pain, Headaches, Muscle strains and sprains, Repetitive stress injuries, e.g., when the same movement over and over puts strain on a body part” [Web MD 2005-20].
CPS can also be diagnosed as a like-fibromyalgia condition that causes muscle pain throughout the body [whereas I believe, pain depression can also change brain chemical balance]. Illness and disease and injury are also suspected triggers of CPS, e.g., “Nerve damage, Lyme disease, Broken bones, Cancer, Acid reflux or ulcers, Inflammatory bowel disease (IBD), Irritable bowel syndrome (IBS), Endometriosis, when tissue in the uterus grows outside of it, Surgery” [Web MD 2005-20]. For those diagnosed with CPS, it is much harder for medical specialists to explain the long term pain story after symptoms have been adequately treated and physical therapy is complete; and brain chemical(s) are in balance.
“CPS can be hard to treat, but it’s not impossible. A mix of treatments like counseling, physical therapy, and relaxation techniques can help relieve your pain and the other symptoms that come with it … The roots of CPS are both physical and mental. Some experts think that people with the condition have a problem with the system of nerves and glands that the body uses to handle stress. That makes them feel pain differently” [Web MD 2005-20].
The American College of Rheumatology diagnosis criteria has proven that the origin of pain does not solely stem from a brain signal that produces the pain. Instead a physiological chemical shortfall is present in many cases that prevent the patient from completely alleviating pain. Think of it this way… ‘A person whose immune system is down… gets a cold and can never completely get rid of it.’ So you’re always in pain. Whereas it does not take much physical, or mental stress to aggravate and exasperate ‘a weakened immune system’ and cause an acute to chronic pain condition to transpire.
The key differences between fibromyalgia versus CPS diagnosis appears to be based on three fibromyalgia markers: Muscle tenderness, joint ache pain, which produce stiffness and fatigue, often coupled with emotional stress that can last years.
Fortunately there are chemical identifiers that can determine a neurosensory interlink between the brain and spinal cord for those diagnosed with fibromyalgia. “Research has found people with fibromyalgia have abnormally low levels of the hormones serotonin, noradrenaline and dopamine in their brains. Low levels of these hormones may be a key factor in the cause of fibromyalgia, as they’re important in regulating things like: mood” [Google 2020].
CPS is often the diagnosis for chronic pain patients for lack of fibromyalgia markers/symptoms and when medical history of illness, disease and/or past injury are a likely cause of increased pain sensitivity after ill-health or injury: E.g., cancer, immune disorders, rheumatoid arthritis, migraines, herniated disk, sports injury, or car accident with radiating neuropathies, etc… Substantiated by MRI, Cat scan, x-Ray, ultra-sound, blood/urine test, other lab test markers etc.
CPS patients can also have brain chemical imbalances due to chronic pain-depression. When a physiatrist [pain specialist] substantiates a diagnosis through lab tests identifying neurochemical brain imbalances – treatment can be prescribed. However, this does not mean chronic pain can be completely resolved through pain block and elevated mood pharmaceuticals, or other alternative medical treatment regardless of the pain disorder.
Patients diagnosed with fibromyalgia today are taken much more serious than a decade ago. In May 2014 when I first wrote this article, approximately 35% of all Americans had experienced, or have had some form of short/long term chronic pain. And some 50 million had experienced partial to full disability due to chronic pain. Science has come a long way to identify and treat fibromyalgia. However, CPS appears now… in many ways become the unexplained chronic pain Phenomenon after completion of therapy and treatment of an illness, disease or injury… much like fibromyalgia was not long ago. To date ~50 million suffer from chronic pain. That’s 20% of our population. “About 20 million of them have “high-impact chronic pain” — pain severe enough that it frequently limits life or work activities” [Google 2020].
Patients diagnosed with CPS also experience the same internalizing and rationalizing effect of fibromyalgia pain patient. If a patient feels overly inhibited by medication, or under medicated to treat a chronic pain condition, that can lead to unhealthy lifestyle habits and behavioral changes: e.g., relational conflict, unhealthy diet, drinking, smoking, illegal drug use, prescription abuse, out-of-control behavior etc., which often lead to other increased health risk.
If you experience chronic pain, and/or pain depression and anxiety and experiencing a complex pain story and need help, be sure to seek medical treatment by your PCP (Primary Care Provider). Request a referral to pain management specialist [physiatrist]. Especially if you’ve not been diagnosed with CPS or Fibromyalgia and suffer from chronic pain. Get the correct diagnosis and pain alleviation treatment from a pain management specialist you need and deserve now.
The Free Dictionary, by Farlex. Fibromyalgia.
Dellwo, Adrienne. About.com. Fibromyalgia and Chronic Fatigue. July 2, 2012.
Wikipedia. Chronic Pain.
Health Encyclopedia. Diseases and Conditions.
Singh, Manish K. Chronic Pain Syndrome. Medscape.
Woodamarc. Pain Depression Origins. Hubpages.com.
Author: Marc T. Woodard, MBA, BS Exercise Science, ARNG, CPT, RET. 2014-20 Copyright. All rights reserved, Mirror Athlete Inc., www.mirrorathlete.org, Sign up for your Free eNewsletter.