Pain and fatigue, it’s not in your head—or is it?

Pain syndromes are very commonly associated with autoimmune diseases like rheumatoid arthritis or systemic lupus erythematosus. Despite the best efforts of many, no cause is known. Recently, those with post-COVID syndrome were found to have new-onset pain syndromes like fibromyalgia or myalgic encephalomyelitis, also known as chronic fatigue syndrome.

Considering the immune system as one large police department within the body, we must consider how the various cells and tissues communicate. We know that most urban armies and policing agencies have sophisticated radio networks and the ability to speak to each other in real time. This network within the immune system is “the biological regulatory system.” It is comprised of potent chemicals called cytokines and chemokines. One chemical, called a cytokine, tells cells what to do, and the other, called a chemokine, tells them where to go.

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Although chronic fatigue and fibromyalgia are separate diseases that cause exhaustion and more pain and discomfort, respectively, they are more common in women. I rarely see a man with fibromyalgia.

There is data to support the idea that chronic fatigue and fibromyalgia are the residues of viral infection in some patients. The condition is actual, and haunts patients with unrelenting pain and sleep deprivation, and some physicians force their patients onto the psychiatrist’s couch. It is the source of endless discomfort, with no response from steroids or anti-inflammatory medicines. It can be pure hell.

The possible reasons for this unrelenting pain syndrome could be cytokines and/or chemokines and their effects on the brain. In other words, these syndromes could be a problem with cellular communication in the brain. Complex and interesting, the approach to these pain syndromes should be explored in the nervous system and not in the painful muscles at the heart of the patient’s complaints.

Are these immune diseases? We think not. Patients with these pain syndromes feel as though they have inflammation while they do not. The patient believes that some medication might take away the pain, as seen with conditions like arthritis or muscle disease, but no medication will remove the pain successfully. The drugs that remove the pain act on the central nervous system. Medications like Lyrica, Savella, and gabapentin offer some relief to this discomfort, but they are not perfect.