Poorly Understood Conditions of the 21st Century: A Look at Chronic Fatigue Symdrome, Fibromyalgia, and Multiple Chemical Sensitivity

by Dr. Lynne Marshall. The Canadian Journal of Diagnosis. July 2003.

Case Criteria Checklist for Chronic Fatigue Syndrome, Fibromyalgia and Multiple Chemical Sensitivity

Diseases of the 21st Century - Chronic Fatigue Syndrome (CFS) Clinical Diagnostic Worksheet; Diagnostic Criteria for the Classification of Fibromyalgia (FM); Multiple Chemical Sensitivity (MCS) Case Criteria Checklist. Dr. Lynn Marshall, Dr. Alison Bested and Dr. Riina Bray. Published in : July 9, 2003. From the Ontario College of Family Physicians.

Chronic Fatigue Syndrome Clinical Guidelines - The 2003 Canadian Concensus Protocol

Published in Journal of Chronic Fatigue Syndrome. Vol 11 Number 1. 2003.

Immune Manifestations: tender lymph nodes, recurrent sore throat, recurrent flu-like symptoms, general malaise, new sensitivities to food, medications and/or chemicals. [Emphasis added.]

Considerations for the Diagnosis of Chemical Sensitivity

William J. Rea, Alfred R. Johnson, Gerald H. Ross, Joel R. Butler, Ervin J. Fenyves, Bertie Griffiths, John Laseter.

Fibromyalgia Syndrome (The)

This link now goes to the final version of the below document. It is now titled:

The Fibromyalgia Syndrome: A Clinical Case Definition for Practitioners.

Full title of document: Fibromyalgia Syndrome: Canadian Clinical Working Case Definition, Diagnostic and Treatment Protocols - A Consensus Document. Published in Journal of Musculoskeletal Pain. Volume 11, Number 4.

A. Etiology

Most patients enjoyed a healthy active lifestyle prior to the onset of FMS. There is no known single initiating cause [etiology] however, genetics appear to play a factor in some patients while numerous physical events such as trauma, surgery, repetitive strain, childbirth, viral infections, and chemical exposure can be associated with the onset of FMS in other patients. Extreme or chronic stress may be risk factors but that has not been proven. In some cases there is no known prodromal event and the symptoms come on gradually. [Emphasis added.]

Functional impairment in chronic fatigue syndrome, fibromyalgia, and multiple chemical sensitivity

Can Fam Physician Vol. 56, No. 2, February 2010, pp.e57 - e65
Copyright © 2010 by The College of Family Physicians of Canada. (Lavergne, Cole, Kerr, Marshall.)

Full article is available in pdf format.

Abstract: Chronic fatigue syndrome (CFS), fibromyalgia (FM), and multiple chemical sensitivity (MCS) are relatively common chronic conditions with the potential to substantially limit functioning and health-related quality of life.1-7 The Statistics Canada 2005 Canadian Community Health Survey found that 1.2 million Canadians, or 5% of those aged 12 or older, reported having been diagnosed with at least 1 of these 3 illnesses: 1.3% with CFS, 1.5% with FM, and 2.4% with MCS.8 The overall prevalence rose with age to 6.9% for women aged 45 to 64-a period in women's lives when they would usually be employed and active contributors to society. All 3 of these conditions have symptoms referable to multiple body systems, and studies in the United States show high rates of overlap among them.5,7,9,10 However, they each have some distinct features, as outlined in the case criteria and descriptions provided in Boxes 1 to 311-16; the most notable are the profound physical and cognitive fatigue of CFS, the widespread musculoskeletal pain of FM, and the common triggering of neurologic symptoms in MCS on exposure to diverse chemicals at previously tolerable levels or at levels tolerated by most people. There is a paucity of Canadian literature describing these commonly encountered illnesses, particularly in the clinical setting.

This study aimed to describe a clinical patient population in a Canadian context, to document functional status with the Medical Outcomes Study's 36-item short form (SF-36)17 compared with Canadian population average values, and to determine whether level of function was associated with demographic or diagnostic characteristics.

Immunological Mechanisms of Disease and the Multiple Chemical Sensitivity Syndrome

By. William J. Meggs. The National Acadamies Press. 2002. This article will discuss proposed and hypothetical immunological mechanisms for the Multiple Chemical Sensitivity Syndrome. In the next section, descriptions of this syndrome will be discussed, and the syndrome will be described in terms of a chemical stress syndrome. Known immunological mechanisms for the pathophysiology of established diseases will then be discussed and compared with MCS to see if any are feasible explanations. Finally, the hypothesis that the mechanism of MCS involves neuroimmunology, the interplay between the immune and nervous systems, will be presented.

ME/CFS Given Official Recognition by Ontario Government

"Chronic Fatigue Syndrome" has been given the OHIP Diagnostic Code 795 by the Ontario Medical Association as a Neurological Illness.

Multiple Chemical Sensitivities: Addendum to Biologic Markers in Immunotoxicology (1992)

National Research Council, from National Academies Press.

Multiple Chemical Sensitivity: A 1999 Consensus

Archives of Environmental Health v.54, n.3 May/Jun99.

Consensus Criteria for MCS

The following consensus criteria for the diagnosis of MCS were gleaned from the study by Nethercott et al.(14) (funded in part by grants from US NIOSH and US NIEHS):

1. "The symptoms are reproducible with [repeated chemical] exposure."
2. "The condition is chronic."
3. "Low levels of exposure [lower than previously or commonly tolerated] result in manifestations of the syndrome."
4. "The symptoms improve or resolve when the incitants are removed."
5. "Responses occur to multiple chemically unrelated substances."
6. [Added in 1999]: "Symptoms involve multiple organ systems."

Given the only other explicit consensus ever published on MCS-the 1994 statement of the American Lung Association, American Medical Association, U.S. Environmental Protection Agency, and U.S. Consumer Product Safety Commission, that "complaints [of MCS] should not be dismissed as psychogenic, and a thorough workup is essential" (ALA 1994)-we recommend that MCS be diagnosed whenever all 6 of the consensus criteria are met, along with any other disorders that also may be present, such as asthma, allergy, migraine, chronic fatigue syndrome (CFS), and fibromyalgia (FM). MCS should be excluded only if a single other multi-organ disorder can account for both the entire spectrum of signs and symptoms and their association with chemical exposures, such as mastocytosis or porphyria, but not CFS or FM, which are not so associated.

To assist physicians who are unfamiliar with the evaluation of MCS, we recommend that clinical protocols include validated questionnaires for screening and characterizing chemical sensitivity,(15,16) a list of overlapping disorders to consider in the differential diagnosis of MCS, and a list of signs and test abnormalities associated with MCS in the peer-reviewed literature (summarized by Ashford and Miller(17) and Donnay(18)). Although no single test is yet considered diagnostic of MCS, those suggested by signs, symptoms, or history may be helpful in treating and tracking the disorder.

The Development of a Revised Canadian Myalgic Encephalomyelitis Chronic Fatigue Syndrome Case Definition
American Journal of Biochemistry and Biotechnology 6 (2): 120-135, 2010 ISSN 1553-3468. Conclusion/Recommendations: In this article, we specified explicit rules for determining whether critical symptoms meet ME/CFS criteria using a revised Canadian case definition and a questionnaire has been developed to assess core symptoms. It is hoped that these developments will lead to increased reliability of this revised Canadian case definition as well as more frequent use of these criteria by investigators.