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Buchwald's Comparison fo Patients with Chronic Fatigue Syndrome, Fibromyalgia, and Multiple Chemical

Buchwald's Comparison fo Patients with Chronic Fatigue Syndrome, Fibromyalgia, and Multiple Chemical

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Comparison of Patients With Chronic Fatigue Syndrome, Fibromyalgia, and Multiple Chemical Sensitivities Dedra Buchwald, MD, Deborah Garrity, MD Background: Chronic fatigue syndrome (CFS), fibro- myalgia (FM), and multiple chemical sensitivities (MCS) are conditions associated with fatigue and a variety of other symptoms that appear to share many clinical and demo- graphic features. Our objectives were to describe the simi- larities and differences among patients with CFS, FM, and MCS. Additional objectives were to determine how fre- quently patients with MCS and FM met the criteria for CFS and if they differed in their health locus of control. Methods: Demographic, clinical, and psychosocial mea- sures were prospectively collected in 90 patients, 30 each with CFS, FM, and MCS. Patients were recruited from a university-based referral clinic devoted to the evalua- tion and treatment of chronic fatigue and three private practices. Variables included demographic features, symp- toms characteristic of each condition, psychological com- plaints, a measure of health locus of control, and infor- mation on health care use. Results: Overall, the three patient groups were remarkably similar in demographic characteristics and the presence of specific symptoms. Patients with CFS and FM frequently reported symptoms compatible with MCS. Likewise, 70% of patients with FM and 30% of those with MCS met the criteria for CFS. Health care use was substantial among patients with CFS, FM, and MCS, with an average of 22.1, 39.7, and 23.3 visits, respectively, to a medical provider during the prior year. Health locus of control did not differ among the three populations. Conclusions: In general, demographic and clinical fac- tors and health locus of control do not clearly distin- guish patients with CFS, FM, and MCS. Symptoms typi- cal of each disorder are prevalent in the other two conditions. (Arch Intern Med. 1994;154:2049-2053) Chronic fatigue syn¬ drome (CFS) is a disor¬ der that has received an increasing amount of at¬ tention over the last few years. The hallmark of CFS is debilitat¬ ing fatigue of at least 6 months' duration accompanied by other symptoms such as fever, pharyngitis, painful lymph nodes, headache, myalgias, sleep disturbances, neurocognitive complaints, and depres¬ sion.12 It is more common in women and frequently has its onset following a "flu-" like illness.2 Findings on physical exami¬ nation are infrequent and, at present, there is no diagnostic test for CFS.23 Recently, the Centers for Disease Control and Pre¬ vention, Atlanta, Ga, has formulated spe¬ cific diagnostic criteria for CFS consist¬ ing of a combination of a minimum number of signs and symptoms.14 Fibromyalgia (FM) is a common rheumatologic condition characterized by chronic myalgias, fatigue, and disrupted sleep, often associated with headache, ir¬ ritable bowel syndrome, and interstitial cystitis.5 It occurs most commonly in women and may follow a viral illness.6 The American College of Rheumatology has proposed criteria for the classification of FM that require widespread musculoskel- etal
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