Central Mechanisms of Chronic Pain and Fatigue Subtitle: Functional Imaging of Brain and Spinal Cord

Chronic fatigue (ME/CFS) and fibromyalgia syndrome (FM) are a chronic musculoskeletal pain
disorder that predominantly afflicts women. Frequently associated insomnia, cognitive
abnormalities, and fatigue may lead to early disability. No consistent soft tissue
abnormalities have been identified so far in these patients. The cause of these disorders is
unknown, no highly effective treatment is available and the current methods of diagnosis are
imprecise and unreliable. The Investigators previously used quantitative sensory testing to
improve upon diagnoses of these disorders by supplementing the current procedure of
manipulating defined pressure points by hand and noting the presence or absence of pain. The
quantitative methods of evaluation involve repetitive application of brief, non-injurious
thermal/mechanical stimulation that normally produces a moderate degree of temporal summation
of sensation intensity. The patients and normal control subjects will verbally rate the
magnitude of late sensations elicited by each stimulus, using a numerical scale. Chronic pain
in these patients results, at least partially, from exaggerated activation of central
N-methyl-D-aspartate (NMDA) receptors as a result of enhanced input from unmyelinated
peripheral afferent nerve fibers supplying deep tissues. Temporal summation of second pain
can lead to central sensitization with subsequent signs of hyperalgesia and allodynia.
Functional brain imaging of ME/CFS and FM patients, as proposed in this study, will be used
to document their ratings of repetitive experimental stimuli and the resulting pain
augmentation. Successful completion of this study will provide a new method for the
evaluation of chronic pain/fatigue mechanism and their response to therapy.

Inclusion Criteria:

- diagnosis of FM will require a history of chronic widespread pain as well as the
presence of at least eleven out of eighteen paired tender points.

- diagnosis of ME/CFS will require a history of chronic fatigue persisting or relapsing
for more than 6 months as well as the presence of at least four out of eight
designated symptoms.

- willing to reduce anti-depressants to low levels like Elavil 10 mg/day, trazodone 50
mg/day, celexa 20 mg/day

Exclusion Criteria:

- Patients unwilling or unable to discontinue or modify analgesics, hypnotics,
anxiolytics, or anti-depressants during the study period will be excluded from this
trial.