Raynaud's Syndrome in Fibromyalgia & Chronic Fatigue Syndrome

More than just cold hands and feet

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Are your hands and feet cold all the time? That's a common complaint in people with fibromyalgia (FMS) and chronic fatigue syndrome (ME/CFS). In some case, it's just a symptom.

In others cases, however, it could be due to a common overlapping condition called Raynaud's syndrome (also known as Raynaud's phenomenon).

What Is Raynaud's Syndrome?

In Raynaud's syndrome, the blood vessels constrict, which allows less blood to get through.

That not only makes your extremities cold, it makes them extremely difficult to warm up. The most commonly affected body parts are the fingers and toes, but your lips, nose, ear lobes, knees, and nipples may also be involved.

Raynaud's isn't all about the cold, though. The diminished blood flow can cause pain in the affected areas, and it may also cause the skin there to turn blue. Skin ulcers (sores) are possible, since prolonged episodes can damage tissue.

Increased symptoms, called attacks, are often triggered by exposure to cold or high levels of stress. An attack may last for just a few minutes or could go on for hours.

Some people have Raynaud's syndrome as a primary condition, meaning that it doesn't accompany another illness. In other people, it's a secondary condition, meaning that it wouldn't be present without the other illness.

Raynaud's is also common in lupus, rheumatoid arthritis and Sjogren's syndrome.

We don't yet know what causes Raynaud's and there is no cure.

Diagnosing Raynaud's Syndrome

A Raynaud's syndrome diagnosis is generally based on symptoms and a physical exam. However, your doctor may also order a cold stimulation test, in which heat sensors will record the temperature in your fingers before and after soaking them in cold water.

Your doctor may also ask a lot of questions about your medical history and perform additional tests to look for causes of secondary Raynaud's syndrome. These are also tests that are common in the exclusion process for a diagnosis of FMS, and may be part of the ME/CFS diagnostic process depending on your symptoms. They include:

Treating/Managing Raynaud's Syndrome

Several treatment and management strategies can help ease the symptoms of Raynaud's. The first line of defense is modifying your habits to help prevent symptoms. You can do this by:

  • not exposing your hands to cold or protecting them when you can't avoid exposure
  • not smoking
  • not wearing anything that constricts blood flow, including rings or tight socks
  • exercising to improve circulation
  • managing your stress
  • avoiding possible symptom triggers, including vibrations

When a Raynaud's attack occurs, you can help ease it by:

  • moving or massaging the affected parts
  • finding a warmer place
  • running warm (not hot!) water over the cold areas

Medical treatment options include:

  • in rare cases, tissue damage can occur and may need to be surgically removed

Some alternative treatments, including biofeedback and supplementation with gingko or fish oil, have been recommended for treating Raynaud's. However, a 2009 review of available research found that they did not make a significant difference.

Raynaud's in Fibromyalgia/Chronic Fatigue Syndrome

We don't know exactly why Raynaud's is common in people with FMS and ME/CFS, but it's possible that they share underlying physiological properties. Raynaud's symptoms are caused by inadequate blood flow, and some research indicates impaired blood flow in FMS and ME/CFS.

Raynaud's symptoms may aggravate certain symptoms of FMS and ME/CFS, which often involve temperature sensitivity. Getting chilled can cause pain for someone with FMS/ME/CFS and may, in some cases, trigger a symptom flare. That makes it especially important to prevent Raynaud's symptoms in those patients.

While treatments for Raynaud's and FMS/ME/CFS are different, lifestyle changes such as not smoking, managing stress and gentle exercise (appropriate to your tolerance level) may help alleviate symptoms of all those conditions.

If you suspect you have Raynaud's syndrome, be sure to bring it up with your doctor so you can be properly diagnosed and treated.

Sources:

Malenfant D, Catton M, Pope JE. Rheumatology (Oxford). 2009 Jul;48(7):791-5. the efficacy of complementary and alternative medicine in the treatment of Raynaud's phenomenon: a literature review and meta-analysis.

Pope JE. Drugs. 2007;67(4):517-25. The diagnosis and treatment of Raynaud's phenomenon: a practical approach.

Smith NL. Journal of pain & palliative care pharmacotherapy. 2004;18(4):31-45. Serotonin mechanisms in pain and functional syndrome: managemtne implications in comorbid fibromyalgia, headache, and irritable bowel syndrome - case study and discussion.

Staud R. Future rheumatology. 2008 Oct 1;3(5):475-483. Heart rate variability as a biomarker of fibromyalgia syndrome.

Wigley FM. Patient information: Raynaud phenomenon UpToDate.com. All rights reserved. Accessed December 2011.

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