Chronic pain, depression, fibromyalgia and chronic fatigue all seem to feed off each other but which came first? What is the root of this debilitation? It may not help much but I'd like to know.

It varies! Fibromyalgia often follows chronic pain, and pain for over 3 months is a diagnostic measure. This is usually neck trauma. However other types of fibromyalgia are linked to depression, often following a mental trauma. There is more than one type of fibro. Fibro also seems to work by stopping restorative delta sleep, so you are fatigued, and whether it is chronic varies. Or, chronic fatigue can bring on fibro. See these things as more of a vicious circle instead of a straight line, and then you will be closer to an answer!

hi, this might help: Stein, E. Assessment and Treatment of Patients with ME/CFS: Clinical Guidelines for Psychiatrists http://www.eleanorsteinmd.ca/download/260/ Stein E., Identifying and Treating Common Psychiatric Conditions Comorbid with Myalgic Encephalomyelitis and/or Fibromyalgia. http://www.eleanorsteinmd.ca/download/802/ Duffy FH, et al. http://www.biomedcentral.com/1471-2377/11/82. BCM Neurology 2011, 11:82. doi:10.1186/1471-2377-11-82. You may also be interested in: VanNess, JM, et al. Diminished Cardiopulmonary Capacity During Post-Exertional Malaise. 2007. J CFS 14(3). (see 2014 Keller paper for replication) Gene expression alterations at baseline and following moderate exercise in patients with Chronic Fatigue Syndrome and Fibromyalgia Syndrome. January 2012. J of Intern Med 271(1):64–88.  Brenu EW, Huth TK, Hardcastle SL, Fuller K, Kaur M, Johnston S, Ramos SB, Staines DR, Marshall-Gradisnik SM. Role of adaptive and innate immune cells in chronic fatigue syndrome/myalgic encephalomyelitis. Int Immunol. 2014 Apr;26(4):233-42. doi: 10.1093/intimm/dxt068. Jones DE, Hollingsworth KG, Taylor R, Blamire AM, Newton JL. Abnormalities in pH handling by peripheral muscle and potential regulation by the autonomic nervous system in chronic fatigue syndrome. J Intern Med. 2010 Apr;267(4):394-401. doi: 10.1111/j.1365-2796.2009.02160.x. Streeten, D. Circulating Blood Volume in Chronic Fatigue Syndrome. J Chronic Fatigue Syndrome, 4(1) 1998.http://www.ncf-net.org/library/Bell-StreetenJCFS1998.htm Last accessed 6/21/2014 Hollingsworth KG, Hodgson T, Macgowan GA, Blamire AM, Newton JL. Impaired cardiac function in chronic fatigue syndrome measured using magnetic resonance cardiac tagging. J Intern Med. 2012 Mar;271(3):264-70. doi: 10.1111/j.1365-2796.2011.02429.x. (see also 2003 Peckerman study) Stanford University ME/CFS Symposium March 2014. Videos of presentation.  http://mecfs.stanford.edu/2014SymposiumVideo.html Nakatomi , et al. http://jnm.snmjournals.org/content/early/2014/03/21/jnumed.113.131045.abstract   J Nucl Med. 2014 Mar 24;11(6):945-950.[Epub aheal of print]. Rowe, P., Chronic Fatigue Center, John Hopkins Children’s Center. General Information Brochure on Orthostatic Intolerance and its Treatment. March 2014 http://www.dysautonomiainternational.org/pdf/RoweOIsummary.pdf ME/CFS (and I think fibro, too, not 100% sure, but it would make sense since it 'tags along' with so many autoimmune diseases) are more and more being seen as subtle inflammatory and possibly autoimmune. This would explain why these patients tend to collect more and more diagnoses (as this is common in inflammatory/autoimmune diseases). Depression is subtlety inflammatory, too, which is one reason (besides grief/loss being diagnosed as depression) why it would tend to go with many chronic illnesses (including Lupus and RA, for example, in a similar lowish percentage to ME/CFS--percentage higher in FM likely because it's part of the diagnostic protocol).

Pain generation is the Great Initiator. In females pelvic girdle injuries result from mechanical injuries and childbirth; often on a substrata of the delicate female bony pelvis and a condition called Joint Hypermobility Syndrome; wherein there is an inherited hyper-laxity of ligaments that tether joint bones together. In men the inciting event is commonly a mechanical injury to the axial spine and pelvis. In both sexes, an illness that results in prolonged (a least a few weeks) convalescence can incite generalized musculoskeletal deconditioning leading to widespread chronic muscle weakness, spasm, and a multitude of painful anoxic and ischemic muscle trigger points. Chronic pain generation in soft tissues (fascia, ligaments, tendons, and muscles) interferes with sleep; causing these patients to toss and turn and to suffer chronic loss of REM sleep.  Chronic non-restorative sleep results in daytime fatigue, mental grogginess, mood alterations, and depression.

It looks like this question has been here for quite some time, so I thought some who suffer from ME/CFS (like me) might find the results of this recent study conducted by Stanford helpful - https://med.stanford.edu/news/all-news/2014/10/study-finds-brain-abnormalities-in-chronic-fatigue-patients.html

My experience was, had some pain went to the doctor. Doctor gave me pills, pills helped me sleep but short time after taking pills the pain got worse. Now chronic pain. more pills, then finally got a diagnoses of FIBROMYALGIA. More pills, then came the fatigue in turn brought the depression.I was depressed because I was in so much pain and to tired to do anything about it.My theory is, the medications create a realm of issues & conditions which make what ever it is that get’s a person to the doctor, 100% worst real fast.The root could be life style, stress, trauma’s one experiences in life and or all the medications doctors push on patients to take, not knowing the root/cause behind the issue’s.Don’t give up hope, you can cure it.

All of the specified conditions are symptoms or complexes of symptoms from the same base cause.  None of these cause each other.  At the root appears to be some genetic polymorphisms that affect usage of folates and B12.  As the folate-B12 cycles break down the biochemical processes break down.  In research I have seen it claimed that B12 deficiencies cause the malfunction of over 600 biochemical reactions.  The dominant folate in the American diet now is folic acid and that is only partially effective for 50%, even less partially effective for 30% and not at all effective for 20% of population.  Lack of effective folate causes lack of the ability to properly use B12.   This compounding biochemical breakdown gets stuck in a 4 way (or more) deadlock preventing proper biochemical functioning of the body and causing multi system breakdown.  The 4 way or more deadlock makes it very complicated to treat.  When it is particularly severe there is excess MMA and excess Hcy and more severe problems and all systems in the body breaking down.  In the 20 or 30 years this often takes less severe and partial breakdowns occur in body causing all the symptoms listed in the question.   Recently found is Adult onset Cobalamin C disease, in many but unknown numbers of variations.  Before it kills a person or causes severe neurological damage there can be decades of lead-up diseases that manifest as CFS and FMS from hell with extreme prejudice.  It is often triggered by something; perhaps a traumatic or disease situation that upsets a delicate balance.    I'm not a doctor.  I went through this most of my life and learned by experience.

Recent study has shown that CFS is a biological illness not psychological. Please go through the following link http://www.ecumenicalnews.com/article/study-shows-chronic-fatigue-syndrome-could-be-a-biological-illness-and-not-a-psychological-disorder-28530 http://www.sciencedaily.com/releases/2015/02/150227144903.htm

This disease strikes the people who are in more stress (job responsibility, family problems), chronic overwork and lack of rest. They can choke the brain and nervous system. If your nervous system is out of balance it affects every organ in your body: immune system, bowel (irritable bowel syndrome), feeling lack of air (autonomic dysfunction), body temperature 37, 37.5 C (also may be due to autonomic and hypothalamic dysfunction or infections) and cognitive disturbance. CFS is the result of nervous system failure. The concept of "chronic fatigue syndrome" in medicine appeared relatively recently, but more and more cases of this condition in people registered every year, especially in the developed world. To date, this problem has become global. This is due to the rhythm of modern life in the big cities, excessive emotional and mental stress, as well as the deteriorating environmental conditions. Statistics show that women are more susceptible to this disease than men. The disease should not be confused with simple fatigue, which is a natural reaction of the body to overwork, and indicating that a person needs a rest. Chronic fatigue syndrome - is unfounded, pronounced, debilitating body fatigue that does not go after the rest and does not allow a person to live in a normal rhythm.

Have to disagree with Kate. The order in which CFS, FM, depression and I would add MCS appear in any co-morbid case is is not a hard problem. To find out which appeared first, second etc you just need to ask the patients. They remember.