• Timing of light (upset of normal circadian rhythms, seasonal affective disorder, sleep disorders)
• Intensity of light (photophobia, sunburn, skin cancer)
• Wavelength of light ( in lupus, urticaria )
• Rapid flickers in intensity of light may trigger or aggravate epilepsy or migraine headaches.
• Other effects may include vertigo, or chronic fatigue syndrome.

In rare cases individuals with solar urticaria (allergy to sunlight) can get a rash from fluorescent lighting or may experience disease activity in very photosensitive individuals with Systemic lupus erythematosus. Standard acrylic diffusers over the fluorescent lamps absorb nearly all the UV-B radiation and appear to protect against this.

In rare cases, fluorescent lighting can also induce depersonalization and derealization, subsequently, it can worsen depersonalization disorder symptomology. Research on these rare cases is very limited and cause and effect often cannot be duplicated.

Controlled application of artificial light can be used in a program of Light therapy to treat some disorders.

Associated Conditions

Ultraviolet radiation risk

Some fluorescent lamps emit ultraviolet radiation that in some circumstances can exceed safe levels. The Health Protection Agency of the United Kingdom has conducted research that concluded exposure to some compact fluorescent lamps (CFLs) for 1 hour per day at a distance of less than 30 cm can exceed safe levels. Touching the exposed bulb results in equivalent exposure to ultraviolet radiation as that of being in direct summer sunlight.

Skin and retinal cancers

Ultraviolet radiation emitted by fluorescent lighting increases an individual's exposure to carcinogenic radiation by 10 to 30 per cent per year, with an associated increased probability of contracting squamous cell carcinoma by 4 percent. Melanoma has been shown to not be affected by CFLs through normal use.

The constituent blue light of CFLs can aggravate retinal diseases in susceptible people, but it is unlikely to occur.

Migraine

Blue light, such as that emitted by CFLs, can aggravate migraine, and fluorescent lamps can cause eye-strain and headache. There is no available data on the existence of CFL-induced migraine, but there is anecdotal evidence of "problems" with blue light. The charity Migraine Action says its members suffer migraines induced by CFLs and there are many anecdotal reports of such occurrences.

Autism and Asperger syndrome

The SCENIHR report states that "people with Autism/Aspergers syndrome have reported problems which they attributed to fluorescent lighting", and any deleterious effects on sufferers of autism or Asperger Syndrome from CFLs cannot be dismissed.

Ménière's disease and Vertigo

The inner-ear condition Ménière's disease can be aggravated by flicker. Sufferers of vertigo are recommended to not use fluorescent lights.

Polymorphous light eruption

Polymorphous light eruption is a condition affecting the skin thought to be caused by an adverse reaction to ultraviolet light. Its prevalence across Europe is 10-20% of the population. Artificial light sources may provoke the condition, and CFLs have been shown to produce an eruption.

Chronic actinic dermatitis

Chronic actinic dermatitis is a condition where a subject's skin becomes inflamed due to a reaction to sunlight or artificial light. Its prevalence in Scotland is 16.5 per 100,000 population. There is evidence that CFLs worsen the condition.

Lupus

The autoimmune disease Lupus is exacerbated by CFLs.

Actinic Prurigo

There is evidence that Actinic prurigo is worsened by CFLs. This disease affects 3.3% of the general population.

Solar Urticaria

3.1% of the population suffer Solar urticaria, a skin disorder affected by ultraviolet light. Some patients are directly affected by CFLs.

Phytophotodermatitis

Phytophotodermatitis may be aggravated by the additional levels of ultraviolet light emitted by CFLs.

Additional risk for patients undergoing photodynamic therapy

Patients undergoing photodynamic therapy are at additional risk of adverse photosensitive reactions caused by CFLs.

Chronic fatigue syndrome

Self-reporting suggests that 21% of chronic fatigue syndrome patients experience sensitivity to light, and there have been no studies into the association between chronic fatigue syndrome and CFLs.

Cataracts

One cause of cataracts is exposure to ultraviolet light. Provided the level of UV emission from lamps is within safe limits, and the lamp a sufficient distance away from the individual, there should be no increased risk of developing cataracts.

Photophobia

Photophobia is a symptom of excessive sensitivity to light which affects 5 to 20% of the population. No studies have been conducted into the effect of CFLs on sufferers of photophobia, but there is the possibility for CFLs to affect sufferers.

Epilepsy

There is evidence that flicker can cause seizures in patients with photosensitive epilepsy, but there has yet to be any evidence to date attributing seizures to compact fluorescent lamps.

Dyslexia

Self-reporting suggests fluorescent lamps aggravate dyslexia. Tests show that dyslexic patients are unable to detect flicker emanating from light sources.
 

Genetic predisposition

There is evidence that genetic factors may play a role in the development of fibromyalgia. For example, there is a high aggregation of fibromyalgia in families. The mode of inheritance is currently unknown, but it is most probably polygenic. Research has demonstrated that fibromyalgia is associated with polymorphisms of genes in the serotoninergic, dopaminergic and catecholaminergic systems. However, these polymorphisms are not specific for fibromyalgia and are associated with a variety of allied disorders (e.g. chronic fatigue syndrome, irritable bowel syndrome) and with depression.

Stress

Stress may be an important precipitating factor in the development of fibromyalgia. Fibromyalgia is frequently comorbid with stress-related disorders such as chronic fatigue, posttraumatic stress disorder, irritable bowel syndrome and depression. Two studies that employed single-voxel magnetic resonance spectroscopy (1H-MRS) reported metabolic abnormalities within the hippocampal complex in patients with fibromyalgia, with significant correlations between hippocampal metabolic abnormalities and severity of clinical symptoms.

Other authors have proposed that, because exposure to stressful conditions can alter the function of the hypothalamic-pituitary-adrenal (HPA) axis, the development of fibromyalgia may stem from stress-induced disruption of the HPA axis. This proposition is supported in part by a prospective epidemiology study which found that variations in HPA function characterized by high levels of circulating cortisol following dexamethasone suppression testing, low levels of morning salivary cortisol and high levels of evening salivary cortisol are all associated with the development of chronic widespread pain.

Central dopamine dysfunction (hypodopaminergia)

The 'dopamine hypothesis of fibromyalgia’ proposes that the central abnormality responsible for symptoms associated with fibromyalgia is a disruption of normal dopamine-related neurotransmission. Dopamine is a catecholamine neurotransmitter with roles in pain perception and natural analgesia. There is also strong evidence for a role of dopamine in restless leg syndrome, which is a condition found frequently in patients with fibromyalgia. Some fibromyalgia patients responded in controlled trials to pramipexole, a dopamine agonist that selectively stimulates dopamine D2/D3 receptors and is used to treat both Parkinson's disease and restless leg syndrome.

Abnormal serotonin metabolism

In 1975, researchers hypothesized that serotonin, a neurotransmitter that regulates sleep patterns, mood, concentration and pain, could be involved in the pathophysiology of fibromyalgia-associated symptoms. In 1992, decreased serotonin metabolites in patient blood samples and cerebrospinal fluid were reported. However, selective serotonin reuptake inhibitors (SSRIs) have met with limited success in alleviating the symptoms of the disorder, while drugs with activity as mixed serotonin-norepinephrine reuptake inhibitors (SNRIs) have been more successful. Duloxetine (Cymbalta), a SNRI originally used to treat depression and painful diabetic neuropathy, has been demonstrated by controlled trials to relieve symptoms of some patients. However, the relevance of dysregulated serotonin metabolism to pathophysiology is a matter of debate. Complicating the analysis, one of the more effective types of medication for the treatment of the disorder (i.e. serotonin 5-HT3 antagonists) actually blocks some of the effects of serotonin.

Deficient growth hormone (GH) secretion

Levels of hormones under the direct or indirect control of growth hormone (GH), including IGF-1, cortisol, leptin and neuropeptide Y may be abnormal in people with fibromyalgia, but supplementing growth hormone in patients does not have large effects, and a 2007 literature review reported a need for "further study before any solid recommendations can be made." There is disagreement about the role of HGH in fibromyalgia.

Psychological factors

There is strong evidence that major depression is associated with fibromyalgia[54], although the nature of the association is controversial. A comprehensive review into the relationship between fibromyalgia and major depressive disorder (MDD) found substantial similarities in neuroendocrine abnormalities, psychological characteristics, physical symptoms and treatments between fibromyalgia and MDD, but currently available findings do not support the assumption that MDD and fibromyalgia refer to the same underlying construct or can be seen as subsidiaries of one disease concept. Indeed, the sensation of pain has at least two dimensions: a sensory dimension which processes the magnitude of the pain, and an affective-motivational dimension which processes the unpleasantness. Accordingly, a study that employed functional magnetic resonance imaging to evaluate brain responses to experimental pain among fibromyalgia patients found that depressive symptoms were associated with the magnitude of clinically-induced pain response specifically in areas of the brain that participate in affective pain processing, but not in areas involved in sensory processing which indicate that the amplification of the sensory dimension of pain in fibromyalgia occurs independently of mood or emotional processes.

An alternative hypothesis regarding the development of fibromyalgia in relationship to psychological conflict proposes that the disorder may be a psychosomatic illness as described by John E. Sarno's writing related to "tension myositis syndrome," in which chronic pain is proposed to be a psychic diathesis of the mind's subconscious strategy of distracting painful or dangerous emotions. Education, attitude change, and in some cases, psychotherapy are proposed as treatments.

Other hypotheses

Other hypotheses have been proposed. One of these is an aberrant immune response to intestinal bacteria.

Because there is currently no completely objective clinical test for fibromyalgia, and "because everyone has had the experience of pain and therefore knows how it should appear to others,"[59] fibromyalgia is thought to be relatively easy to simulate. A significant percentage of reported cases may be due to malingering, a type of fraud wherein a patient feigns having an illness or exaggerates symptoms for non-medical personal gain (often financial), including obtaining access to prescription drugs for recreational use or for illegal resale. A 2007 review states that 25-30% of diagnosed fibromyalgia cases may be due to malingering, and a review of personal injury claims finds that 35-39% of fibromyalgia and chronic fatigue syndrome claims appear to be feigned, based on clinicians' impressions of "multiple sources of evidence, including reported severity, illness patterns, cognitive impairment inconsistent with the purported condition, and discrepancies among records, self-report, and observed behavior."
 

Most people become infected with EBV sometime during their lives, and therefore gain adaptive immunity, preventing repeated sickness from re-infection through EBV antibodies. In the United States, as many as 95% of adults between 35 and 40 years of age have been infected. Infants become susceptible to EBV as soon as maternal antibody protection disappears. Many children become infected with EBV, and these infections usually cause no symptoms or are indistinguishable from the other mild, brief illnesses of childhood. In the United States and in other developed countries, many persons are not infected with EBV in their childhood years. When infection with EBV occurs during adolescence or young adulthood, it causes infectious mononucleosis 35% to 69% of the time. In immunocompromised individuals, the Epstein-Barr virus can also present as an opportunistic infection known as hairy leukoplakia.

A condition in which the body lacks or has lost strength either as a whole or in any of its parts. General asthenia occurs in many chronic wasting diseases, such as anemia and cancer, and is probably most marked in diseases of the adrenal gland. Asthenia may be limited to certain organs or systems of organs, as in asthenopia, characterized by ready fatiguability.

Asthenia is also a side effect of some medications and treatments, such as Ritonavir (a protease inhibitor used in HIV treatment), vaccines such as the HPV vaccine Gardasil and fentanyl patches (an opioid used to treat pain).

The condition is also commonly seen in patients suffering from chronic fatigue syndrome, sleep disorders or chronic disorders of the heart, lungs or kidneys.

Differentiating between psychogenic asthenia and true asthenia with muscular weakness is often difficult, and in time apparent psychogenic asthenia accompanying many chronic disorders is seen to progress into a primary weakness.

Causes of asthenia

• Addison's disease
• Anemia
• Anxiety
• Cancer
• Chemotherapy
• Chronic fatigue syndrome
• Chronic pain
• deconditioning/sedentary lifestyle
• Dehydration and electrolyte disturbance
• Depression and PMDD
• Diabetes
• Fibromyalgia
• Heart disease
• Hypothyroidism
• Infections
• Medications including amiodarone, Anastrazole, and fentanyl
• Narcotics
• Paraneoplastic syndrome
• Polymyalgia Rheumatica
• Pregnancy/postpartum
• Pulmonary disease
• Renal disease
• Sleep disorders
• Temporal arteritis

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