Skip to main content
Submitted by Dr S. Patel on 7 February 2018
A woman lying in pain due to Chronic Fatigue Syndrome or Fibromyalgia

Chronic Fatigue Syndrome and Fibromyalgia have many overlapping symptoms with chronic pain and fatigue being the most common threads.  Dr. Shital Raval explains the differences between the two conditions and the different diagnostic criteria

Chronic Fatigue Syndrome or CFS is a medical condition with an unknown cause, presenting initially with constant or recurring fatigue for 6 months or more. Myalgic encephalitis or ME is the now the internationally accepted term for CFS.

Fibromyalgia or FM is a medical condition with unexplained cause, often presenting with quadrant pain and multiple tender points for minimum of 6 months.

Fatigue and pain seem to be present in both conditions along with several other overlapping symptoms such as bowel problems, headaches, low mood etc. Both conditions are usually seen in women above the age of 40. Physiologically, both show reduced blood flow to the midbrain & cortex, symptomatic orthostatic tachycardia, non-refreshing sleep, suppressed hypothalamic pituitary axis, low levels of CSF serotonin & growth hormone, and genetic clustering of traits. Due to these similarities, they have been in the past suggested to be the same illness. Diagnosis would be based on whether a patient saw a Physician or a Rheumatologist.

Due their parallel presentation, these two disorders may possibly be related. Widely clubbed as twins, experts now understand the differences between Chronic Fatigue Syndrome(CFS) and Fibromyalgia. CFS is frequently triggered by a flu-like or infectious illness whereas, FM is triggered by trauma.

Treatment has yet to be tailored because of lack of specific etiology of the diseases. Symptom management, psychiatric assistance and supportive care are common routes taken. Diet and lifestyle modification long with alternative therapies (such as meditation, yoga, acupuncture etc.) have gained favor in recent times.

Comparing Chronic Fatigue Syndrome(ME) and Fibromyalgia :

  CFS/ME FIBROMYALGIA
Type of illness Immunological Rheumatic/Arthritic
Predominant Presentation Fatigue or lack of energy!
Symptom often starts after a viral infection.
Pain (usually muscle or joint)!
Symptom is usually followed by physical trauma or emotional stress.
Duration of symptom Chronic (>6 month) Chronic (>6 month)
Site of pain No specific pain sites are seen. Pain or tenderness is seen in distinct locations. About 11/18 such sites have to been identified for diagnosis.
Inflammation Signs of inflammation such as fever, sore throat, swollen or tender lymph nodes are noted. No inflammation is seen.
Common Signs and symptoms
  1. Fatigue and weakness
  2. Generalized pain and malaise
  3. Sleep disturbances
  4. Dizziness
  5. Headaches
  6. Numbness, tingling
  7. Poor memory, confusion, irritability
  8. Bowel problems (bloating, diarrhea, constipation etc.)
  9. Anxiety/depression
Tests Diagnosis of exclusion
Normal levels of Substance P*
Increased levels of RNasaL**
Tender-point Exam
Increased levels of Substance P
Normal levels of RNasaL
Treatment options
  1. Fatigue management.
  2. Get plenty of sleep.
  3. Avoid alcohol, tobacco and caffeine.
  4. Avoid strenuous exercising.
  1. Pain relief.
  2. Get plenty of sleep.
  3. Avoid alcohol, tobacco and caffeine.
  4. Daily aerobic exercises.

*Substance P is a neurotransmitter that is responsible for pain stimulation.
**RNaseLis an enzyme which destroys viral RNA during an infection.

If you are struggling with Fibromyalgia please join the Fibromyalgia Support Community

When More Exercise is Not The Answer

It took two years to get a diagnosis

References:

https://www.everydayhealth.com/fibromyalgia/fibromyalgia-and-chronic-fatigue-syndrome.aspx

https://www.verywell.com/is-it-fibromyalgia-or-chronic-fatigue-syndrome-716181

http://www.arthritis.org/living-with-arthritis/tools-resources/expert-q-a/fibromyalgia-questions/chronic-fatigue-syndrome-fibromyalgia.php

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3198210/

Stories

  • Prevention of Chronic Fatigue Syndrome
    Chronic Fatigue Syndrome cannot be prevented but it can be managed and the symptoms can be treated. The best option is to eat a balanced diet, exercise regularly and meditate or do a fun activity to keep stress levels low.
  • Management of Chronic Fatigue Syndrome
    Diet guidelines Nutritionists advise on eating right as it increases energy levels, strengthens immunity and helps one feel better. Extreme diets should be avoided as they can worsen your symptoms. Eat a balanced diet that includes vegetables, grains, fruits, protein and dairy. Certain foods can trigger symptoms or make them worse. Such foods are: Fatty and fried foods Monosodium glutamate (MSG) Nutrasweet (aspartame) Cigarettes or tobacco products Things like alcohol, caffeine and sugary…
  • Chronic Fatigue Syndrome Treatment
    Treatment for chronic fatigue syndrome focuses on symptom relief.  1. Medication choices may include:  Pain relievers and anti-inflammatory drugs such as acetaminophen, ibuprofen and naproxen, which aim to relieve joint/ muscle pain, headaches and fevers.  Anti-convulsants, also called anti-seizure medicines such as gabapentin and pregabalin are used for pain and sleep problems. Narcotics such as tramadol, codeine or morphine, is sometimes prescribed for severe pain not relieved…
  • Chronic Fatigue Syndrome Causes and Risks
    The cause of chronic fatigue syndrome is unknown, although there are many theories. In some cases, CFS seems to follow a viral illness, major physical or emotional trauma or exposure to toxins. Other theories point to the immune system, glands and hormones, and family history. Some believe it might be triggered by a combination of factors. Risk Factors: Tends to affect people in their 40s and 50s Women are more likely to be diagnosed with CFS Stress seems to be a risk factor
  • CFS Tests and Diagnosis
    There's no single test to confirm a diagnosis of chronic fatigue syndrome. A variety of medical tests are done to rule out other health problems that have similar symptoms.  CFS and Myalgic Encephalomyelitis (ME) Some people believe that CFS and ME are two separate conditions while others believe that the two conditions are the same but symptoms are different. Myalgic means muscle aches or pains and Encephalomyelitis is inflammation of the brain and spinal cord.  When fatigue is the…
  • Caregiver Training Video - Touch Therapy
    This is a caregiver training video resource from HCA Hospice Care, Singapore.  It shows how you can gently massage to soothe an elderly person or a patient.   
  • Chronic Fatigue Syndrome
    Crushing tiredness that doesn’t diminish with rest, CFS can wreck lives. It’s also hard to diagnose, so patients may be seen as hypochondriacs. By Dr Shital Raval.  Chronic fatigue syndrome (CFS) is a complex disorder characterised by extreme fatigue that is unexplained by any underlying medical condition. The fatigue does not improve with rest and tends to worsen with physical activity or mental exertion.  CFS affects more women than men and is seen mostly between the…