What is the difference between Fibromyalgia and Chronic Fatigue Syndrome?

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	Fatigue and weakness Generalized pain and malaise Sleep disturbances Dizziness Headaches Numbness, tingling Poor memory, confusion, irritability Bowel problems (bloating, diarrhea, constipation etc.) 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	Fatigue management. Get plenty of sleep. Avoid alcohol, tobacco and caffeine. Avoid strenuous exercising.	Pain relief. Get plenty of sleep. Avoid alcohol, tobacco and caffeine. Daily aerobic exercises.