Q: What is the difference between chronic fatigue syndrome and fibromyalgia?

A: There are wide differences of opinions on the two conditions, even among medical experts. Most would agree that fibromyalgia and chronic fatigue syndrome (CFS) are similar, and probably related, disorders. One faction in the fibromyalgia/CFS debate believes these are simply two names for the same thing, while others say they are completely different and still others (though their numbers are small and diminishing) contend that neither condition exists at all.

My opinion is that the conditions are similar and probably related. Pain, fatigue and a host of other problems are seen in fibromyalgia. CFS displays similar symptoms. However, a practical way to differentiate the disorders is that pain is the predominant problem in people with fibromyalgia, whereas fatigue is the major complaint in people with CFS.

The pain of fibromyalgia is typically chronic and widespread, and is often associated with stiffness. On examination, many patients have specific sites (called tender points) that are extremely tender to touch. The detection of these tender points is helpful in making a diagnosis of fibromyalgia.

The fatigue seen in people with CFS is generally profound, and can be completely incapacitating. Criteria for CFS established by the Centers for Disease Control and Prevention (CDC) are fatigue that has been present for more than six months and is accompanied by the following:

  • a sore throat;
  • enlarged or tender lymph nodes;
  • muscle or joint pain;
  • other signs of systemic illness.

Signs and symptoms that are commonly present in botfh fibromyalgia and CFS include the following:
 

  • sleep disturbances;
  • headaches;
  • impaired memory or concentration;
  • dizziness;
  • bowel complaints (such as bloating, diarrhea and/or constipation);
  • anxiety or depression.

Despite the differences between fibromyalgia and CFS, the approaches to treatment of the two disorders are, in fact, quite similar. Most patients benefit from education about the conditions, participation in local and national support groups such as the Arthritis Foundation Self-Help Course, the use of low-dose antidepressant drugs at bedtime to improve sleep, as well as low-impact aerobic exercises.

Learn more about fibromyalgia from the Arthritis Foundation.

John Klippel, MD, Rheumatologist