Chronic Fatigue Syndrome and Fibromyalgia are separate but related disorders in that they both share the common symptom of extreme fatigue, with Fibromyalgia, there is debilitating muscle pain, and with chronic fatigue there is some muscle pain but overwhelming fatigue.

1. What is Fibromyalgia Syndrome?
2. What is Chronic Fatigue?


FMS (fibromyalgia syndrome) is a widespread musculoskeletal pain and fatigue disorder. Fibromyalgia means pain in the muscles, ligaments, and tendons – the soft fibrous tissues in the body. Sometimes the muscles twitch and at other times they burn. More women than men are afflicted with FMS, and it shows up in people of all ages. FMS may resemble a post-viral state. Fibromyalgia Syndrome (FMS) is a pain disorder associated with multiple tender points, sleep disturbances (insomnia and non-restorative sleep), and fatigue.


With physical examination, the fibromyalgia patient will be sensitive to pressure in certain areas of the body called tender points. To meet the diagnostic criteria, patients must have:

  • A) Widespread pain in all four quadrants of their body for a minimum of three months

  • B) At least 11 of the 18 specified tender points. Where are these 18 Tender Points Located for the diagnosis of Fibromyalgia? These 18 points that are used for diagnosis cluster around the neck, shoulders, chest, hips, knees and elbow regions.


Chronic Fatigue Syndrome (CFS) is described as a severe, debilitating fatigue, lasting at least six months (of new and definite onset), associated with at least four of the following symptoms: impaired memory or concentration, sore throat, lymphadenopathy, muscle pains, joint pains, new headaches, unrefreshing sleep, and post-exertion malaise. Hypothalamic dysfunction, immune dysfunction, and nutritional inadequacies can all cause or perpetuate this severe syndrome.

Chronic fatigue syndrome is diagnosed using the CDC 1994 guidelines. To meet the criteria, patients must have:

A. Fatigue

Severe, unexplained fatigue that is not relieved by rest, which can cause disability and which has an identifiable onset (i.e., not lifelong fatigue). It must be persistent or relapsing fatigue that lasts for at least six or more consecutive months.

B. Four or more of the following symptoms:
  • impaired memory or concentration problems
  • tender cervical or axillary lymph nodes in neck region (note that they do not have to be swollen but just tender; this can be a problem for people with FMS who have tenderness in these areas as well)
  • sore throat (but may not show signs of infection)
  • muscle pain
  • multi-joint pain (but not arthritis)
  • new onset headaches (tension-type or migraine)
  • unrefreshing sleep (wake up in the morning feeling unrested)
  • post-exertional malaise (fatigue, pain and flu-like symptoms after exercise)

NOTE: Five of the above eight criteria relate to pain and are often present in FMS as well. For both the fibromyalgia and chronic fatigue syndrome criteria, patients should be evaluated for other problems that could cause pain and fatigue, such as low thyroid function, low iron stores, arthritis and many other medical conditions.

CFS and FMS may be opposite ends of the same disorder. With CFS the emphasis is on fatigue; with FMS the emphasis is on the pain.

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