Therapists Explore: Chronic Fatigue Syndrome vs Fibromyalgia

Chronic fatigue syndrome (CFS) and fibromyalgia are both central sensitivity syndromes. This means they both share symptoms of chronic pain, leading many to believe that they are similar, or in fact the same conditions, but this isn’t the case. Whilst some symptoms are shared, they affect people differently and have varying impacts on people’s lives.

An accurate diagnosis can be hard to come by, but there are some key differences between the two that can make it easier to determine which condition you might have, and which treatment options could work best.

In this article, we’re going to look at chronic fatigue syndrome and fibromyalgia in more detail, looking at what causes them, what the symptoms are, how they’re diagnosed, and what treatment can look like.

What is chronic fatigue syndrome?

Chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME), is a long-term condition that tends to develop in people in their mid-20s to their mid-40s, although it can be diagnosed at any stage, including in childhood.

Symptoms of chronic fatigue syndrome

There are a number of symptoms that someone with CFS might experience, with the most common being:

  • Feeling fatigued most of the time
  • Extended recovery after doing something physical
  • Sleep problems
  • Memory and concentration issues
  • Nausea and dizziness
  • Pain in muscles and joints
  • Heart palpitations
  • Headaches
  • Cold/flu symptoms e.g., sore throat

 

The symptoms of CFS/ME can vary in severity, ranging from mild to more severe between days. Sometimes, symptoms get worse or better during the same day, making it difficult to plan activities.

CFS/ME symptoms often mirror lots of other conditions, making it essential to accurately relay symptoms to your GP so the right diagnosis is made. It’s a good idea to keep track of symptoms in a diary as soon as they start.

Diagnosing chronic fatigue syndrome

CFS/ME isn’t always easy to diagnose due to the wide scope of symptoms and how similar they are to lots of other conditions and disorders. With this in mind, your GP will likely ask you in detail about your symptoms, look at your medical history, and monitor how long it takes you to recover from your symptoms. In doing so, they’ll be able to rule out other conditions and determine CFS/ME as the main cause.

You might undergo some blood tests to make sure your symptoms aren’t being caused by conditions like anaemia, an underactive thyroid gland, or conditions involving the liver or kidneys. Due to CFS/ME mostly being diagnosed by ruling other conditions out, a diagnosis can take a while.

There are some guidelines set out by the National Institute for Health and Care Excellence (NICE) that can be used to diagnose CFS/ME where extreme fatigue and tiredness can’t be attributed to other causes. Under the guidelines, the tiredness must:

  • Have started recently
  • Last a long time
  • Recur
  • Worsen after light physical activity like a walk
  • Prevent you from being able to do things you normally would

 

For a CFS/ME diagnosis to be made, the NICE guidelines also state that a patient must present with some of the common symptoms listed earlier, such as nausea, headaches, and sleep issues.

Your GP will look to make a diagnosis if symptoms persist for three months or longer, and they may refer you to a specialist if necessary (or a paediatrician if you’re under 18).

What causes chronic fatigue syndrome?

It’s not entirely clear what causes CFS/ME, but there is some research that suggests the following may be mitigating factors:

  • Genetics: CFS/ME causing genes haven’t yet been identified, but the condition is known to run in families
  • Energy production issues: If your cells don’t work to produce energy in the right way, your body can be depleted, resulting in CFS/ME
  • Dysregulated stress: Stress levels have a direct impact on on the immune system and cause inflammation – a key factor in CFS/ME
  • Infection: A number of infections have been linked to CFS/ME, including the Ross River virus, Q fever, and the Epstein-Barr virus
  • Autoimmune changes: Abnormal immune system changes can lead to the function of cells being damaged
  • Traumatic events: CFS/ME may be onset by a big life event, such as a car crash or surgery

 

Whilst a root cause isn’t always known, one of the above scenarios could potentially bring the onset of CFS/ME.

What is fibromyalgia?

Fibromyalgia syndrome (FMS) is a long-term condition that affects the musculoskeletal system. It mostly causes widespread and chronic pain across the body, but there are other symptoms. It’s thought around 2% of the population has fibromyalgia, with most people being diagnosed between 20 and 60 years old. That being said, it can affect anyone of any age, sex or race. It generally affects how the brain processes pain signals.

Fibromyalgia symptoms

Fibromyalgia is typically characterised by widespread pain and tenderness across the body, but there are a number of other symptoms that can present themselves, including:

  • Extreme fatigue and tiredness
  • Stiff muscles/muscle pain
  • Headaches
  • Sleep issues
  • Dizziness
  • Pins and needles
  • Poor body temperature regulation
  • Heightened pain sensitivity (hyperalgesia and/or allodynia)


Some people with FMS also develop irritable bowel syndrome, a disorder in the digestive system that can cause pain and bloating in the stomach. Symptoms can vary in severity and treatment is available to help manage them, but in most cases, they don’t disappear and it’s a long-term condition.

Diagnosing fibromyalgia

Fibromyalgia can be tricky to diagnose because the symptoms are similar to those of several other conditions, including chronic pain disorder which is not the same as FMS. With this in mind, a ruling out approach is taken whereby your GP will look to rule out other conditions that could be responsible for your symptoms, leaving fibromyalgia as the next obvious cause.

Conditions that may need to be ruled out include chronic fatigue syndrome, rheumatoid arthritis, and multiple sclerosis (MS). To do this, you may undergo blood tests, scans like X-rays, and urine sample tests. It’s possible that you can have fibromyalgia in addition to other conditions, including those above.

To help make the distinction between FMS and other conditions, your GP will look at the fibromyalgia diagnostic criteria. They will look to see:

  • If you have severe pain in 3-6 parts of your body or mild pain in 7+ parts of your body
  • Symptoms persist for three months or more
  • There is no other obvious cause for your symptoms


It can take time to go through the tests, especially if your GP thinks you might be suffering from other health conditions on top of FMS.

What causes fibromyalgia?

There is no specific cause for FMS, but research suggests that there are a number of factors that can lead to the development of the condition, with the main one being chemical changes in the nervous system. The central nervous system is responsible for processing pain messages around the body, so any changes to this system could result in heightened pain and sensitivity around the body.

Hormonal imbalances are present in most people with fibromyalgia, with low levels of serotonin, dopamine, and noradrenaline in the brain. These hormones are responsible for things like your mood, sleeping patterns, and how you respond to certain situations. They also have a role to play in how pain messages are processed in your nerves, also contributing to pain sensitivity.

Disrupted sleeping patterns are a symptom of FMS, but they might also be one of the causes. Genetics can also play a role, but the genes aren’t yet identified. The theory is that certain genetic sequences might make you more likely to develop FMS following a triggering event.

Lots of people with FMS find that they developed the condition following a big life event or change. Common ones include:


It’s not always the case that FMS is triggered by a specific event, but it certainly can be for some people.

A number of other conditions have been linked to FMS, including:

  • Lupus
  • Temporomandibular disorder (TMD)
  • Rheumatoid arthritis
  • Osteoarthritis


As mentioned, it’s possible to have FMS as well as other conditions.

Similarities between chronic fatigue syndrome and fibromyalgia

Now you know a bit more about each condition, we’ll discuss the similarities between chronic fatigue syndrome and fibromyalgia. Firstly, both conditions are largely unexplained and have no easily identifiable cause. The reasons for the conditions developing can vary, but researchers are unable, as yet, to specifically point to one single cause for either condition. Below are some other similarities.

  • Causes: Some of the suggested causes are the same, including infections, traumatic events, and genetics.
  • Symptoms: Some of the symptoms between CFS/ME and FMS are similar, such as chronic fatigue/fibromyalgia fatigue, sleep disturbances, headaches, and pain.
  • Demographics: Both CFS/ME and FMS are more prevalent in women and diagnoses can occur at a similar age.
  • Diagnosis: The method used to diagnose both conditions is similar in the sense that other conditions are ruled out first because there is no single test for either condition.

 

Differences between chronic fatigue syndrome and fibromyalgia

There are a number of differences between CFS/ME and FMS, with the main one being that with chronic fatigue syndrome, fatigue is the main symptom, whereas with fibromyalgia, widespread pain is the main symptom. Whilst people with CFS/ME can experience pain and people with FMS can experience fatigue, each condition has a more prevalent symptom.

With this in mind, treatment for each option is different.

Treating chronic fatigue syndrome

There are a number of treatment options to help reduce the symptoms of CFS, with the main approach being to tackle the often debilitating fatigue that is felt by many people with the condition. Overall, treatment consists of a number of different approaches tailored to your exact symptoms. Some of the more common treatments that are offered include:

Cognitive behavioural therapy (CBT)

CBT is a type of talking therapy that is used to treat lots of conditions, both mental and physical. It helps you to change how you think and behave. It’s common for people with CFS/ME to suffer with anxiety and depression due to the limitations their condition can pose, but CBT helps to disrupt negative thought patterns and can help you to better come to terms with your diagnosis.

Medication

Some of the more painful symptoms of CFS/ME can be treated with medications. For example, muscle, joint, and head pains can be treated with over the counter painkillers, although your GP may prescribe stronger painkillers for more intense pain.

Antidepressants can be used to help ease muscle pains, and they can also help with sleep problems, too.

Energy management

If you have CFS/ME, your energy levels may change day to day. Exercise is important for everyone, but it can be hard for those with CFS/ME. Energy treatment plans are aimed at helping you to manage your energy levels so that you can remain active without irritating your symptoms further or making them worse. Physiotherapy is sometimes offered.

Other treatments

You may be offered other treatments such as lifestyle advice, sleep advice, and the implementation of aids such as a parking blue badge or home modifications to make moving around easier.

Treating fibromyalgia

There is no cure for fibromyalgia, but treatments are available to better your quality of life and ease the severity of your symptoms. The main treatments focus on pain relief and management, with psychologists, rheumatologists, and neurologists potentially being involved in devising your treatment plan.

Medication

One of the main treatments for FMS is painkillers, most of which you can buy over the counter. These can help, but sometimes, stronger painkillers may be prescribed, such as tramadol or codeine. These are addictive medications that require careful monitoring, and they can cause side effects such as fatigue which can amplify other symptoms of your FMS.

Antidepressants are often prescribed to help relieve pain by increasing the level of neurotransmitters. Sleep medications could also help if your sleeping routine is affected.

FMS can cause muscle stiffness, in which case muscle relaxing medications like diazepam can help.

Cognitive behavioural therapy (CBT)

Like with CFS/ME, CBT has been shown to be helpful for some people with FMS, alongside other types of counselling and psychotherapy.

Other treatments

Some common treatments that can also help FMS include hydrotherapy, acupuncture, and massages.

Treating fibromyalgia and chronic fatigue syndrome at Psymplicity Healthcare

Here at Psymplicity Healthcare, we understand the differences between CFS/ME and FMS, and our team are experts in helping people with either condition through the means of counselling, CBT, graded exercise therapy (GET) , and psychotherapy. To find out more about how we might be able to help you, please contact us.

Mavish Sikander

Mavish Sikander

Mavish is a BABCP Accredited CBT and EMDR Therapist and CBT Clinical Lead at Psymplicity.

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