The Connection Between Fibromyalgia and Chronic Fatigue Syndrome

In a Nutshell

As any Pain Doctor will tell you: “body aches and fatigue, are symptoms of both fibromyalgia and chronic fatigue syndrome, however, research shows primary symptoms and pathophysiology set these conditions apart” [1]

• Fibromyalgia is a condition which generates unrelenting musculoskeletal pain throughout the body. Moreover, in addition to long-term pain, another common symptom is extreme fatigue (that is not caused by exertion)
• Chronic Fatigue Syndrome (CFS), which is also referred to as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), is a condition involving overpowering fatigue (which can be associated with concurrent physical aches and pains) [1]

The Overlap in Symptoms

“Literature acknowledges a significant overlap in the symptoms of fibromyalgia and CFS — so much so that experts [including some Pain Doctors], have continued to debate whether or not these are two separate conditions or one and the same.
A 2020 research commentary points out there are biochemical, genetic, and physiological differences between fibromyalgia and CFS that support them being separate conditions. Both, however, remain medically unexplained illnesses predominantly affecting biological women, and a link between them cannot be completely ruled out yet” [1]

Putting a Spotlight on the Differences

Fibromyaligia and chronic fatigue syndrome have key pathological differences in the spheres of:
• Sleep pathology
• The composition of spinal fluid
• The activity of neurotransmitters
• The release of hormones
• Exercise response
• Comorbid mental health disorders [1]

Fibromyalgia Symptoms

General symptoms of fibromyalgia reported by Pain Doctors, comprise:
• Widespread touch tenderness and musculoskeletal pain
• Fatigue, especially when waking; after periods of inactivity; and during the mid-afternoon
• Fibro fog (difficulty concentrating)
• Headaches
• Anxiety
• Depression
• Gastrointestinal issues
• Tingling or numbness in the extremities
• Breathlessness
• Irregular heartbeat
• Insomnia
• Sensory sensitivity
• Difficulty swallowing
• Dry eyes

Chronic Fatigue Syndrome Symptoms

General symptoms of fibromyalgia reported by Pain Specialists, include:
• Reduced functional ability together with fatigue (which is present for 6 months-plus)
• Post-exertional malaise (PEM); symptom worsening post-physical or mental activity
• Insomnia
• Difficulty concentrating/cognitive impairment
• Orthostatic intolerance; symptom worsening if sitting upright or standing upright
• Irregular heartbeat
• Breathlessness
• Sensory sensitivities
• Headaches
• Musculoskeletal pain
• Gastrointestinal issues
• Long-term sore throat
• Tenderness in the lymph nodes
• Allergies
• Night sweats/chills [1]

Preparing a Pain Diary to Show Your Pain Doctor

When a patient has their first in-person or online consultation with a Pain Specialist, it is very important that they have prepared a ‘Pain Diary,’ which they can show to them. This diary should be divided into separate pages for each day, and this should be divided into 24 hourly spaces. The latter should have sufficient space to describe the type of pain you were experiencing; what you were doing before, and at the time it came on; how long it went on for, and what you were doing when it stopped (for example, ‘I lied down on the sofa’).

How Does a Pain Doctor Diagnose Fibromyalgia & Chronic Fatigue Syndrome?

While at the present time, there are no one-size-fits-all specific tests that can definitively diagnose chronic fatigue syndrome or fibromyaligia, your Pain Doctor, who has substantial experience and expertise in these fields, will give you an accurate diagnosis according to:
• The presentation of your symptoms, and
• Ascertaining whether or not any other conditions can account for your experience, thereby necessitating the Pain Doctor to arrange a number of tests (so that other causes can be ruled out) [1]
Such tests may include:
• Blood work
• Urine tests
• Diagnostic imaging
• Neurological testing
• Psychological evaluations
• Sleep studies [1]


[1]. Gillette, H. (2023). “What’s the Difference Between Fibromyalgia and Chronic Fatigue Syndrome?” Healthline.

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