Do I have fibromyalgia?  Do I have chronic fatigue syndrome?  Do I have chronic myofascial pain?

The overlap of these conditions can cause significant confusion.  About 70% of people with fibromyalgia meet the diagnostic criteria for CFIDS (chronic fatigue immune dysfunction syndrome, also known as chronic fatigue syndrome).  About 55% of people with CFIDS meet the criteria for a diagnosis of fibromyalgia (FM).  Almost everyone with FM will have chronic myofascial pain (CMP), but not everyone with CMP will have FM.  There has been no studies to date on the incidence of CMP among CFIDS patients, but myofascial trigger points are potentially the most common cause of chronic pain, so it is very likely that there is a higher than normal incidence of CMP among CFIDS patients. To further complicate things, people with CFIDS can have quite severe pain and people with fibromyalgia can have quite severe fatigue.  Many people will have all three conditions, as the above statistics show.

However, there are differences between the conditions.  And although treatment for the three conditions is often very similar, certainly knowing what conditions you have and what is causing what symptoms can really help treatment.   Also, if you are applying for disability, it can become very important to document having more than one condition since your chances of approval will go up with other co-morbid conditions.  CMP is an often overlooked cause of pain, and is potentially misdiagnosed as fibromyalgia.  Since CMP is potentially curable, since CMP has some treatments that are much more effective for it then for FM pain, and since CMP can be a precursor to FM, particularly if it’s not treated, it is important to know if that is part of things. CMP is actually in the muscle region, where FM pain is actually due to neuroendocrine issues.

It is important to note that chronic fatigue is a symptom, not a condition.  Chronic Fatigue Syndrome is a condition. Chronic fatigue is a symptom of fibromyalgia and many other health conditions as well.  Chronic fatigue is only one of the diagnostic criteria for CFIDS. This confusion is one of the many reasons that many CFIDS advocates are trying to get the name of the condition changed.  Pain is not exclusive to fibromyalgia.  Pain is one of the diagnostic criteria for CFIDS, particularly headaches, joint pain, and throat pain.

Similarities between CFIDS and FM are:

Both conditions involve multiple body systems and have abnormal pathology in the central nervous system, endocrine system, and immune system.  It is likely that both conditions involve some levels of central sensitization of almost all systems in the body. However, despite the presence of abnormal pathology in multiple systems, diagnostic lab testing is usually negative.

Both have severe fatigue not substantially relieved by rest, cognitive dysfunction, difficulty with exercise or other stressors, frequent headaches, and chronic pain.

Both overlap with numerous other disorders, such as irritable bowel syndrome (IBS), allergies, migraines, irritable bladder, restless legs, sleep apnea, chronic pelvic pain, chronic sinusitis, and other issues.

Patient population- predominantly female

Treatment is very similar or the same.

Symptoms more strongly associated with CFIDS:

Severe fatigue not substantially relieved by rest

Exercise intolerance and post-exertional malaise (an increase of symptoms, particularly fatigue, 24-72 hours after even minor activities).  To a certain extent, this is a part of FM. However, patients with CFIDS tend to have much more difficulty with exercise or any other physical exertion then patients with FM and/or CMP alone. 

Sore throat, temperature fluctuations (low-grade fevers or lower-than-average body temperature, and an abnormal temperature response to illness) and tender and/or swollen lymph glands

Infectious onset, bacterial or viral.  Not all CFIDS has infectious onset, and among the infectious onset group, the infectious onset is not always the Epstein-Barr virus.

Chemical, dietary, or sensory sensitivity- or all of the above!

Dysautonomia (a condition that is a dysfunction of the autonomic nervous system and usually affects temperature, pulse rate, and breathing) is common in both conditions but is present in up to 96% of CFIDS patients.

Mild abnormalities in test results (not enough to make a diagnosis of another condition, but enough to show up as abnormal in lab testing)

CFIDS has been reported in epidemic form, but FM has not

FM is considered more common, although there are other potential reasons for this. CFIDS is considered a diagnosis of exclusion (not with all conditions) where FM is not.  A diagnosis of lupus or thyroid dysfunction, for example, does not rule out FM but it does rule out CFIDS.  The presence of FM does not exclude CFIDS, since it is not confirmed through lab testing.  Many doctors have the mistaken idea that CFIDS must be linked with the mono virus and therefore will not diagnose a patient with CFIDS if their EBV levels are absent or negligible.  Chronic myofascial pain (CMP) is sometimes misdiagnosed as FM, particularly when there is co-morbid chronic illness present.  The actual rate of misdiagnosis is unspecified, but some evidence suggests it could be substantial. CDC studies say that as many as 80% of people with CFIDS have not been diagnosed. 

Symptoms more strongly associated with fibromyalgia:

Severe, widespread body pain

11 out of 18 tender points on the tender point examination is the official diagnostic criteria for fibromyalgia.  A CFIDS patient who meets these first two symptoms almost certainly has co-morbid fibromyalgia.

Although it is likely common in CFIDS as well, chronic myofascial pain is almost universal among FM patients.  

Physical trauma onset (accidents, surgery), particularly neck or back trauma

Allodynia (a painful response to non-painful stimuli)

TMJ dysfunction, chronic pelvic pain (due to sacral/pelvic dysfunction, PCOS, endometriosis or adenomyosis) and joint hypermobility are more common with FM.

Symptoms more strongly associated with chronic myofascial pain:

Active trigger points.  Unlike fibromyalgia, trigger point pain radiates or gives a referred pain pattern, and the active trigger points can often be felt.

Radiating pain

Greater response to treatments such as stretching, heat and cold, massage or other manual therapies, and muscle relaxers

Other symptoms that are helped by treatment of the trigger point, such as headaches, stuffy sinuses, nausea and/or vomiting, carpal tunnel-like pain, numbness and tingling, or restricted range of motion. Trigger points can be a migraine trigger, and dealing with the trigger point may relieve the migraine.  An example of this would be shoulder pain that radiates down the arm causing numbness, restricted motion, and tingling.  When the pain is decreased or relieved, the other symptoms decrease or are relieved as well.

Potential inflammatory factor, as trigger point injections containing steroids is often more effective then trigger point injections without steroids.  Trigger point pain also antidotally responds more to NSAID’s such as ibuprophen then fibromyalgia pain does.