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By Bruce Campbell

Fibromyalgia and Chronic Fatigue Syndrome (CFS) are common, long-term medical conditions. Both are now widely recognized as real illnesses, not psychological problems. Diagnostic criteria have been established for both and a diagnosis of either condition qualifies a person to receive disability payments. (Chronic Fatigue Syndrome is known by other names, such as Chronic Fatigue and Immune Dysfunction Syndrome [CFIDS] and Myalgic Encephalomyelitis [ME]).

The severity of both conditions varies widely. Some people have mild cases and continue to lead relatively normal lives, while most are affected more deeply. The average case of fibromyalgia or CFS creates moderate to severe symptoms and reduces a person's activity level by 50% to 85%.

As long-term conditions, fibromyalgia and CFS affect many parts of people' lives, including relationships, career, moods, and finances. FM and CFS both create challenges and require adaptations. Adaptations may include reducing or eliminating paid work, adjusting family responsibilities, managing increased stress and intense emotions, and coming to terms with loss.

Research suggests that there are probably more than one million people with CFS in the United States, about three-quarters of whom are women. Estimates of the prevalence of fibromyalgia vary, but there are probably at least four to five million people in the United States with FM, possibly many more. Studies suggest that more than 90% are women.

Symptoms

Both fibromyalgia and CFS are characterized by the presence of multiple symptoms, which are usually moderate to severe in intensity. Many people with FM and/or CFS also have additional medical problems as well.

The most prominent symptom of fibromyalgia is widespread pain, which is generally felt all over the body, although it can start in one region and spread or move from one area to another. The pain may be accompanied by neurological problems such as tingling and burning or numbness in the hands, arms, feet, legs or face. Pain may be intensified by overactivity, non-restorative sleep, anxiety and stress, and changes in the weather.

Other common symptoms of fibromyalgia include unrefreshing sleep, fatigue and cognitive difficulties that are often called "fibro fog." These include confusion, difficulty concentrating, fumbling for words and lapses in short-term memory. Most patients suffer from a sleep disorder, but poor sleep can also be increased by stress, overactivity, and the absence of a good sleep environment or good sleep habits.

People with fibromyalgia may also experience many other symptoms, including tension or migraine headaches, strong emotions such as depression and anxiety, jaw pain, ringing in the ears, dizziness, rashes, sensitivity to light, sounds, smells and temperature, and dry eyes or dry mouth.

The central symptom of CFS is a fatigue that is experienced as deep exhaustion. Fatigue can be intensified by overactivity, poor sleep, deconditioning, stress, emotions and poor nutrition. Other prominent symptoms include pain, sleep that is not refreshing and cognitive problems similar to those in fibromyalgia.

Additional symptoms that often appear with CFS include headaches, low-grade fevers, sore throat, tender lymph nodes, anxiety and depression, ringing in the ears, dizziness, abdominal pain (gas, bloating, periods of diarrhea and/or constipation), allergies and rashes, sensitivity to light and sound, abnormal temperature sensations such as chills or night sweats, weight changes and intolerance of alcohol.

A majority of people diagnosed with either CFS or fibromyalgia are later found to have the other condition as well. In addition, people with either or both conditions often have additional medical problems, such as irritable bowel syndrome (IBS), food and chemical sensitivities (such as candida, celiac disease and lactose intolerance), myofascial pain, orthostatic intolerance, Lyme disease, myofascial pain syndrome, sleep disorders like apnea and restless legs syndrome, and thyroid conditions.

Treatments

Because no cure has been developed so far for either condition, treatment aims at managing symptoms and improving quality of life. Approaches include medications, alternative treatments and self-help measures.

Medical treatment is tailored to the individual patient, often focusing on addressing the most bothersome symptoms such as poor sleep and pain. Since no medication is consistently effective, there is often a period of experimentation to find what works for a given individual. Medications may have to be changed periodically, as they can lose effectiveness. Patients are usually started with very low dosages.

Lifestyle adaptations are more consistently helpful. The most common technique for limiting fatigue is to adjust to the limits imposed by illness, using strategies such as reducing overall activity, taking regular rests and having short activity periods. Pacing is usually helpful with pain as well. Staying within activity limits, having short activity periods, switching from task to task frequently and taking rest breaks all reduce pain.

Adapting to either condition requires individual adjustments. There are many different patterns of symptoms, and an individual's illness may vary over time. Some symptoms may disappear, only to be replaced by new ones. Some people may have a relatively stable course, while others may fluctuate between times of severe symptoms and times of remission.

Prognosis

Fibromyalgia does not damage tissue and is neither progressive nor fatal. Some patients experience a spontaneous recovery and many experience notable improvement. In fact improvement is probably the most common outcome for fibromyalgia, experienced by half to two-thirds of patients.

The course of Chronic Fatigue Syndrome varies greatly. A small number recover. Another, larger group achieves notable improvement, while others remain quite ill and a few worsen over time.

Though neither is curable at present, both fibromyalgia and CFS can be treated. Medications and lifestyle adaptations can help reduce pain and discomfort, bring greater stability and lessen suffering.

Related Articles

• Basics: CFS & FM 101
  More information about symptoms, diagnosis, treatment options and prognosis.
• Treating CFS and Fibromyalgia
  More on treatment options for fatigue, pain, sleep and cognitive problems.
• Overlapping and Related Conditions 
  An examination of some of the medical problems that often occur together with CFS and FM.