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Fibromyalgia and chronic fatigue syndrome
Fibromyalgia is chronic widespread pain with fatigue and unrefreshing sleep without tissue damage, and chronic fatigue syndrome is severe fatigue with worsening after exertion — in both the diagnosis is clinical, tests serve to exclude another disease, and treatment rests on explanation, activity management and support.
Why it matters in the exam
The exam asks what characterises the course of fibromyalgia, which treatment works (aerobic exercise, amitriptyline, duloxetine, pregabalin) and which does not (opioids, steroids), and what is true about treating chronic fatigue syndrome. Other questions describe a woman with widespread pain and fatigue and ask which work-up is enough.
Remember post-exertional malaise as the core sign of chronic fatigue syndrome, and that under the 2021 British guideline a fixed, pre-set graded increase in activity should not be recommended.
These patients often move between doctors and tests, so a clear diagnosis, acknowledgement of their suffering and a regular follow-up plan with the family doctor reduce unnecessary work-ups and improve function.
A recurring question: which tests are required before the diagnosis — the answer is a basic, limited work-up, not a series of rheumatological antibodies. In these patients it is important to look for and treat depression, anxiety and sleep disorders too.
Key points
- Fibromyalgia — widespread pain for 3 months or more, fatigue, unrefreshing sleep.
- Tests serve to exclude; in fibromyalgia they are normal.
- Graded aerobic exercise is the most effective treatment for fibromyalgia.
- ME/CFS — fatigue for 6 months or more with post-exertional worsening; energy management.
- No opioids and no steroids.
Summary table
| Topic | Fibromyalgia | Chronic fatigue syndrome (ME/CFS) | Exam note |
|---|---|---|---|
| Core feature | Widespread pain for 3 months or more | Severe fatigue for 6 months or more with reduced function | Unrefreshing sleep in both |
| Diagnosis | Clinical criteria (ACR 2016); tender points are not required | Post-exertional malaise, unrefreshing sleep, and cognitive impairment or orthostatic intolerance | Tests are normal |
| Basic work-up | Blood count, ESR or CRP, TSH, liver and kidney tests | The same, and glucose, ferritin or coeliac serology as needed | No battery of rheumatology tests without signs |
| Evidence-based treatment | Graded aerobic exercise, cognitive behavioural therapy, low-dose amitriptyline, duloxetine, pregabalin | Energy management (pacing), symptom treatment, support | — |
| What not to do | Opioids, steroids, NSAIDs as main treatment | Fixed pre-set graded activity increase; prolonged complete rest | Opioids harm in fibromyalgia |
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Sources
- American College of Rheumatology, 2016 revision — Fibromyalgia diagnostic criteria
- EULAR, 2017 — Revised recommendations for the management of fibromyalgia
- NICE guideline NG206, 2021 — Myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome: diagnosis and management
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.