May 7, 2023/Chronic Pain

Fibromyalgia vs. Chronic Fatigue: Which One Are You Dealing With?

Pain is the distinguishing factor for determining if you have fibromyalgia

Person sleeping on dictionary, too tired to study.

Getting out of bed can be a struggle for many, especially if you’re dealing with chronic pain, fatigue, anxiety and disruptive sleep. There could be many possible causes for those symptoms, and among them are mysterious, debilitating conditions like fibromyalgia and chronic fatigue syndrome.


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People who have either condition may experience many of the same symptoms, and it can be hard to pinpoint exactly which condition they may have. So, how do you find out which one it is and how does the specific diagnosis affect your treatment?

“Doctors diagnose these diseases through somewhat of a process of elimination,” says pain management specialist Benjamin Abraham, MD. “Despite what you may hear advertised, there is no widely accepted blood test to help diagnose the condition, but they rely on one main difference between the two.”

There could be several reasons why you’re tired all the time. And while fibromyalgia can cause fatigue, the dominant symptom of fibromyalgia is pain. But for people with chronic fatigue syndrome, the dominant symptom is fatigue.

Dr. Abraham breaks down the differences between fibromyalgia and chronic fatigue syndrome, along with what you can do if you have either condition.

What do we know about fibromyalgia?

Of the two, fibromyalgia ​affects about 4 million Americans and is one of the most misunderstood conditions. Many times, family members and friends don’t understand what having fibromyalgia means and what it means to try and manage it.

Many people get diagnosed with fibromyalgia between the ages of 20 and 50, but the incidence increases with age. By age 80, about 8% of adults have fibromyalgia according to the National Fibromyalgia Association. About 75% to 90% of those who have fibromyalgia are women and people assigned female at birth (AFAB).

“The cause of fibromyalgia is unknown,” says Dr. Abraham. “Genetics, trauma or an infection may play a role. People who have fibromyalgia say it feels like having the flu all the time.”

Symptoms include:

  • Widespread pain.
  • Headaches.
  • Stiffness.
  • Joint swelling.
  • Fatigue and morning stiffness.
  • Sleep issues.
  • Fatigue and tiredness.

What do we know about chronic fatigue syndrome?

Those who have chronic fatigue syndrome, also called myalgic encephalomyelitis, or ME/CFS, report fatigue that’s worsened with activity and doesn’t get better after resting.

Other symptoms, which may come and go, include dizziness, muscle or joint pain, headaches and trouble with concentration, sitting and standing.

The U.S. Centers for Disease Control and Prevention (CDC) estimates that 836,000 to 2.5 million Americans suffer from ME/CFS, but most cases are undiagnosed. To help diagnose you, your healthcare provider may suggest a blood and urine test after talking with you about your symptoms and medical history.

How do doctors treat fibromyalgia and chronic pain syndrome differently?

“Both diagnoses are sometimes called into question as to not being ‘real’ diseases,” notes Dr. Abraham. “But that’s a misconception. Chronic pain and fatigue are real, and often debilitating, for those who have it.”

To get relief through medications or a variety of therapies, a proper diagnosis is crucial.

“Medical options are just the tip of the iceberg for both conditions, and the best treatments often don’t come in a capsule,” says Dr. Abraham. “But when we do use medications, we need to ensure that we are targeting pain without excess sedation.”

When it comes to non-pharmacological help, providers use a variety of tools, like counseling or support groups.

Physical activity is also crucial in staying healthy and helping treat both conditions. It’s important to stay active, but remember to always pace yourself. Set a structured activity program that avoids overexertion and reach out to your provider for help in putting together a list of physical activities you can do to boost your energy levels and help reduce symptoms.


“On a good day, a patient may decide to walk four miles, then require two to three days to recover,” says Dr. Abraham. “Try to walk one mile a day so you are active every day.”

Other helpful activities can include:

How your family can help

Always remember that you’re not alone. Support from your family can make your condition easier to bear by spending time with you on good days, as well as on bad days.

“I try to make family members a partner in treatment,” says Dr. Abraham. “When you just want to spend the day in bed watching TV because of fatigue or pain, a family member can encourage simple, fun activities to help get you moving.”

Whether your diagnosis is chronic fatigue or fibromyalgia, a healthcare provider’s role in treating the condition is often small. Healthcare providers function as a coach and can help you with the first 10% to 15% of improvement, while you have to help yourself manage the remaining 85% to 90%.

If you’re dealing with chronic pain and/or fatigue, talk to your healthcare provider. A diagnosis can put you in a better position to manage your symptoms — even if there are still some mysteries surrounding your condition.​

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