Fibromyalgia vs Chronic fatigue syndrome and myofascial pain
How to tell Fibromyalgia and Chronic fatigue syndrome and myofascial pain apart when a board question makes them look alike.
Fibromyalgia is widespread pain amplification; chronic fatigue is post-exertional malaise; myofascial pain is regional trigger-point pain.
Side by side
Fibromyalgia causes widespread chronic pain, fatigue, sleep disturbance, cognitive fog, normal inflammatory labs, and diffuse tenderness without objective tissue inflammation.
Chronic fatigue syndrome centers on disabling post-exertional malaise and unrefreshing sleep; myofascial pain is regional pain with trigger points and referred pain.
Central sensitization amplifies pain processing despite normal muscle, joint, and inflammatory testing.
Chronic fatigue syndrome involves exertional intolerance and autonomic/neuroimmune symptoms; myofascial pain involves localized taut muscle bands.
Normal ESR/CRP/CK and widespread pain index pattern support fibromyalgia after excluding inflammatory disease.
Post-exertional malaise supports chronic fatigue syndrome; focal trigger points with referred pain support myofascial pain.
The trap
Fatigue and pain overlap, but distribution, exertional crash, trigger points, and objective inflammatory findings separate them.
The repair move
For chronic pain syndromes, decide whether the dominant pattern is widespread sensitization, exertional crash, or regional trigger point.
Try a free question
CoreA 42-year-old woman has 18 months of widespread chronic pain involving the neck, shoulders, lower back, hips, and knees. She also reports unrefreshing sleep, fatigue, and 'fibro fog' with poor concentration. Exam shows tenderness at multiple soft tissue sites. ESR, CRP, CK, TSH, ANA, and rheumatoid factor are all normal. Which diagnosis is most likely?
Show answer and explanation
Answer: A. Fibromyalgia. Fibromyalgia is widespread pain amplification with cognitive symptoms, sleep disturbance, and normal inflammatory labs; treatment includes exercise, CBT, duloxetine, milnacipran, or pregabalin.
Why the other choices are tempting
- B. Polymyalgia rheumatica affects patients over 50 with proximal shoulder/hip stiffness and elevated ESR/CRP.
- C. Polymyositis has true muscle weakness with elevated CK.
- D. Hypothyroidism would show elevated TSH; this patient's is normal.
- E. Lyme disease causes regional arthritis with positive serology, not the diffuse pain syndrome.
Flashcards
Tap a card to flip it.
What labs are expected in fibromyalgia?
Inflammatory markers and CK are typically normal in fibromyalgia.
What feature supports chronic fatigue syndrome?
Post-exertional malaise strongly supports chronic fatigue syndrome.
Quick answers
What is the fastest way to tell Fibromyalgia from Chronic fatigue syndrome and myofascial pain?
Fibromyalgia is widespread pain amplification; chronic fatigue is post-exertional malaise; myofascial pain is regional trigger-point pain.
What is the key clue for Fibromyalgia?
Fibromyalgia causes widespread chronic pain, fatigue, sleep disturbance, cognitive fog, normal inflammatory labs, and diffuse tenderness without objective tissue inflammation.
What is the key clue for Chronic fatigue syndrome and myofascial pain?
Chronic fatigue syndrome centers on disabling post-exertional malaise and unrefreshing sleep; myofascial pain is regional pain with trigger points and referred pain.
What is the common trap with Fibromyalgia vs Chronic fatigue syndrome and myofascial pain?
Fatigue and pain overlap, but distribution, exertional crash, trigger points, and objective inflammatory findings separate them.