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For the most part, routine laboratory testing reveals nothing about fibromyalgia or chronic fatigue syndrome. However, upon physical examination, the fibromyalgia patient will be sensitive to pressure in certain areas of the body called tender points. To meet the diagnostic criteria, patients must have:

A. Widespread pain in all four quadrants of their body for a minimum of three months

B. At least 11 of the 18 specified tender points
(see diagram)

These 18 sites used for diagnosis cluster around the neck, shoulder, chest, hip, knee and elbow regions. Over 75 other tender points have been found to exist, but are not used for diagnostic purposes.

*The 18 Tender Point Locations for FMS on "The Three Graces" Masterpiece.

While many chronic pain syndromes display symptoms that overlap with fibromyalgia, the 1990 ACR multi-center criteria study (published in the February 1990 issue of Arthritis and Rheumatism) evaluated a total of 558 patients, of which 265 were classified as controls. These control individuals weren't your typical healthy "normals." 

They were age and sex matched patients with neck pain syndrome, low back pain, local tendonitis, trauma-related pain syndromes, rheumatoid arthritis, lupus, osteoarthritis of the knee or hand, and other painful disorders. These patients all had some symptoms that mimic FMS, but the trained examiners were not foiled--they hand-picked the FMS patients out of the "chronically ill" melting pot with an accuracy of 88%. FMS is not a wastebasket diagnosis!

Although the above criteria focuses on tender point count, a consensus of 35 FMS experts published a report in 1996 saying that a person does not need to have the required 11 tender points to be diagnosed and treated for FMS. This criteria was created for research purposes and many people may still have FMS with less than 11 of the required tender points as long as they have widespread pain and many of the common symptoms associated with FMS. Commonly associated symptoms include:

  • fatigue
  • irritable bowel (e.g., diarrhea, constipation, etc.)
  • sleep disorder (or sleep that is not refreshing)
  • chronic headaches (tension-type or migraines)
  • jaw pain (including TMJ dysfunction)
  • cognitive or memory impairment
  • post-exertion malaise and muscle pain
  • morning stiffness (waking up stiff and achy)
  • menstrual cramping
  • numbness and tingling sensations
  • dizziness or light-headed
  • skin and chemical sensitivities


Chronic fatigue syndrome is diagnosed using the CDC 1994 guidelines published in the Annuals of Internal Medicine. A copy of this article can be downloaded from the CDC (Centers for Disease Control and Prevention) Internet site listed here.

To meet the criteria, patients must have:

A. Fatigue

Severe, unexplained fatigue that is not relieved by rest, which can cause disability and which has an identifiable onset (i.e., not lifelong fatigue). It must be persistent or relapsing fatigue that lasts for at least six or more consecutive months.

B. Four or more of the following symptoms:

  • impaired memory or concentration problems
  • tender cervical or axillary lymph nodes in neck region (note that they do not have to be swollen but just tender; this can be a problem for people with FMS who have tenderness in these areas as well)
  • sore throat (but may not show signs of infection)
  • muscle pain
  • multi-joint pain (but not arthritis)
  • new onset headaches (tension-type or migraine)
  • un-refreshing sleep (wake up in the morning feeling unrested)
  • post-exertion malaise (fatigue, pain and flu-like symptoms after exercise)

NOTE: Five of the above eight criteria relate to pain and are often present in FMS as well. For both the fibromyalgia and chronic fatigue syndrome criteria, patients should be evaluated for other problems that could cause pain and fatigue, such as low thyroid function, low iron stores, arthritis and many other medical conditions. 

If any of these problems are found and corrected, but the individual still meets the FMS criteria, these other disorders (FMS and CFS) are viewed as coexisting and deserving of special medical attention. 

Unfortunately, the CDC criteria excludes people with other medical problems such as hypothyroidism and lupus, but it is okay to have the tender points of FMS or a mild case of depression/anxiety.

As a patient, you are deserving of medical care if the CFS symptoms persist and you should pursue therapy options with your doctor. However, when it comes to research studies or prevalence figures determined by the CDC, you will not be included as a CFS patient if you have any other co-existing medical condition (other than FMS and mild depression/anxiety). 

On the other hand, FMS is viewed as a distinct clinical entity that stands on its own, regardless of whether a person has other medical problems. This may be one reason why the prevalence figures for FMS (2% of the general population) are so much higher than CFS (roughly 0.5% of the general population).




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