Distinguishing between chronic fatigue syndrome vs fibromyalgia can be challenging, as both conditions share symptoms like persistent fatigue, widespread pain, brain fog, and sleep disturbances. Despite these similarities, they have different root causes and treatment approaches, making accurate diagnosis essential for effective care.

Understanding whether you have CFS, fibromyalgia, or both is the first step toward finding targeted treatments that improve energy, reduce pain, and enhance overall well-being. At Hol+, we specialize in diagnosing and treating complex chronic conditions through a functional medicine approach, helping patients uncover underlying imbalances and create personalized treatment plans for lasting relief. If you’re struggling with fatigue and pain, identifying the right condition is key to regaining control of your health.

Chronic Fatigue Syndrome vs Fibromyalgia: What You Need to Know

Chronic Fatigue Syndrome (CFS) is a complex, long-term condition that causes extreme exhaustion, often interfering with daily life. Unlike normal tiredness, CFS fatigue doesn’t improve with rest and can be worsened by even minimal physical or mental activity.

What is CFS?

CFS is believed to be caused by viral infections, immune dysfunction, metabolic imbalances, or nervous system dysregulation. It can develop suddenly after an illness or gradually over time. Because symptoms overlap with other conditions, many people go undiagnosed or misdiagnosed for years.

Common Symptoms of CFS

CFS affects multiple systems in the body, leading to a wide range of debilitating symptoms.

  • Extreme fatigue lasting at least six months, making everyday activities difficult.
  • Post-exertional malaise (PEM) – symptoms worsen after minor physical or mental effort.
  • Brain fog – trouble concentrating, processing information, and remembering details.
  • Sleep disturbances, including insomnia, unrefreshing sleep, or circadian rhythm imbalances.
  • Frequent sore throats, swollen lymph nodes, or flu-like symptoms, even when not sick.

What is Fibromyalgia?

Fibromyalgia is a chronic pain disorder that affects the musculoskeletal system and how the nervous system processes pain. Unlike injuries or inflammatory conditions, fibromyalgia does not cause damage to the muscles or joints, but it leads to widespread pain, fatigue, and heightened sensitivity to stimuli.

While the exact cause remains unclear, fibromyalgia is believed to be triggered by stress, trauma, infections, or nervous system imbalances. Many people experience an overactive nervous system, making them more sensitive to pain and external stimuli. This hypersensitivity affects both physical and emotional well-being, often leading to additional symptoms beyond pain.

Common Symptoms of FM

Fibromyalgia is more than just chronic pain—it affects multiple systems in the body and varies from person to person.

  • Widespread muscle and joint pain, often localized in tender trigger points.
  • Chronic fatigue, but unlike CFS, it is not always worsened by exertion.
  • Increased sensitivity to pain, due to nervous system hypersensitivity.
  • Digestive issues, such as bloating, irritable bowel syndrome (IBS), and food sensitivities.
  • Mood disturbances, including anxiety, depression, and heightened stress responses.

Fibromyalgia vs Chronic Fatigue Syndrome: What Makes Them Different?

Many people confuse chronic fatigue syndrome (CFS) and fibromyalgia because they share overlapping symptoms like fatigue, brain fog, and sleep disturbances. However, these conditions have different root causes and primary symptoms, which can help distinguish one from the other.

Primary Symptom Focus

Chronic fatigue syndrome is characterized by extreme, persistent fatigue that does not improve with rest and often worsens after physical or mental exertion. In contrast, fibromyalgia is primarily defined by widespread musculoskeletal pain and tenderness, with fatigue being a secondary symptom rather than the main complaint.

Pain vs. Fatigue

One of the biggest differences between chronic fatigue syndrome vs fibromyalgia is the role of pain.

CFS: Some muscle aches may be present, but pain is not the defining characteristic of the condition.

Fibromyalgia: Pain is a primary symptom and often affects:

  • Muscles and joints, causing persistent aches and stiffness.
  • Trigger points—specific areas of tenderness found in fibromyalgia patients.
  • Widespread discomfort that can fluctuate in intensity and location.

Cognitive Issues & Brain Fog

Both conditions can cause brain fog, but the severity differs. Individuals with CFS often struggle with memory lapses, concentration issues, and mental fatigue, making daily tasks challenging. Fibromyalgia can also cause cognitive difficulties, but brain fog is generally less pronounced than in CFS.

Sleep Disturbances

Both conditions disrupt normal sleep patterns, but in different ways:

CFS:

  • Often associated with dysregulated circadian rhythms.
  • Can cause insomnia or difficulty staying asleep despite exhaustion.
  • Sleep may feel unrefreshing, leaving individuals drained even after long rest periods.

Fibromyalgia:

  • Characterized by light, restless sleep with frequent awakenings.
  • Often linked to heightened nervous system sensitivity, making it difficult to fall into deep sleep.
  • Can result in waking up feeling stiff and sore, even after a full night’s rest.

Response to Physical Activity

A major hallmark of CFS is post-exertional malaise (PEM)—a worsening of symptoms after even minimal physical or mental exertion, sometimes lasting days or weeks. Fibromyalgia patients may experience pain flares after exercise, but it does not necessarily lead to extreme exhaustion like in CFS.

Underlying Causes & Triggers

The root causes of CFS and fibromyalgia are different, which is why treatment approaches often vary.

CFS:

Chronic Fatigue Syndrome is often linked to viral infections, such as Epstein-Barr virus, which may trigger long-term immune system dysregulation. Many individuals with CFS experience immune dysfunction, making it harder for their bodies to recover from illness and daily stressors. Additionally, metabolic imbalances affecting energy production can contribute to the deep, unrelenting fatigue that defines this condition.

Fibromyalgia:

Fibromyalgia is believed to stem from nervous system hypersensitivity, where the brain and nerves overreact to pain signals, making discomfort feel more intense. Chronic stress, trauma, or past physical injuries are often reported as triggers for the onset of fibromyalgia. Many individuals with fibromyalgia also experience hormonal imbalances, which can interfere with the body’s ability to regulate pain and inflammation effectively.

How to Tell If You Have Chronic Fatigue Syndrome or Fibromyalgia

Many people with CFS or fibromyalgia struggle for years without a clear diagnosis. Because both conditions share overlapping symptoms, they are often misdiagnosed as depression, anxiety, or general fatigue. Unfortunately, there is no single test that can definitively diagnose CFS or fibromyalgia, which is why a comprehensive evaluation is necessary.

Why Diagnosis Can Be Difficult

Doctors often rely on symptom patterns and medical history rather than a single test to diagnose CFS or fibromyalgia. Many standard lab tests fail to detect these conditions, leading some healthcare providers to overlook or dismiss symptoms. A proper diagnosis requires ruling out other conditions, such as thyroid disorders, autoimmune diseases, or sleep disorders, which can mimic CFS and fibromyalgia.

Comprehensive Testing for an Accurate Diagnosis

To distinguish chronic fatigue syndrome vs fibromyalgia, doctors may recommend several tests, including:

  • Bloodwork – Identifies hormonal imbalances, infections, and inflammation markers that may contribute to symptoms.
  • Sleep Studies – Assesses sleep quality and determines whether unrefreshing sleep or sleep disturbances are affecting energy levels.
  • Tender Point Examination – Used to evaluate fibromyalgia-specific pain patterns, focusing on widespread muscle tenderness in key areas.
  • Metabolic & Immune System Assessments – Helps uncover nutrient deficiencies, immune dysfunction, and mitochondrial issues that may be causing fatigue.

Real Solutions for CFS & Fibromyalgia at Hol+

Chronic Fatigue Syndrome and Fibromyalgia are complex conditions that require more than just symptom management. At Hol+, we take a functional medicine approach to uncover the root causes of fatigue, pain, and inflammation. Instead of masking symptoms, we focus on personalized treatment strategies designed for long-term relief.

Comprehensive Functional Medicine Approach

Unlike conventional treatments that rely on medications to manage symptoms, our approach identifies and treats the underlying causes of CFS and fibromyalgia. We examine immune function, gut health, mitochondrial health, and hormone balance to create a treatment plan that restores energy and reduces pain naturally.

Advanced Testing & Personalized Treatment Plans

Each patient is unique, which is why we use advanced testing to pinpoint the root of your symptoms. Our personalized plans address:

  • Immune function – Identifying hidden infections and inflammation that contribute to fatigue.
  • Gut health – Evaluating microbiome imbalances, food sensitivities, and leaky gut syndrome.
  • Hormone balance – Checking thyroid, adrenal, and sex hormone levels for energy regulation.
  • Inflammation levels – Identifying chronic inflammation that worsens pain and fatigue.

Multidisciplinary Team

Our board-certified, expert team includes functional medicine doctors, nutritionists, and holistic practitioners who work together to provide comprehensive care. We believe in collaborative healing, ensuring that every aspect of your physical and emotional health is addressed in your treatment plan.

We combine multiple healing modalities to create a truly integrative approach to recovery. Our treatment strategies include:

  • Nutrition therapy to fuel energy and reduce inflammation.
  • Stress management techniques like breathwork and mindfulness for nervous system regulation.
  • Natural supplements and herbal support to enhance mitochondrial function and support the immune system.

Break Free from Fatigue & Pain with Hol+’s Expert Care

Getting the right diagnosis is the first step toward effective treatment for chronic fatigue syndrome vs fibromyalgia. These conditions share many overlapping symptoms, but their causes and treatment approaches are different. A personalized, functional medicine approach that targets immune health, inflammation, hormone balance, and lifestyle factors can make all the difference in managing symptoms and restoring quality of life. At Hol+, we go beyond symptom relief—we focus on whole-body healing to help you regain energy and reduce pain naturally.

If you’re tired of struggling with fatigue, brain fog, and chronic pain, we’re here to help. Don’t let CFS or fibromyalgia control your life—schedule a consultation today and take the first step toward real healing!

FAQs

How can I tell the difference between chronic fatigue syndrome vs fibromyalgia?

CFS is primarily characterized by extreme fatigue that worsens after exertion, while fibromyalgia is defined by widespread pain and tenderness. Both conditions cause brain fog and sleep disturbances, but CFS is more linked to immune dysfunction, while fibromyalgia is often related to nervous system hypersensitivity.

Are there tests that can confirm chronic fatigue syndrome or fibromyalgia?

There’s no single test for either condition, but comprehensive testing can help rule out other illnesses. Doctors often use bloodwork, sleep studies, metabolic assessments, and tender point exams to identify patterns consistent with CFS or fibromyalgia. A functional medicine approach helps uncover root causes for better treatment.

Can someone have both CFS and fibromyalgia at the same time?

Yes, it’s possible to have both conditions simultaneously, as they share common triggers like stress, infections, and immune dysfunction. Many people experience overlapping symptoms such as fatigue, pain, and cognitive issues, which makes getting a proper diagnosis essential for finding the right treatment approach.

What causes chronic fatigue syndrome and fibromyalgia?

The exact causes are unclear, but both conditions are linked to viral infections, immune dysfunction, nervous system dysregulation, and hormonal imbalances. Fibromyalgia is often associated with past trauma or stress, while CFS may develop after an illness that weakens the body’s energy production systems.

Is fibromyalgia more painful than chronic fatigue syndrome?

Yes, fibromyalgia is primarily a pain condition, while CFS is an energy-depleting condition. People with fibromyalgia experience widespread musculoskeletal pain, whereas those with CFS often describe deep exhaustion with occasional muscle aches but less severe pain overall.