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Invisible but Real: Fibromyalgia and Chronic Fatigue Syndrome

Although things have begun to improve, women are still too often dismissed and even ridiculed for health complaints such as pain and fatigue. No matter what society says, these feelings should not be a part of everyday life. Two chronic conditions that sometimes underlie lasting pain and tiredness when no other illnesses are present are fibromyalgia and chronic fatigue syndrome.

An illustration representing the hidden struggles of fibromyalgia and chronic fatigue syndrome, two real but often misunderstood conditions causing lasting pain and fatigue.

These are two distinct conditions, even though they sometimes occur at the same time. Fibromyalgia is characterised by widespread, inexplicable pain throughout the body, whereas chronic fatigue syndrome, as its name suggests, causes excessive tiredness. The conditions are similar in that they are both elusive—they present as vague, long-lasting symptoms without a clear cause—and they are diagnosed in female patients much more often than in their male counterparts.

Pain and fatigue are extremely common symptoms that accompany most health conditions from common stress to life-threatening cancer. When a symptom becomes chronic the pain stimuli live on in the body even after the physical injury has healed. However, that does not mean it’s “all in your head”.

Both the modern medical establishment and holistic practitioners have now understood that these seemingly minor symptoms can be extremely complex. When they go on for extended periods and interfere with your day-to-day activities, there is no such thing as “just” pain or “just” tiredness. And feeling crummy is definitely not “just an unavoidable part of being a woman”. All too often such symptoms are attributed to PMS and not investigated further.


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We have written about various types of pain and tiredness and a variety of conditions that can cause these symptoms. Discomfort is your body’s way of signalling that something is off and should be addressed so you can feel better again.

When dealing with chronic pain and/or tiredness, a blood test is a must. The results will indicate which other diagnostic tests should be performed to eliminate possible illnesses and external factors. If no cause presents itself over time, some doctors might dismiss the symptoms. However, if you continue to feel debilitating effects, no matter how vague, keep looking for other causes and ways to improve your quality of life.

If you face a dismissive attitude from medical personnel and the people around you, don’t be afraid to ask for second and third opinions to get to the bottom of the issue.

Both fibromyalgia and chronic fatigue syndrome are relatively recent discoveries. Chronic fatigue syndrome was first described in the late 1980s, and fibromyalgia only in the 1990s. Both conditions are still somewhat controversial. Not all doctors agree on their characteristics and even on their existence. Nevertheless, experiencing pain and tiredness over the long-term is bound to be detrimental to a person’s well-being. The good news is that patient-reported symptoms are now considered valuable information, which was not always the case. Positive or indeterminate test results are no longer sufficient reason to ignore a patient’s experience.


Fibromyalgia, or fibromyalgia syndrome (FMS) is a common condition where the patient experiences chronic widespread pain within the body, brain fog, poor sleep, and general exhaustion with no clear cause. Between 2 and 4% of people worldwide are believed to have this condition.

Some of the most common symptoms of fibromyalgia include:

  • Widespread pain, often in unidentifiable areas of the body
  • Muscle stiffness
  • Lack of refreshing sleep, exhaustion
  • Cognitive difficulties
  • Depression
  • Headaches
  • Muscle cramps
  • Sensitivity to cold and heat

Pain is considered widespread when it is felt in the left and right sides and the upper and lower parts of the body. The term “chronic widespread pain” is sometimes used interchangeably with “fibromyalgia”. There are no decisive diagnostic tests that can be performed to identify fibromyalgia as it resembles and overlaps with many other conditions. For a patient to receive a diagnosis of fibromyalgia to be diagnosed, they must report experiencing a number of the symptoms listed above over a longer period of time.

The main causes of fibromyalgia are thought to be genetic factors, and certain environmental or psychological triggers that can set off the condition, including:

  • Infection
  • Psychological trauma—experiencing a traumatic event
  • Physical trauma that becomes chronic pain
  • Chronic stress
  • Lifestyle risk factors such as smoking, obesity, and others

If a person is genetically predisposed to fibromyalgia and has also experienced a health concern that isn’t properly treated, the condition may develop. Researchers now believe that people with fibromyalgia may have heightened sensitivity to pain in general and their neurotransmitters are “wired” to make the sensation of pain stronger.

Fibromyalgia is a real condition that takes a serious toll on a person’s physical and mental well-being. The brain fog that comes with it, sometimes called “fibrofog”, can be just as detrimental to one’s quality of life as the physical pain.

Various treatment options for managing fibromyalgia symptoms and improving quality of life

Treatments for fibromyalgia

As the mechanisms that underlie the condition remain unclear, only the symptoms can currently be treated. As with most chronic conditions, there is no real cure for fibromyalgia, but treating the various symptoms and working to improve overall health can be extremely effective.

Treating separate symptoms can  improve your quality of life surprisingly well, making the condition manageable.

Treatments for fibromyalgia include:

  • Using over-the-counter painkillers such as ibuprofen, acetaminophen, naproxen, and others to reduce pain and inflammation
  • Taking antidepressants to counter mental fog and improve sleep
  • Engaging in cognitive behavioural therapy or some other form of psychotherapy that can help sufferers develop strategies for living with the condition.

Chronic Fatigue Syndrome

Like fibromyalgia, chronic fatigue syndrome exists in something of a grey area. If a patient experiences at least six months of excessive tiredness that affects their ability to function physically and mentally and does not improve with rest, they may be diagnosed with CFS.

Other names for this condition are myalgic encephalomyelitis (ME) and systemic exertional intolerance disease (SEID). Chronic fatigue syndrome is characterized by:

  • Long-lasting exhaustion that does not improve with sleep or rest
  • Cognitive difficulties
  • Sleep difficulties of various kinds
  • Dizziness
  • Heart palpitations

Disrupted sleep and lasting fatigue can arise from myriad internal and external circumstances—almost any underlying health condition will cause fatigue, as will having a stressful and demanding schedule or something as trivial as using the wrong mattress/pillow or having a partner who snores.

However, when a person experiences extreme fatigue for over six months even though they are making adequate time for sleep (7–8 hours) and no other illness can be identified through diagnostic testing, they may be suffering from what is now recognized as chronic fatigue syndrome.


CFS has no clear cause. It can start after an injury, an infection, or a traumatic event, or for some other reason. Researchers believe that patients with chronic fatigue syndrome are genetically predisposed to having a low tolerance for lack of sleep and becoming exhausted faster.

If you have been diagnosed with CFS or are experiencing the symptoms of long-term exhaustion, treat tiredness like a recovering addict treats alcohol—even a little is too much. Take it easy.

Don’t provoke your body. After recovering from chronic fatigue, you might be tempted to go back to living as you did before, pushing yourself to get things done and enjoying late-night parties, but that can severely disrupt your body’s energy levels and reignite the CFS.

Treatments for Chronic Fatigue Syndrome

There are even fewer options for treating chronic fatigue syndrome than there are for treating fibromyalgia. Tiredness is an all-encompassing symptom; how much energy we have is intrinsically linked with everything we do, and we must sleep every day. For most of us it is impossible to achieve perfect refreshing slumber 100% of the time, especially when our schedules and family situations demand our energy attention and energy at unpredictable times.

Establish routines to alleviate stress. Create the healthiest schedule you can for yourself and commit to it.

Nourish your body. Drink plenty of water to stay hydrated throughout the day and eat healthy, nutritious foods. Avoid caffeine, alcohol, and inflammatory foods that mess with your sleep. Make things easier for yourself by setting up a convenient grocery shopping and meal schedule to ensure your body is getting what it needs.

Ask your doctor to prescribe pain/anxiety medications to combat migraines and the other effects of disrupted sleep that often come with chronic fatigue syndrome.

Live an active, healthy lifestyle. However, if you are experiencing chronic fatigue syndrome, be mindful of your personal limit for how much physical and mental activity you can handle right now. Overdoing it can worsen the CFS and  condition

Living with a chronic condition

The symptoms of both fibromyalgia and chronic fatigue syndrome can be effectively managed, although it does take considerable effort. What makes living with a chronic condition that much harder is that the struggle is often invisible to the rest of the world.

When living with a condition for which there is no known cure it is possible to adapt and go on with your life, but that doesn’t necessarily mean things will get easier. For some people, they do, for others—not so much.

Women have historically been expected to bear the pain and fatigue that come with having periods, raising children, and running a household (in addition to holding down a job). To some extent these problems are unavoidable, but not to the point where you are suffering 24/7. We all deserve to be listened to and to have our symptoms taken seriously.

Take things one step at a time. Track your symptoms to really understand the condition and how your body is reacting to it. Then begin with small lifestyle changes that create improvements or bring relief. Trust the information your body is giving you and respect its needs; then you will be better prepared to face whatever comes your way.

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Häuser, W., Ablin, J., Fitzcharles, MA. et al. Fibromyalgia. Nat Rev Dis Primers 1, 15022 (2015). -
Komaroff AL. Advances in Understanding the Pathophysiology of Chronic Fatigue Syndrome. JAMA. 2019;322(6):499–500. doi:10.1001/jama.2019.8312

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