Fibromyalgia and chronic fatigue syndrome: an update for athletic trainers.
Cramer, C R · Journal of athletic training · 1998
Quick Summary
This article reviews what we know about ME/CFS and fibromyalgia, two conditions that cause severe fatigue, muscle pain, and sleep problems. The authors looked at medical research and government health information to summarize how these conditions affect people, especially athletes. They discuss various treatments being tested, including exercise, relaxation therapy, and medications, and emphasize the importance of careful medical evaluation and psychological support during diagnosis and treatment.
Why It Matters
This editorial provides an important overview for athletic trainers and sports medicine professionals encountering ME/CFS and fibromyalgia in athletic populations, acknowledging that these conditions can devastate promising athletic careers. By synthesizing available evidence and documenting the evolution of diagnostic criteria, it contributes to clinical recognition and legitimacy of these syndromes at a time when they were often dismissed or misunderstood. The emphasis on comprehensive evaluation and psychological support reflects emerging understanding of the need for holistic, multidisciplinary care.
Observed Findings
CFS was historically confused with infectious mononucleosis and later with chronic Epstein-Barr virus infection before receiving formal diagnostic criteria in 1988
Primary fibromyalgia syndrome was once considered a subsyndrome of CFS but is now diagnostically classified as nonarticular rheumatism
Prevalence rates are estimated at less than 2% for CFS and approximately 2% for PFS in the general population
Affected athletes commonly experience training interruptions, feelings of loss of control, and concerns about psychiatric referral
Multiple therapeutic approaches including relaxation therapy, exercise, imagery, serotonin supplementation, and antiviral therapy are in clinical trials
Inferred Conclusions
ME/CFS and fibromyalgia are legitimate medical conditions distinct from psychiatric illness, requiring comprehensive medical documentation and physician oversight
Multidisciplinary care including physical, pharmacological, and psychological/neuropsychological interventions is necessary for optimal management
Athletes with these conditions require specialized understanding from sports medicine professionals to safely guide return to activity and prevent further disability
Remaining Questions
What are the specific diagnostic criteria that distinguish CFS from fibromyalgia, and do these conditions share common pathophysiological mechanisms?
What This Study Does Not Prove
As a narrative review and editorial, this article does not present original research data, clinical trial results, or comparative effectiveness evidence for any specific treatment. It cannot establish causation or prove efficacy of recommended therapies, and the proposed mechanisms of disease remain speculative. The prevalence estimates cited are not rigorously validated in this paper, and the article does not demonstrate that any single intervention is superior to others.
Tags
Symptom:Unrefreshing SleepPainFatigue
Phenotype:Infection-Triggered
Method Flag:PEM Not DefinedWeak Case DefinitionExploratory Only
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
Which therapeutic approaches (relaxation, exercise, pharmacological interventions, imagery) are most effective, and what are optimal dosing/duration protocols?
How should activity and exercise be safely reintroduced in athletes with ME/CFS without triggering post-exertional malaise or disease exacerbation?
What is the long-term prognosis and likelihood of return to full athletic function in affected athletes?