E2 ModerateModerate confidencePEM unclearCross-SectionalPeer-reviewedMachine draft
High frequency of fibromyalgia in patients with chronic fatigue seen in a primary care practice.
Goldenberg, D L, Simms, R W, Geiger, A et al. · Arthritis and rheumatism · 1990 · DOI
Quick Summary
This study looked at whether people with chronic fatigue also have fibromyalgia, a condition involving widespread muscle pain and tender points. Researchers examined 27 patients with debilitating fatigue lasting at least 6 months and found that 70% of them had the widespread pain and tender points typical of fibromyalgia. This suggests that many people with chronic fatigue may also have fibromyalgia.
Why It Matters
This early study documents a high frequency of fibromyalgia features in ME/CFS patients, suggesting these conditions frequently co-occur. Understanding this overlap is important for clinicians evaluating ME/CFS patients and for researchers studying whether these represent related or distinct pathophysiological processes.
Observed Findings
- 70% (19/27) of patients with chronic fatigue had persistent, diffuse musculoskeletal pain
- Patients with chronic fatigue and musculoskeletal pain had tender point examination results similar to fibromyalgia patients
- 8 patients with chronic fatigue denied any current persistent diffuse musculoskeletal pain and had tender point scores similar to normal controls
- Among the 16 patients meeting full CFS criteria, the majority also met historical and tender point criteria for fibromyalgia
Inferred Conclusions
- The majority of debilitating chronic fatigue patients, including those meeting CFS criteria, have concurrent fibromyalgia
- Presence of current musculoskeletal pain can identify which ME/CFS patients have fibromyalgia
- A substantial subset of ME/CFS patients (approximately 30%) do not have associated widespread musculoskeletal pain and fibromyalgia features
Remaining Questions
- Do ME/CFS and fibromyalgia share common underlying pathophysiology or represent distinct conditions that frequently co-occur?
- Does the presence or absence of fibromyalgia features predict different disease trajectories or treatment responses in ME/CFS?
- How do these findings apply to ME/CFS patients in other clinical settings beyond primary care practices?
What This Study Does Not Prove
This study does not establish whether fibromyalgia causes ME/CFS, whether they share common underlying mechanisms, or whether they represent different manifestations of the same disease. The cross-sectional design cannot determine causality or temporal relationships, and findings from a single primary care practice may not generalize to all ME/CFS populations.
Tags
Symptom:PainFatigue
Method Flag:Weak Case DefinitionNo ControlsSmall Sample
Metadata
- DOI
- 10.1002/art.1780330311
- PMID
- 2317224
- Review status
- Machine draft
- Evidence level
- Single-study or moderate support from human research
- Last updated
- 8 April 2026
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 →
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