I think at some point we have to make a division between the people with cognitive issues (apparently the majority) and those with primarily fatigue or exhaustion or pain symptoms "only". Of course it could be possible that down the road the latter will eventually experience cognitive issues as well (if the source/root problem really is the same), but that yet remains to be proven. When it comes to discussion of cognitive issues I often feel like I might have joined the "wrong" forum as this is something I never experienced, even when I was hit in the past with never severe but at least moderate to significant FM pain and fatigue/exhaustion. Maybe PVFS and CFS/ME and FM are only loosely related or maybe there are just continuations of each other. And maybe early recognition and aggressive therapy will avoid certain symptoms altogether?? It also looks like that thee are quite a few similarities between ME and MS whereas there are hardly any between CFS or FM and MS.