Do You Really Have Fibromyalgia?
Are you one of millions of individuals silently suffering from widespread pain and fatigue? Have you been diagnosed with fibromyalgia, but recovery seems to elude you? Mass confusion exists over fibromyalgia and the associated syndromes incorrectly diagnosed as fibromyalgia. The common thread of widespread pain and fatigue blurs the lines of distinction between these syndromes, leading to incorrect treatment and poor recovery. Far too often, fibromyalgia is incorrectly used to diagnose a complex of symptoms that can have multiple causes. Worse yet, a single treatment package is prescribed and this one-size-fits-all prescription rarely leads to recovery.
Overlapping symptoms of fibromyalgia and other global pain and fatigue syndromes has led to misdiagnosis and mismanagement of fibromyalgia. Approximately, 15 million people in the United States are suffering from fibromyalgia, according to a 2011 National Institutes of Health finding. However, true diagnosis is difficult when the only diagnostic criteria available is based on subjective questions on patient’s pain perception. Therefore, many individuals may be suffering from fibromyalgia, but not properly diagnosed. Meanwhile, up to two thirds of individuals diagnosed with fibromyalgia, may be suffering from a chameleon condition. Fibromyalgia is the correct diagnosis only when all other medical and functional conditions have been ruled out - a task most physicians do not tackle. Therefore, many individuals needlessly suffer from an improper diagnosis and improper treatment.
The mimicry of widespread pain and fatigue syndromes
The presence of widespread pain and fatigue opens the door for a plethora of medical conditions, stemming from a variety of root causes and making it critical for the practitioner to conduct a systematic evaluation before landing on the diagnosis of fibromyalgia. There are 3 broad categories of conditions - other than classic fibromyalgia - that are most often the cause of widespread pain and fatigue:
(1) Medical problems are caused by the presence of any medical condition or disease such as thyroid disease, diabetes, Lyme disease, cancer, and others.
(2) Musculoskeletal problems cause pain that is actually arising from a specific muscle or joint and includes myofascial pain syndrome, trigger points or “muscle knots”, and spinal joint problems such disc degeneration and pinched nerves.
(3) Metabolic/Functional problems represent sub-clinical conditions involving dysfunction of internal organs and individual metabolism, rather than true pathology or disease. These include subtle functional hypothyroidism, inefficiency of energy production in the cells due to mitochondrial dysfunction, nutritional deficiencies, chemical and food sensitivities, reactions to medications, and other problems with body metabolism and biochemistry.
Unfortunately, the standard treatment approach for classic fibromyalgia will not help patients whose pain and fatigue is rooted in any of these 3 categories.
A typical case of misdiagnosis
Mary’s complex case illustrates the necessity of a systematic evaluation and the ease of misdiagnosis in the absence of an appropriate evaluation. For decades, Mary experienced terrible digestive issues, including substantial bloating and excessive gas that robbed her of a social life. Fatigue and achiness emerged after her first pregnancy and became a bedrock for depression and anxiety. Multiple trips to her family physician and a gastroenterologist did not yield positive results after lab work, an endoscopy, and a colonoscopy returned normal. After being referred to a rheumatologist, Mary was diagnosed with fibromyalgia and prescribed the routine medication, Lyrica. After a few months, Mary’s symptoms remained unaltered.
After Mary was referred to me, it was evident from her answers on a fibromyalgia questionnaire that there were many symptoms associated with fibromyalgia, but she lacked the classic history of high stress or trauma in either her childhood or current life, that are generally found in classic fibromyalgia. A physical exam revealed many muscle trigger points, muscle spasms, and localized areas of pain, but lacked a widespread hyper-perception of pain to normal stimuli. After reviewing lab work from a functional perspective, several areas of concern were identified. The entire evaluation indicated Mary was suffering from a combination of functional/metabolic imbalances, musculoskeletal problems, and autoimmune issues that accounted for her pain and fatigue.
After addressing the metabolic/functional, musculoskeletal, and medical root problems, Mary regained full health and a productive life, which would have been impossible if she had accepted her original diagnosis and continued with the medication. Fibromyalgia was misdiagnosed in Mary and therefore, treatment yielded poor results.
The root of classic fibromyalgia
So what sets fibromyalgia apart from its camouflaging conditions? The simple answer is the central nervous system. Classic fibromyalgia involves a hyper-responsive nervous system that accentuates pain in response to normal stimuli. Studies are showing strong correlations between physical and/or emotional trauma, particularly during early life (childhood), and the development of fibromyalgia. Some people develop fibromyalgia after a severe car accident, work related injury, serious surgical procedures, physical or emotional abuse, or after witnessing a horrific event. These traumatic events derail the central nervous system and may lead to a heightened and prolonged pain response to normal stimuli such as bright lights, sounds, changes in temperature, moderate pressure on the skin or muscles, household chemicals, etc. Many fibromyalgia patients have extraordinary amounts of stress in their life or have experienced intensely emotional events in the past. The stress and emotional trauma disrupts the brain’s ability to process pain appropriately. Therefore, widespread pain and fatigue in the presence of stress and trauma, but in the absence of a metabolic, functional, or musculoskeletal problem, often points to classic fibromyalgia.
Do you have classic FM?
So do you think you might have classic fibromyalgia? Remember, fibromyalgia is the correct diagnosis only when all other medical, musculoskeletal, and metabolic/functional conditions have been ruled out. Fibromyalgia is a real problem with a real solution, when diagnosed correctly.
Take this short quiz and find out whether its likely that you may be experiencing fibromyalgia. If you score over 13 after adding your scores from sections 1, 2, and 3, and you answer “yes” to section 4, and “no” to section 5, you may have classic fibromyalgia.
Dr. Brady’s new book, The Fibro Fix, will give you a wealth of information on how to negotiate your way toward getting the proper diagnosis and the proper treatment for your symptoms of widespread pain and fatigue. The book can be ordered on Amazon, Barnes & Noble, Books-A-Million and other fine book vendors, or at FibroFix.com. Also, learn more about The Fibro Fix Summit where Dr. Brady interviews 30+ experts on FM at FibroFixSummit.com. Also, please visit Dr. Brady’s main website at DrDavidBrady.com and follow him on Facebook at DrDavidBrady.
- David Brady