Editor’s note: National Pain Report recently ran an interview with Dr. Brady, which dives even deeper into this topic. If this article interests you, you also be interested in the interview found here.
It is important to know that only a small number of patients diagnosed with fibromyalgia actually suffer from the classic (actual) variety of the syndrome. Up to 2/3 of people who are told they have fibromyalgia have actually received a fibromyalgia misdiagnosis and are really suffering from another real problem1. Fibromyalgia is the correct diagnosis only when all other medical and functional conditions have been ruled out2.
Doctors often use the single word fibromyalgia to diagnose a complex of symptoms that can have multiple causes. Worse yet, doctors often prescribe the same treatment package to all the patients they label with the term fibromyalgia. It is like using the term back pain and prescribing muscle relaxers to all patients with back pain. Sometimes the one-size-fits-all prescription may help patients get better, but not usually.
There are three broad categories of conditions – other than classic fibromyalgia – that are most often the cause of widespread pain and fatigue; non-fibromyalgia medical conditions, musculoskeletal problems, and functional/metabolic disorders. Unfortunately, the standard treatment approach for actual classic fibromyalgia will not help patients with pain and fatigue caused by conditions within any of these other three categories.
So what’s the solution to this dilemma? Actually the answer is simple. Find the root cause of the widespread pain and fatigue, and prescribe treatments that eliminate that cause3.
What Else Could it Be?
In patients who complain about vague and diffuse body pain associated with pronounced fatigue, it is imperative that the doctor rule-out the presence of any medical condition or disease that is known to cause many of the symptoms associated with classic fibromyalgia. Examples include hypothyroidism, anemia, rheumatoid arthritis, autoimmune connective tissue disorders, Lyme disease, rheumatic auto-immune disorders such as ankylosing spondylitis or scleroderma, multiple sclerosis, inflammatory arthritis, small fiber polyneuropathy, and cancer. Most of the medical assessments appropriate in this type of situation come in the form of laboratory testing, to include any or all of the following screening tests:
- Complete red and white blood cell count with white cell differential
- Thyroid function tests (total and free T3 & T4, TSH, and thyroid antibodies)
- Standard blood chemistry
- C-reactive protein (CRP) and/or erythrocyte sedimentation rate (ESR)
- Lyme, co-infections and rheumatic/autoimmune profiles (as necessary)
Examples of musculoskeletal problems that may cause widespread pain and fatigue are trigger points and spinal joint problems such as disc degeneration and pinched nerves.
Myofascial pain syndrome is one of the most common reasons for a mistaken diagnosis of classic fibromyalgia and is pain that is actually arising from several muscles and joints of the body, which, all put together, feels like one big painful condition.
This happens quite frequently with senior patients who often have some degree of arthritis in several joints, combined with myofascial problems, and come to their doctor with a complaint of widespread pain. Consequently, there is overlap of general widespread pain from arthritis, but also one or two localized muscle or joint problems that could respond well to treatment by a physical therapist, chiropractor, or massage therapist.
A basic principle of diagnosis can quickly determine if pain is coming from a muscle or joint. Certain movements should reproduce the exact pain being experiencing if the pain is coming from a musculoskeletal structure. For example, if the patient has pain between the shoulder blades coming from the neck or shoulders, movements of the neck or shoulders should cause the pain to get worse. If there is absolutely no movement or position that makes the pain worse, the pain may not be coming from a muscle or joint and other sources of the pain should be considered.
More subtle “functional” and metabolic disorders may represent various types of sub-clinical disease states and disorders involving dysfunction of internal organs and individual metabolism, rather than true pathology. These functional disorders range the gamut from simple vitamin and mineral insufficiencies (including vitamin D, CoQ10, carnitine, B vitamins and magnesium, etc.), to more hidden functional disorders such as energy metabolism disorders (e.g., mitochondrial dysfunction), subtle endocrine imbalances (subclinical thyroid disorders and abnormalities in stress physiology, etc.), opportunistic intestinal infections (dysbiosis), blood sugar abnormalities (reactive dysglycemia), post-viral immune suppression, reactions to medications, chemical and food sensitivities, problems with body metabolism and biochemistry, and conditions that are not readily apparent on standard laboratory screening tests.
Does Diet Matter?
Many pain syndromes are produced by some form of inflammation. Correctly diagnosed fibromyalgia is a problem arising from deep in the nervous system and brain that causes aberrant pain perception. While this condition is not overtly systemically inflammatory, new evidence has emerged indicating that there’s some accompanying inflammation within the microglia of the brain4. It is also very common for people to either suspect or be told that they have fibromyalgia when in reality they do not have actual fibromyalgia, but instead have other conditions that are commonly caused, at least in part, by significant inflammation. That is why removing foods that can lead to immunogenic activity and inflammation is key. It is my clinical experience over more than two decades of successfully helping patients recover from a FM diagnosis that having them follow an ancestral Paleo diet is critical to their successful outcome. Removing foods that are not part of a Paleo diet, such as field-grass grains (including those containing gluten and gliadin), dairy, and legumes makes for less activation of innate immune pathways, which translates into less inflammation and less pain perception.