By Dr. David M. Brady
Are you one of tens 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 what is truly fibromyalgia and what are the associated syndromes incorrectly diagnosed as fibromyalgia. The common thread of widespread pain and fatigue blurs the lines of distinction, leading to incorrect treatment and poor recovery. Far too often, doctors diagnose a patient with fibromyalgia, when in fact she has a complex set of symptoms with multiple causes. Worse yet, doctors may prescribe a single treatment package, when this one-size-fits-all approach rarely leads to recovery.
Approximately five million people in the United States are suffering from fibromyalgia and an estimated 80 to 90 percent of fibromyalgia patients are women. True diagnosis is difficult, however, when the only diagnostic criteria available is based on subjective questions about someone’s perception of pain. As a result, many individuals are suffering from fibromyalgia but are not properly diagnosed as such, and up to two-thirds of individuals diagnosed with fibromyalgia are suffering from a chameleon condition.
Fibromyalgia is the correct diagnosis only when all other medical and functional conditions have been ruled out. Most physicians, however, do not tackle this arduous task. For this reason, many individuals needlessly suffer from improper diagnosis and 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 three broad categories of conditions, other than classic fibromyalgia, that are most often the cause of widespread pain and fatigue:
- Musculoskeletal problems cause pain that is actually arising from a specific muscle or joint. Examples include myofascial pain syndrome, trigger points or “muscle knots,” and spinal joint problems such disc degeneration and pinched nerves.
- Metabolic/Functional problems represent subclinical conditions involving dysfunction of internal organs and individual metabolism, rather than true pathology or disease. Examples 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.
- Medical problems are caused by the presence of any medical condition or disease such as thyroid disease, diabetes, Lyme disease, and cancer.
Unfortunately, the standard treatment approach for classic fibromyalgia will not help patients whose pain and fatigue are rooted in any of these other three 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. After her first pregnancy, she also experienced fatigue and achiness, which in turn led to depression and anxiety. Mary made numerous visits to her family physician and a gastroenterologist, getting comprehensive lab work, an endoscopy, and a colonoscopy. To her frustration, the results were all normal. After being referred to a rheumatologist, Mary was diagnosed with fibromyalgia and prescribed the routine medication, Lyrica. After a few months, however, Mary’s symptoms remained unaltered.
Eventually, Mary was referred to me. From her answers on my fibromyalgia questionnaire, it was evident to me that she had many symptoms associated with fibromyalgia but that she lacked the classic history of high stress or trauma, in either her childhood or current life, that are generally found in classic fibromyalgia cases. 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. Because Mary had been misdiagnosed with fibromyalgia, her 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 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 lives 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 fibromyalgia?
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 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.
Source: 2011 Modification of the American College of Rheumatology Diagnostic Criteria for Fibromyalgia.
Dr. David Brady, a foremost authority on properly diagnosing and treating fibromyalgia, has been featured in top popular media including ELLE and NPR; has published in leading peer-reviewed medical journals including Open Journal of Rheumatology and Autoimmune Disease and Integrative Medicine: A Clinician’s Journal; has published chapters on fibromyalgia in definitive medical textbooks including Advancing Medicine with Food and Nutrients and Integrative Gastroenterology; and has presented at prestigious medical conferences including the Annual Symposium of Functional Medicine and the Integrative Healthcare Symposium. In private practice at Whole Body Medicine in Fairfield, CT, Dr. Brady additionally is the VP of Health Sciences and the Director of the Human Nutrition Institute at the University of Bridgeport, as well as the Chief Medical Officer of Designs for Health, Inc. and of Diagnostic Solutions Laboratory, LLC. Having witnessed his own mother suffer through the wringer of the medical system, Dr. Brady is uniquely passionate not only as a doctor but also as a patient advocate, ensuring that patients receive compassionate care and meaningful results. For more information, visit FibroFix.com and DrDavidBrady.com.