More on Symptom Overlap
An important part of obtaining a diagnosis of fibromyalgia is to rule out other illnesses which could be causing a patient's symptoms. Below are some of the conditions and illnesses which have a major symptom overlap with fibromyalgia that you may wish to get ruled out as part of your diagnosis.
|Widespread muscle and joint pain||100%|
|Numbness and tingling||64%|
|Swollen feeling in tissues||40%|
|Aggravating Factors of Pain|
|Overuse or trauma||62%|
|Chronic fatigue syndrome||64%|
|Irritable bowel syndrome||60%|
|Multiple chemical sensitivity||55%|
|Restless legs syndrome||31%|
|Female urethral syndrome||12%|
|Temporomandibular dysfunction||Common *|
|Periodic limb movement||Common *|
|*These conditions are common in crucial practice, but there is specific data regarding their frequency.|
Anxiety/ Panic Attacks: Panic attacks are surprisingly common. Up to 40 per cent of the population will experience a panic attack at some time in their life. Some of the common signs and symptoms of a panic attack include: a sense of overwhelming panic or fear, the thought that you are dying or choking or 'losing control' or 'going mad', increased heart rate, difficulty breathing (feeling that there is not enough air), feeling choked, excessive perspiration, dizziness, light-headedness or feeling faint. People experiencing a panic attack may also experience 'derealisation'; a sense that you or the world around you is not real. This symptom is thought to be associated with the physiological changes that occur in the body during the anxiety response.
Arthritis: Osteoarthritis characterized by cartilage degeneration leading to tissue and bone damage and severe joint pain, is the most common type of arthritis. Symptoms include stiffness in the joints, tenderness and pain, often in the hips and knees, but can affect any joint.
Carpal Tunnel Syndrome: The main symptom of CTS is intermittent numbness of the thumb, index, long and radial half of the ring finger. The numbness often occurs at night, with the hypothesis that the wrists are held flexed during sleep. Recent literature suggests that sleep positioning, such as sleeping on one's side, might be an associated factor.
Celiac Disease: An autoimmune disorder of the small intestine that occurs in genetically predisposed people of all ages from middle infancy onward. Symptoms include pain and discomfort in the digestive tract, chronic constipation and diarrhoea, failure to thrive (in children), anaemia and fatigue, but these may be absent, and symptoms in other organ systems have been described. Vitamin deficiencies are often noted in people with coeliac disease owing to the reduced ability of the small intestine to properly absorb nutrients from food.
Central Sensitisation: Central sensitization is a condition of the nervous system that is associated with the development and maintenance of chronic pain. When central sensitization occurs, the nervous system goes through a process called "wind-up" and gets regulated in a persistent state of high reactivity. This persistent, or regulated, state of reactivity subsequently comes to maintain pain even after the initial injury might be healed. Central sensitization has two main characteristics. Both involve a heightened sensitivity to pain and the sensation of touch. They are called 'allodynia' and 'hyperalgesia.' Allodynia occurs when a person experiences pain with things that are normally not painful.
Chronic Back Pain: Some cases of chronic pain can be traced to a specific injury that has long since healed -- for example, an injury, a serious infection, or even a surgical incision. Other cases have no apparent cause -- no prior injury and an absence of underlying tissue damage. However, many cases of chronic pain are related to these conditions:
- Low back pain
- Arthritis, especially osteoarthritis
- Multiple sclerosis
- Nerve damage (neuropathy)
Treating your underlying condition is, of course, vitally important. But often that does not resolve chronic pain. Increasingly, doctors consider chronic pain a condition of its own, requiring pain treatment that addresses the patient's physical and psychological health.
Chronic Fatigue Syndrome: Like Fibromyalgia, the cause of CFS is not known. The major symptom is debilitating fatigue, accompanied by problems with memory, headache, and pain in the muscles and joints. Problems falling asleep, waking up feeling tired and unrefreshed, difficulty concentrating or thinking and forgetfulness and IBS-like symptoms are common. It is said that around 50% of people with fibromyalgia also meet the criteria for CFS.
Chronic Pelvic Pain: Pelvic pain in women refers to pain in the lowest part of your abdomen and pelvis. If asked to locate your pain, you might sweep your hand over that entire area rather than point to a single spot. Chronic pelvic pain is pain in your pelvic region — the area below your bellybutton and between your hips — that lasts six months or longer. Chronic pelvic pain can be a symptom of another disease, or it can be a condition in its own right. The cause of chronic pelvic pain is often hard to find. If the source of your chronic pelvic pain can be found, treatment focuses on that cause.
Cognitive Impairments: consistent or increasing concern about your mental performance may suggest mild cognitive impairment (MCI). Cognitive issues may go beyond what's expected and indicate possible MCI if you experience any or all of the following:
- You forget things more often.
- You forget important events such as appointments or social engagements.
- You lose your train of thought or the thread of conversations, books or movies.
- You feel increasingly overwhelmed by making decisions, planning steps to accomplish a task or interpreting instructions.
- You start to have trouble finding your way around familiar environments.
- You become more impulsive or show increasingly poor judgment.
Your family and friends notice any of these changes. If you have MCI, you may also experience:
- Irritability and aggression
Depression: It is common for people with fibromyalgia to suffer from depression. Many doctors have refused to make a diagnosis of fibromyalgia, attributing the patient's symptoms directly to depression. Depression can cause problems with memory and concentration. Symptoms of depression can include mood changes, changes in mood depending on the time of day, fatigue, apathy, hopelessness, self-reproach and suicidality.
Drugs and Alcohol: Many prescription and over-the-counter medications, such as antihistamines, can cause side effects including fatigue, headaches, poor sleep and can affect the nervous system. Constant fatigue is also a symptom of drug and alcohol dependency or abuse. Something as simple as
caffeine withdrawal can have quite dramatic side effects.
Ehlers Danlos Syndrome: An inherited connective tissue disorder that has 6 major recognised types. Symptoms can include early onset osteoarthritis, chronic joint disease, muscle weakness and pain, joint pain, nerve compression disorder including carpel tunnel and neuropathy, and sleep apnoea.
Endometriosis: A hormonal and immune disease affecting girls and women. The most common symptoms are pain before and during periods, pain during or after sexual activity, fatigue, infertility, and heavy bleeding. Other symptoms that may occur with periods include painful bowel movements, lower back pain, and diarrhoea and/or constipation or other intestinal upsets.
Headache: Migraine, tension headaches. Some experts believe that migraine headaches and fibromyalgia may share common defects in the systems that regulate certain chemical messengers in the brain, including serotonin and epinephrine (adrenaline). Low levels of magnesium have also been noted in patients with both fibromyalgia and migraines. Chronic migraine sufferers who do not benefit from usual therapies may also have fibromyalgia.
Food intolerances: Many fibromyalgia patients suffer from intolerances to certain foods. Common ones are gluten (see also Celiac Disease), sugar, artificial sweeteners (particularly aspartame), some vegetables, spices like chilli and garlic, lactose, and many more. Almost any food can become an issue, depending on the individual. Symptoms can include heartburn, gas, reflux, nausea, diarrhoea, headaches, constipation, muscle pain, changes to heart rate and fatigue.
Hypermobility: Hypermobility describes joints that stretch further than normal. For example, some hypermobile people can bend their thumbs backwards to their wrists, bend their knee joints backwards, put their leg behind the head or perform other contortionist "tricks". It can affect one or more joints throughout the body. Hypermobility syndrome is generally considered to comprise hypermobility together with other symptoms, such as myalgia and arthralgia.
Hypothyroidism: Caused by underproductive hormone gland in the front of the throat. Hypothyroidism is an autoimmune condition where the body mistakenly attacks normal tissue. This causes a reduction in the hormones produced in the thyroid. Symptoms can include all-over pain, fatigue, memory
loss and depression. There are several other conditions that can affect the thyroid gland, including cancer. Thyroid function should be thoroughly tested
before settling on a diagnosis of fibromyalgia.
Interstitial Cystitis: An inflammation of the bladder wall that can feel similar to a urinary tract or bladder infection. The symptoms seem to originate in the nerves and is most common in women.
Irritable Bowel Syndrome: IBS can cause bouts of both constipation and diarrhoea. The cause of IBS is not clear, but can often be triggered or exacerbated by eating certain foods and stress. Cramps and stomach pains are also symptoms.
Lupus: Lupus is an autoimmune condition where the immune system attacks tissues in the body. This causes inflammation if muscles and joints. The pain from this is similar to Fibromyalgia. Lupus symptoms can come and go, much like 'flares' associated with fibromyalgia. A common symptom of lupus is a butterfly shaped rash that forms across the cheeks and nose.
Lyme Disease: Symptoms of Lyme disease include joint pain, fatigue, stiffness, headaches, and associated memory problems and depression. Lyme is caused by a bacterial infection caused by tick bites and can be treated with antibiotics.
Malignancy: The term "malignancy" refers to cancerous cells that have the ability to spread to other sites in the body (metastasize) or to invade and destroy tissues. Malignant cells tend to have fast, uncontrolled growth due to changes in their genetic makeup. Symptoms depend on where the cells manifest. Chronic pain, fatigue and many other symptoms are common.
Multiple Chemical Sensitivity: Symptoms are wide ranging and are caused by (even low) exposure to certain chemicals. Common substances include pesticides, plastics, perfumes, pains, synthetic fabrics, petroleum, cleaning products and many more. Symptoms are quite often non-specific or vague and may include nausea, fatigue, dizziness, rashes, breathing difficulty, rashes and gastrointestinal problems.
Multiple Sclerosis: The symptoms of MS are varied and unpredictable, depending on which part of the central nervous system is affected and to what degree. The relapsing-remitting form of MS is the more common. The person experiences attacks in which the symptoms are severe for a short time and then improve, often with an almost complete recovery. The progressive form of MS is characterised by a steady worsening of symptoms without any remissions. The symptoms can be any combination of the five major health problems of MS, including:
- Motor control – muscular spasms and problems with weakness, coordination, balance and functioning of the arms and legs, tendency to drag one foot.
- Fatigue – including heat sensitivity.
- Other neurological symptoms – including vertigo, pins and needles, neuralgia and visual disturbances.
- Continence problems – including bladder incontinence and constipation.
- Neuropsychological symptoms – including memory loss, depression and cognitive (thought-related) difficulties.
Paraesthesia (Numbness and tingling): Persistent pins-and-needles, numbness, hot or cold patched, sensations as if cold water was being poured over the skin and just some strange sensations that are common with fibromyalgia patients, and also patients with damage to the nerves or brain.
Polymyalgia Rheumatica: An inflammatory disorder, usually in people aged over 50. Symptoms include all over pain, stiffness in the neck, hips, upper arms and shoulders, severe morning stiffness and headaches. Attaches of pain can be very sudden, or occur gradually. PMR is caused by a condition
of blood vessels such as temporal arteritis.
Post-traumatic Stress Disorder: Studies have shown a large correlation between patients with fibromyalgia and patients with PTSD. Patients with fibromyalgia and PTSD have been shown to suffer much greater PTSD symptoms. Studies in 2002 and 2004 found that more than half of patients diagnosed with PTSD also had fibromyalgia. PTSD does have many symptoms that are not common in a diagnosis of fibromyalgia.
Restless Legs Syndrome: RLS is characterised by painful sensations in the legs including pins-and-needles, accompanied by an irresistible urge to move the legs. The pain goes away when the legs are moved but soon builds up again. The causes or RLS are not known. RLS causes sleep disturbance which can then lead to many other symptoms, such as cognitive dysfunction, depression and pain.
Reynaud's Phenomenon: Raynaud's phenomenon is a sudden constriction of the blood vessels that slows blood flow to the extremities, most often fingers and toes. The skin will change in colour, usually accompanied by discomfort such as pain, tingling and numbness. Women under 25 years are most susceptible. In some cases, Raynaud's phenomenon may be caused by an underlying autoimmune disorder, such as scleroderma.
Rheumatoid Arthritis: Stiff, swollen painful joints are common with RA. RA can occur at any age and is not caused by wear and tear, but rather by an inflammation and damage to the linings of the joints. RA often strikes the same joints on both sides of the body and can cause morning stiffness and fatigue.
Sjogren's Syndrome. Sjogren's is another autoimmune disorder, and the symptoms of many autoimmune disorders can overlap. Symptoms include fatigue and musculoskeletal pain and is more prevalent in women. The tell-tale signs are dry eyes and dry mouth.
Sleep Apnoea: Sleep apnoea sufferers tend to snore and stop breathing for fore short periods of time, followed by snorts and gasps for breath. All problems with sleep can lead to symptoms similar to fibromyalgia. Cognitive dysfunction (Memory loss, reduced attention, lost words etc), depression, pain etc.
Temporomandibular Disorder: TM is usually caused by clenching the jaw or grinding of the teeth during sleep. It can cause severe pain when chewing, yawning, or even talking. Another symptom is headaches. Problems falling asleep, waking up feeling tired and unrefreshed, difficulty concentrating or thinking and forgetfulness, and IBS-like symptoms are common.
Vasculitis: An inflammatory disorder that can affect your joints and cause joint pain. When it affects your eyes, you can have blurred vision. When it affects nerves, you can have numbness, tingling, and weakness in limbs.
Vitamin B12 Deficiency: B12 plays a role in the metabolism of fatty acids needed to maintain the myelin sheath, the protective covering of the nerve fibres in the brain and spinal cord. Deficiency can cause symptoms such as fatigue, memory loss, and even depression. It can be identified with a simple blood test.
- Better Health Channel
- National Women's Health Network
- Institute of Chronic Pain
"Overlapping Conditions Among Patients With Chronic Fatigue Syndrome, Fibromyalgia, and Temporomandibular Disorder". Leslie A. Aaron, PhD, MPH; Mary M. Burke, MD; Dedra Buchwald, MD Arch Intern Med. 2000;160(2):221-227. doi:10.1001/archinte.160.2.221.
"Prevalence of post-traumatic stress disorder in fibromyalgia patients: Overlapping syndromes or post-traumatic fibromyalgia syndrome?". Hagit Cohen, Lily Neumann, Yehoshua Haiman, Michael A. Matar, Joseph Press, Dan Buskila. Seminars in Arthritis and Rheumatism Volume 32, Issue 1, August 2002, Pages 38–50.