Fibromyalgia Misdiagnosis: What Else Could it Be and Does Diet Matter?

Fibromyalgia Misdiagnosis: What Else Could it Be and Does Diet Matter?

By Dr. David M. Brady

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.

Dr. David M. Brady, Author of The Fibro-Fix

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.

  1. Fitzcharles MA, Boulos P. Inaccuracy in the Diagnosis of Fibromyalgia Syndrome: Analysis of Referrals. Rheumatology 2003;42:263–267.
  2. Wolfe F, Clauw DJ, Fitzcharles MA, et al. The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity. Arthritis Care & Research, 62, No. 5, May 2010, pp 600–610, DOI 10.1002/acr.2014.
  3. Schneider MJ, Brady DM, Perle SM. Differential diagnosis of fibromyalgia syndrome: proposal of a model and algorithm for patients presenting with the primary symptoms of widespread pain. J Manipulative Physiol Ther. 2006;29:493- 501. Available at no charge online at www.jmptonline.org/issues.
  4. Loggia ML, Chonde DB, Akeju O, Arabasz G, Catana C, Edwards RR, Hill E, Hsu S, Izquierdo-Garcia D, Ji RR, Riley M, Wasan AD, Zürcher NR, Albrecht DS, Vangel MG, Rosen BR, Napadow V, Hooker JM. Evidence for brain glial activation in chronic pain patients. Brain. 2015 Mar;138(Pt 3):604-15. doi: 10.1093/brain/awu377. Epub 2015 Jan 12.

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.

Dr. David M. Brady, is a leading naturopathic medical doctor at Whole Body Medicine in Fairfield, Connecticut. He completed his initial clinical training as a doctor of chiropractic and is also dual board-certified in clinical nutrition. He is the VP of Health Sciences and the director of the Human Nutrition Institute at the University of Bridgeport and the chief medical officer of Designs for Health, Inc., and Diagnostic Solutions Laboratory, LLC. Dr. Brady is a highly sought after presenter and prolific author of medical papers and research articles on fibromyalgia as well as a dedicated champion and advocate for patients suffering with a fibromyalgia diagnosis. Learn more at DrDavidBrady.com and FibroFix.com.

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Authored by: Dr. David M. Brady

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Heather

This is all so sad but true. Drs these days really are bombarded and personally most don’t give a [edit]. A a nurse a well I’ve seen my fair share of things happen and be done I totally disagree with and are wrong. We as nurse to be honest with you know the patients way better than most Drs do any day of the week as we are with them and take care of them continuously. Well in LTC anyways and that is 20 to 30 patients per nurse, yes alot but if you manage your time and really care and pay attention to labs and Xrays etc we always catch things. And I use to question Drs. As we had really close report with them or most nurses. I was nurse manager over 60 bed unit but I was very active and hands on and knew everything about my patients and families.In the hospitals nurses have 1 to 6 patients typically and really don’t give a [edit]. While other attitude. I refuse to go to the ER anymore unless I am about to die. I never get treatment, no blood work, no tests nothing just discharge and follow up with pcp as soon as they find out you follow pain management. Sad but true. They also are rude inappropriate, neglectful, and you are treated inhumanly by Drs nurses ARNPs and PA. So sad what our medical field has become. I have AS and the Dr to nurse had no clue what it was so I had to explain as well as osteoarthritis, fibro, neurapathy, multiple bulging disk, IBS, Gerd, and about 15 other diagnosis all related and the first thing always is we are not here to give you drugs…..Seriously I didn’t ask for them I have my own I need treatment I don’t just come for the hell of it. People here in Florida are refused treatment so often that they are dying in parking lots and police called on them for refusing to leave as we know our bodies and no one wants to go to the ER. I’ve filed formal complaints and I’m and advocate for 8 organizations and pain ambassador for US Pain Foundation and i will continue to stand up and fight the government and local legislature when it comes to all the nonsense going on with CDC and lack of treatment by Drs but it is being forced by CDC. People are cold turkey being stopped off pain meds or decreased and that in itself is so dangerous and harmful as well as neglectful. You some antidepressants are worse than any pain med. We are real PAIN PATIENTS not ADDICTS and this has all stemed from heroin and cocaine with fentanyl overdoses that are illegal and illicit drug use by ADDICTS or for recreational use. Yes there may be some who misuse there meds but they have no scientific proof and have said that. All opioid overdoses is reason from that and it… Read more »

Jean Price

Wow…this is way too long, but I’m submitting it anyway in case some piece will affirm or help someone else. I guess this was my outlet today, and a reminder that our past experiences may keep someone else from harm if we but share them! So I’m sharing away…asking forgiveness for the eyestrain I may cause! ————————————- Unfortunately, I think many health care providers have come to rely on high tech and test results to not only guide them, but to actually be basis and rationale of their whole definitive diagnosis! Negative test results them leave them confused and guessing, for the most part! And they themselves aren’t used to or skilled in taking detailed histories and ASKING THE RIGHT QUESTIONS, along with little practice in doing comprehensive physical exams. So misdiagnosis is a reality! The actual process of a visit leaves so much room for miscommunication and errors…one person checks your vitals, another goes over a brief history mostly of why you’re there today, enters medication use, maybe surgeries and disease history too, maybe not. Neither may communicate with the doctor before he sees you, if ever! (The best detail is given to our FULL insurance information! There’s even more room to write in that area!). When the doctor comes in, he “hears” your story mostly from whatever the nurse/assistant was able to check mark or add brief comments to in a computer program!! It’s like that game of “pass it on”…whispering a beginning phrase to the next person….and the information ends up hysterically different than it began…only this visit is no laughing matter for us! Did you ever check over your doctor’s history notes or progress notes! Or feel like no one had a clue why you were there, and you wondered what was in your chart? It’s distressing and can be misleading, to say the least. Along with the notes from nurses and other staff! I was in the hospital once for an autoimmune muscle inflammation (myositis) and the entire week, even though the treatment I was receiving and my apoearance didn’t indicate outward scrapes, injuries, or bruises…each nurse…even the manager…REPEATEDLY asked me ABOUT “my wreck” and if anyone else was in the car or hurt! (I kept wondering what else important they didn’t know besides my diagnosis!) I have once had LEFT leg pain turn into LESS leg pain in the doctors notes, even though my visit was all about INCREASED LEG PAIN! And once, the left side marker was accidentally switched to right on a CAT scan following a myleogram, causing the doctor to actually leave the surgical suite the next day, still gowned and gloved, to try to verify with my upset husband JUST exactly which side my pain was on!! He hadn’t listened well nor taken the time to preview that expensive test he ordered! It meant more unnecessary exploration of my spine during surgery! And I ended up with a lot of additional internal scarring (besides scarring caused by an unpredictable fragment… Read more »

Bob Schubring

A personal friend of some years was misdiagnosed with fibromyalgia, when she had Lyme disease. What was horrible about the way she was mistreated, is that the surgeon who dreamed up this diagnosis, lied to her about Lyme. He informed her that a blood test was negative for Lyme. During discovery practice into her lawsuit for malpractice, it was discovered that in fact, no Lyme test was ever run.

The surgeon made big bucks implanting an intrathecal catheter and morphine pump, and wasted months, during which time her Lyme infection became intractable.

Had she been timely diagnosed with a Lyme infection and put on antibiotics sooner, she would have regained much functionality. Presently she is in pain and exhausted most days, and the quack surgeon continues pushing implants on people by hook and crook. By tossing her into the dustbin diagnosis of Fibromyalgia, also noticing a few arthritic joints, and arriving at an incorrect diagnosis for long-term chronic pain, the surgeon wrongfully enriched himself by performing surgery that wasn’t necessary, and we taxpayers are stuck paying my friend’s disability payments for the rest of her life.

Thanks to a “tort-reform” statute pushed through by ex-Governor Rick Perry, her lawsuit for malpractice, failed. Texas is loaded with similar cases, I presume, because the lawyers argued and won the concept, that lying about test results falls within the Standard of Care in the state of Texas.

I hope Governor Perry does not bring this brand of “tort reform” to Washington.

Dave

Fibromyalgia reveals the soft underbelly of health care, policies and research. And my question is what is being treated when someone has a fibro diagnosis- is it the diagnoses being treated, the symptoms, the biomarkers, the person? All of the above, none of the above? A fibromyalgia diagnosis is just a shorthand explanation. And what is critical to fibromyalgia is not the diagnosis but the person who has the diagnosis. And what model of health justice will be used to treat the person or diagnosis- the capabilities model, the prioritarianism, sufficientarianism? What if the person asks to be cured or just to have the pain addressed? These questions are not academic ones but realpolitick of fibromyalgia.
The diagnosis of fibromyalgia or Lupus or migraine is a diagnostic bias for it is cupled with treating a diagnosis and not the person who has the diagnosis- not to mention other issues. THe POMR would be a better approach to painful conditions- or should i say people in pain.

Heather

I am just apauld at all of the “new research” that some Drs are coming up with to try and justify 100 million people who suffer daily in pain. Seriously don’t you think most of us have tried diet, exercise, therapy, massage, yoga, etc which by the way insurance companies don’t cover and are very expensive $200 a visit 2-3 x week to be exact until deductible of $4000 is met. If this is the case why don’t ins companies start paying for all these alternative therapies. Well I have Severe Fibromyalgia with Myafacial Pain Syndrome documented by Rheumatologist as well as Ankylosing Spondylitis, Osteoarthritis in my entire facets of my spine, bilateral shoulders and clavicles, right hip, left knee, and both hands and DDD with multiple bulging disc in cervical and lumbar region, Kyphosis and Lordosis, neuropathy just to name a few. So I don’t think diet has ever helped me. Therapy told me my body was to fragile for machines and I could only do water therapy which is great I will say, my heating pad, and TENS unit but I still hurt 24/7 and meds do help me enough to be able to get out of bed and move a little. Not alot but some. I’ve lost my career as a nurse due to progressing disorders and now have been referred to oncology due to Lymph node issues in groin area so this does not work for all and the CDC needs to rethink what they are doing. I’m embarrassed of our medical world today. Patients are being treated with no respect, inhuman, and neglectful in all aspects. Suicides rates are thru the roof and rising daily but spbtjry care people are being cut off their meds cold turkey which should be illegal or decreased causing more agony. You know I believe their are some antidepressants that are way worse than opiods. And this whole ordeal is from illegal and illicit use of herion and cocaine with fentanyl overdoses not the real PAIN PATIENTS. So wake up!!!!
Everyone please take a stand and speak up. Write your local representatives as well as CDC FDA and DEA and let them know your stories. Let your voices be heard and most importantly BE YOUR OWN ADVOCATE FOR NO ONE ELSE WILL………

Lotty Payne

Articles and study are of course a way to bridge the gap between insufficient pain control and possible non invasive controlled chronic pain easing…….for the future. To make those of us adhere to the impossible opioid medication reducing agenda that is happening right now without the help of professional opioid medication reducing physicians will cause multitudes of good people to seek illicit pain relief. . To “do or die” by the CDC “guideline” IS cruel, unjustified, discriminating, punishment for those that have been prescribed sufficient, legal, doctor dispensed, opioid medication to those of us that are and have been both stable and have had ZERO “normal” body function interference with decades of opioid medicinal use.. The act or “guideline” is a “direct” method to achieve a better mortality rate statistic regardless of exactly who the troubled opioid users really are. The opioid prescribed patients that are rigorously examined, evaluated, and held to degrading procedures just to to be prescribed the ONLY approved pharmaceuticals in a sufficient amount to have for some life giving medication and, to all chronic pain patients, a quality of life giving again approved, opioid medication. The CDC ideology is that everyone CAN and WILL “make do” on the dosage and type of opioid medication that the CDC sees fit for the 10’s of millions of Americans to receive. It is irrelevant whether the amount of medication received is either sufficient or affordable.The “one shoe fits all” methodology of opioid medication prescribing without even knowing or having the individual chronic pain patients history to relate to! A “squeeze play” with our physicians placed in the middle and the CDC “studies” claiming the “guideline” is ONLY a recommendation. Then why are people nationwide being immediately reduced in their medication that they have been sufficiently prescribed, and are stable and active on enough to survive for years and decades? With NO impairment or suggestion of harm to their body? Because our physicians know the unpublished truth. The CDC and DEA can revoke one license to practice medicine indiscreetly at a time. Total devastation to the doctors who even may have the guts to fight for their VERY qualified examination and opinion of those who are deemed as needing opioid medication..They have worked hard for years and decades for the “privilege” to treat those in chronic pain. A doctor would rather close up shop or refuse to prescribe life enhancing opioid medication even if they have been doing just that, pre, the “guideline”. To say the “guideline” is just a recommendation for prescribers, doctors, and clinicians in the prescribing of opioid medication is a joke. “Guideline” in print, license revocation for doctors a verbal but very REAL threat to them. It will not just “blow over”. It will take a concentrated effort of “publishing” the truth of what is happening to pain sufferers, everywhere to make those of the public ware of truth even if they care.

Iam Tired Aiken and Eileen Moore Aiken

It is absolutely wonderful that the USA has educated, intelligent doctors and ongoing studies and research to find the exact cause and possible “cure” fr chronic pain causing conditins. I will be FIRST inline for alternative treatment and or a reversal of the severe continuous crippling pain that I still endure daily since the two surgeries that wiped out my maximum insurance benefits. If a better diet will work as well as the opioid medication that I have received for 20 years and can alleviate the agony of chronic pain, then maybe I can apply for assistance and purchase the necessary nutrition needed so that I can survive. Maybe , marijuana will be introduced for use in my state! Even medical marijuana. Then I could go into my back yard and literally grow that which I need to battle mind bending continuous pain without the stigma of opioid medication use. Also may be I can grow a sufficient amount of marijuana to help me, my family, and my friends who suffer to the point of suicide everyday! Somewhere over the rainbow, bluebirds whistle up my …..elm tree too. Until the CDC “guideline” is realized as more than a recommendation, the sooner an action can be taken against the the (N)ot (A)llowed (Z)ero (I)ndulgence regime of non compliance of it.

I have this book, and the videos from the summit-excellent!!! Thank you!

THIS is a quality article! We need more like these!

John Quintner, Consultant Physician in Rheumatology and Pain Medicine

“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.”

Dr Brady, you do not appear to know that the “myofascial pain syndrome/trigger point” construct was based upon theory that has been soundly refuted. It was only ever conjecture but unfortunately it has been promulgated as established knowledge. Link: http://www.bodyinmind.org/evaluating-trigger-point/

“Correctly diagnosed fibromyalgia is a problem arising from deep in the nervous system and brain that causes aberrant pain perception.” Again, this is a widely held belief, but one that is being passed off as established knowledge by those who are championing “centralized” as the third pain descriptor (alongside “nociceptive” and “neuropathic”).

http://www.fmperplex.com/2016/08/23/why-centralized-is-unacceptable-as-a-descriptor-for-the-pain-of-fibromyalgia/