Doctors and patients often use the single word, “fibromyalgia”, to diagnose a complex set of symptoms that can have multiple causes. Medical professionals also often prescribe the same treatment package to all patients they label with fibromyalgia. It is similar to 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.

More than 60 percent of people who are told they have fibromyalgia have actually received a misdiagnosis and may be suffering from another problem. Fibromyalgia is the correct diagnosis only when all other medical and functional conditions have been ruled out.

Other than classic fibromyalgia, there are three broad categories of these conditions that are most often the cause of widespread pain and fatigue. Unfortunately, the standard treatment approach for classic fibromyalgia will not help patients with the other conditions.

Medical Problems 

In patients who complain about generalized pain and fatigue, it is imperative that the doctor rule out the presence of any medical condition or disease known to cause many of the symptoms associated with classic fibromyalgia. Hypothyroidism, anemia, rheumatoid arthritis, Lyme disease, rheumatic auto-immune disorders (such as ankylosing spondylitis or scleroderma), multiple sclerosis, small fiber polyneuropathy and cancer are some possible causes for symptoms of vague and diffused body pain associated with pronounced fatigue. Most of the medical assessments appropriate in this type of situation include conducting a comprehensive medical health history, a quality hands-on physical examination and thorough laboratory testing.

Musculoskeletal Problems

Widespread pain and fatigue can also be caused by myofascial trigger points, spinal joint problems and pinched nerves. Myofascial pain syndrome—one of the most common reasons for a mistaken diagnosis of classic fibromyalgia—is pain that is arising from several muscles and joints of the body. Widespread pain is often caused by several different painful conditions that, when suffered simultaneously, feel like one painful condition.

This happens quite frequently with senior patients, who often have arthritis in several joints combined with myofascial problems; they come to their doctor with a complaint of widespread pain. Many senior patients have an overlap of general widespread pain from arthritis, but also have 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 if it is coming from a musculoskeletal structure. For example, if the patient has pain between the shoulder blades disseminating from the neck or shoulders, movements of those two areas should cause the pain to get worse. If there is no movement or position that makes the pain worse, the pain may not be coming from a muscle or joint and other sources should be considered.

Functional or Metabolic Problems

Examples of this type of problem include subtle functional hypothyroidism, inefficiency of energy production in the cells of the body due to mitochondrial dysfunction, nutritional insufficiencies (including vitamin D, CoQ10, carnitine, B vitamins, magnesium and others), chemical and food sensitivities, reactions to medications, and other problems with body metabolism and biochemistry.

More subtle functional 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, to more hidden functional disorders such as energy metabolism disorders (mitochondrial dysfunction), subtle endocrine imbalances, opportunistic intestinal infections (dysbiosis), blood sugar abnormalities (reactive dysglycemia), post-viral immune suppression and other conditions that are not readily apparent on standard laboratory screening tests.

David M. Brady has over 25 years of experience as an integrative practitioner and academic. He is a licensed naturopathic medical physician in Connecticut and Vermont, a board certified clinical nutritionist and the author of medical papers and research articles on fibromyalgia. His new book, The Fibro Fix, focuses on getting the proper diagnosis and treatment for symptoms of widespread pain and fatigue. Connect at FibroFix.com. See ad, page 2.