Fibromyalgia - 5 important things to know

Sometimes it seems everyone thinks they know what Fibromyalgia is. A lot of medical people probably do. But do those people know what mimics Fibromyalgia? Having your eyes open to the potential of a ‘wrong diagnosis’ is essential when considering what the cause of widespread musculoskeletal pain is. There are 5 important things to know.

1. Know to ask two questions. When someone thinks you have Fibromyalgia - and that includes you - there are two questions to ask them. The first is a logical question: ‘Do you know what Fibromyalgia is according to agreed criteria?’ Fibromyalgia features follow well-established patterns – primarily widespread pains and tender points around the body. Fatigue is often present.  Diagnostic criteria (ACR 2010) exist [https://www.rheumatology.org/Portals/0/Files/2010_Preliminary_Diagnostic_Criteria.pdf] and have been honed iteratively over the years to currently allow quite a precise diagnosis to be made. The second question however is much more important and is much more nuanced. It is ‘Do you know what else that might be causing my symptoms other than Fibromyalgia?’. If the person who thinks you have Fibromyalgia (and that includes you) is honest, the answer to this question should be ‘no’ . If it isn’t then be cautious because ‘no’ will be the correct answer from everyone apart perhaps from only a very few people.

2 There’s too much use of the ‘F’ word. There are in fact a number of rheumatological conditions which can cause widespread musculoskeletal pain, and many of the conditions can cause fatigue and tiredness - not least because pains interfere with sleep and disrupted sleep, whatever the cause, can cause tiredness.. What are these conditions? Well, read on.

3 Understand that pain can be amplified by aberrant central (brain) pain processing. Sensible medical opinion defines Fibromyalgia as a term used to describe the amplification of pain through aberrant brain neural pathways (or for the scientists out there: nociceptor inputs can trigger a prolonged but reversible increase in the excitability and synaptic efficacy of neurons in central nociceptive pathways, termed central sensitization).  Essentially, factors such as non-restorative sleep and psychological issues affect brain processing of pain signals leading to enhanced pain perception (i.e. pain ‘plus’). 

4 Know that there are many conditions which can cause widespread pains and tiredness. There are quite a few autoinflammatory and autoimmune conditions which are subtle, episodic, come and go, can cause pain and/or fatigue and/or tender areas, and can generate abnormal blood tests (or sometimes don’t)… but are not Fibromyalgia. To the unknowledgeable or unwary, these conditions can be erroneously assigned the F-word. Top among these conditions are the Spondyloarthritis conditions (axial Spondyloarthritis, Psoriatic Arthritis and Inflammatory Bowel Disease related Spondyloarthritis). Not surprisingly these conditions are well recognised to be ‘diagnosed late’ (ie missed diagnosis).

5 Know how to go about sorting things out. So, who should you go and ask? Insist on specialist input. A good rheumatologist should be able to confirm the F-word diagnosis, and consider if it is a Primary (the only) diagnosis or Secondary (to, or accompanying, another underlying condition) or most importantly of all, should be able to correct an erroneous diagnosis of Fibromyalgia and successfully diagnose and treat the right condition. Almost always such an assessment will require blood tests and scans. GPs, Physios, Osteopaths, Surgeons, and many different medical specialists will either not have access to the appropriate tests to do. or if they do, be able to interpret them appropriately.

Read more about the approach to diagnosign Fibromyalgia: www.drgavinclunie.com/fibromyalgia

Links
Some patient information about fibromyalgia:
https://www.versusarthritis.org/about-arthritis/conditions/fibromyalgia/