Do you know if you are suffering from Lyme Disease or Fibromyalgia?

The typical short term symptoms of Lyme Disease include (CDC, 2021):

• A bull’s-eye skin rash on the skin at the site of the tick bite. This happens in 70-80% of infected people. It usually appears after 3 to 30 days. The average time for it to appear is 7 days (CDC, 2021).
• Fever, chills, headache, fatigue, muscle/ joint aches. Swollen lymph nodes may also occur, especially if there is no rash.

Additional symptoms may occur days or months after a tick bite (CDC, 2021):

At Medicine with Heart, we specialize in treating and resolving Lyme Disease. We have written extensively on Lyme Disease. You can read more here in our ‘Lyme & Mold Guide’ and here in our recently published book.

What is Fibromyalgia (FM)?

Fibromyalgia affects 2 – 4% of the adult population (CDC, 2020) and (Ranque-Garnier S, 2019). Fibromyalgia is a condition of widespread pain all over the body. People with FM may have what is called ‘abnormal pain perception processing’. This makes them more sensitive to pain than people without Fibromyalgia.

The cause of FM is not known. In many cases, especially when Functional Medicine principles are used, FM can be effectively treated and managed through an individual approach that targets the root causes. Certain conditions such as Lyme Disease can sometimes explain Fibromyalgia. We have seen many people’s Fibromyalgia completely disappear when Lyme Disease was treated.

We have written a 3-part blog on FM, which you can find here.

The common symptoms of Fibromyalgia are (CDC, 2020):

• Fatigue
• Depression and anxiety
• Sleep problems
• Problems with thinking, memory, and concentration
• Headaches, including migraines

Other symptoms may include (CDC, 2020):

• Tingling or numbness in hands and feet
• Pain in the face or jaw, including disorders of the jaw such as TMJ
• Digestive problems, abdominal pain, bloating, constipation and irritable bowel syndrome

*** What is striking from these detailed lists of symptoms is that there can be an Overlap of Symptoms between LD and FM ***

Diagnosing Lyme Disease and Fibromyalgia

Lyme Disease

A Lyme diagnosis is made based on symptoms. We look at the physical signs like the bulls-eye rash, although not everybody gets a rash after a tick bite. Other symptoms are assessed. Blood tests are taken. The Western blot test is the most accurate test to diagnose LD. But not all labs are standardized. We can expertly analyze a Western blot to get the correct diagnosis from it.

Lyme Disease is sometimes called ‘The Great Imitator’ because it mimics so many other health conditions. If you think you have been exposed to ticks and your symptoms and labs indicate Lyme, then it can sometimes be a good idea to treat presumptively. This can be true even if the diagnosis is not 100% indicative of Lyme.

If correctly identified early on, most cases of Lyme Disease can be treated successfully with either herbal natural approaches or antibiotics.

Fibromyalgia

Diagnosing FM is somewhat subjective, based on how the patient describes their symptoms. FM is undiagnosed in as many as 75% of people with the condition (Maffei ME, 2020). There is not a universally accepted diagnostic gold standard (Häuser W, 2017).

FM is a continuum of symptoms, and it can sometimes be an ambiguous disorder (Maffei ME, 2020). Fibromyalgia is usually a diagnosis of exclusion. But most of the time, Lyme Disease is not tested. Even if it is tested, poorly validated tests are used and interpretation is often faulty. In our practice, we have seen many cases of Fibromyalgia disappear after identifying and treating Lyme Disease. If you are a clinician and interested in learning about how to properly identify, test, interpret and treat Lyme Disease and Fibromyalgia, check out our clinician training programs at mindbodyfunctionalmedicine.com.

A patient who has chronic pain should be screened for chronic widespread pain or CWP. This is defined as pain in 4 out of 5 body regions (Häuser W, 2019). People who have CWP should be screened for other FM symptoms like non-restorative sleep and fatigue (Häuser W, 2019). A complete medical history and physical exam can help confirm a FM diagnosis.

It is also important to rule out other diseases that can look like FM. Things to rule out include Rheumatoid Arthritis, depression, Multiple Sclerosis, other autoimmune conditions and bacterial infections such as LD.

The Causes or Mechanisms of Action

Despite the sometimes-similar symptoms, the MOAs of these two conditions are very different:

• Lyme Disease is caused by the bacteria Borrelia burgdorferi and Borrelia mayonii. Lyme is a bacterial infection.
• The cause of Fibro is much less clear and could involve genetic, hormonal or other factors. Gut health may play a role too. But the primary MOA is thought to be a dysfunction of pain sensitization. You can read more in our FM blog here.  
• Fibromyalgia is often triggered by a stressful event, including an infection, trauma (due to an accident, serious injury or divorce) or major surgery. FM can actually be triggered by an infection like Lyme Disease (Wormser GP, 2015).

What is the Link?

Similar Symptoms & Mis-Diagnosis

• FM can be mis-diagnosed as Lyme disease.
• Late-stage chronic Lyme disease can be mistaken for FM (Ranque-Garnier S, 2019).
• Lyme Disease can trigger Fibromyalgia.

So how do we differentiate between LD and FM?

How do we untangle symptoms and identify a case of chronic Lyme disease vs post-infectious Fibromyalgia?

We need to do a thorough exam, the correct labs and a deep analysis of the overlapping symptoms. There are other things to look at to get a correct diagnosis. These include:

• A history of a bulls-eye rash, a tick bite or spending time in areas where Lyme Disease has been reported are good indicators that it could well be Lyme.
• Antibiotics should improve Lyme Disease symptoms, while they don’t help in the case of Fibromyalgia.
• Pain in specific tender points is associated with Fibromyalgia more than other illnesses.
• Stiffness in Lyme Disease occurs mainly in the neck and joints. In Fibromyalgia, it is usually widespread pain.
• Lyme Disease can cause arthritis symptoms and swollen joints, especially in the knees. Fibromyalgia causes pain and stiffness but doesn’t typically involve swelling or damage to the joints.

In our clinic, we have expertise in treating a range of complicated, difficult-to-diagnose conditions like Fibromyalgia and Lyme Disease. We look for the root causes in our patients to identify what could be causing the symptoms. We regularly treat and resolve Lyme, chronic infections and other complex conditions in patients in our Functional Medicine clinic.

** Please stay tuned for our next Blog!  **