Multiple sclerosis (MS) and fibromyalgia are two distinct conditions that share some similar symptoms. This can lead to misdiagnosis in some cases. While the two conditions have key differences, it’s understandable why someone might confuse MS and fibromyalgia.
What is multiple sclerosis?
Multiple sclerosis (MS) is an autoimmune disease that affects the central nervous system. With MS, the immune system mistakenly attacks the myelin sheath that surrounds and protects the nerve fibers. This leads to disrupted communication between the brain and body, resulting in various symptoms.
Some key facts about MS:
- It’s a progressive disease that can cause permanent nerve damage and disability over time.
- Symptoms are variable but often include fatigue, numbness/tingling, vision problems, weakness, balance issues, and mobility problems.
- It’s diagnosed based on clinical presentation plus results from medical imaging and other tests.
- There are several disease courses, with relapsing-remitting MS being most common at diagnosis.
- Treatment focuses on managing acute attacks, slowing progression, and symptom relief.
What is fibromyalgia?
Fibromyalgia is a chronic condition characterized by widespread musculoskeletal pain, fatigue, sleep issues, and cognitive difficulties. It is considered an arthritis-related condition, although there is no inflammation present. Researchers believe it stems from problems with how the brain and spinal cord process painful stimuli.
Key fibromyalgia facts:
- Main symptom is pain and tenderness throughout the body, especially in certain tender point areas.
- Substantial fatigue, tiredness, brain fog, and sleep problems are also common.
- There are no medical tests to confirm diagnosis – it’s based on clinical criteria.
- Treatment involves medications, lifestyle changes, and coping techniques to ease symptoms.
- The exact cause remains unknown, but certain genes, stress, and trauma may play a role.
Shared symptoms between MS and fibromyalgia
MS and fibromyalgia overlap in several areas when it comes to signs and symptoms. Some shared ones include:
- Fatigue – Both conditions involve severe fatigue and low energy levels.
- Pain – MS can cause nerve pain, while those with fibromyalgia have widespread muscle and joint pain.
- Sleep problems – Disrupted sleep and insomnia are common in both illnesses.
- Depression – Mood issues like anxiety and depression frequently occur.
- Brain fog – Difficulty concentrating, focusing, and slowed thinking may happen.
- Numbness/tingling – Sensory symptoms are often seen with MS and sometimes fibromyalgia.
- Bladder issues – Urinary problems can develop with both diseases.
With overlapping symptoms like these, it’s not surprising that MS and fibromyalgia may be confused in some individuals, at least initially. Fatigue and pain are hallmarks of fibromyalgia, yet they are also quite common in MS.
Differences between MS and fibromyalgia
While MS and fibromyalgia share some similarities, there are important differences between the two conditions:
| Multiple Sclerosis | Fibromyalgia |
|---|---|
| Autoimmune condition | Not autoimmune |
| Neurodegenerative disease | Chronic pain disorder |
| Myelin sheath damage | No tissue damage |
| MS lesions and plaques seen on MRI | Normal MRI |
| Muscle weakness | Muscle tenderness |
| Vision problems | Irritable bowel syndrome |
| Numbness | Widespread pain |
| Loss of coordination | Sensitive tender points |
| Cognitive changes | Headaches |
While both fibromyalgia and MS result in fatigue and pain, MS causes distinct neurological symptoms related to nerve damage. Unlike fibromyalgia, you can see these lesions and damaged areas on an MRI. MS also progresses over time, often leading to permanent disability, while fibromyalgia symptoms tend to fluctuate in severity.
What causes misdiagnosis between MS and fibromyalgia?
There are a few reasons why MS and fibromyalgia may be confused, leading to potential misdiagnosis:
- Lack of definitive diagnostic tests for fibromyalgia – Since there are no lab or imaging tests to confirm fibromyalgia, it may become a default diagnosis when no other cause for symptoms is found.
- Mimicry of symptoms – As covered earlier, there is quite a bit of overlap in common symptoms like fatigue, pain, sleep and mood issues.
- Delayed onset of MS – Some people are originally diagnosed with fibromyalgia before developing MS symptoms that lead to the proper diagnosis.
- Atypical MS presentation – Less common or mild MS symptoms can resemble a primary fibromyalgia diagnosis.
- Misinterpretation of sensory symptoms – Numbness and tingling may be mistakenly attributed to fibromyalgia versus nerve dysfunction.
With fibromyalgia frequently becoming a diagnosis of exclusion, it’s easy to see why some experts may land on this as the cause of symptoms when a patient’s presentation is complex or atypical. Since MS can be tricky to diagnose – especially early on – misdiagnosis is not uncommon.
How to distinguish MS from fibromyalgia
Distinguishing multiple sclerosis from fibromyalgia typically involves a complete medical history, physical exam, and certain diagnostic tests. Key things physicians look for include:
- Pattern of symptom onset – MS symptoms tend to start suddenly and worsen over days or weeks, while fibromyalgia develops more gradually.
- Level of disability – MS usually worsens steadily over months and years, leading to neurological disability, unlike fibromyalgia.
- Specific symptoms – Weakness, visual changes, loss of coordination, bladder/bowel issues, and cognitive changes are red flags for possible MS versus fibromyalgia.
- Neurological exam – Abnormal reflexes, altered sensation, weakness, and balance problems point towards MS.
- MRI findings – The MS lesions and nerve damage seen on MRI clearly differentiate it from fibromyalgia.
- Other tests – Spinal fluid analysis and nerve conduction studies can also help confirm MS.
Doctors may also assess things like family history, potential exposure to triggers, response to medications so far, and past illnesses or injuries. Even with extensive testing, MS and fibromyalgia may be challenging to distinguish.
Can you have MS and fibromyalgia together?
Yes, it’s entirely possible to have both MS and fibromyalgia at the same time. Each condition on its own can produce significant symptoms and disability. Together, they may compound each other and result in:
- More severe fatigue, pain, and mobility impairment
- Greater impact on work, activities, and independence
- Higher risk of depression and anxiety
- Reduced quality of life
Some key pointers around concurrent MS and fibromyalgia:
- Anywhere from 2-50% of those with MS also have fibromyalgia, with prevalence rates varying greatly between studies.
- It’s not clear whether having MS increases fibromyalgia risk, or if the two conditions simply overlap by chance at times.
- Distinguishing symptoms between the two may be especially difficult when both are present.
- Treating both conditions simultaneously is needed for optimal management.
If you’ve been diagnosed with either MS or fibromyalgia, stay alert for new symptoms that might suggest the other condition. Ongoing monitoring and communication with your healthcare providers is important.
Can fibromyalgia turn into MS?
Fibromyalgia itself does not turn into MS or directly cause someone to develop MS later on. They are two distinct illnesses.
However, in some cases, a fibromyalgia diagnosis may eventually end up being MS if symptoms appear and progress that point towards MS as the root cause. This scenario can happen when:
- MS is misdiagnosed as fibromyalgia at first due to subtle or atypical symptoms.
- Someone develops additional neurological symptoms later on that warrant an MS diagnosis.
- New MRIs reveal nerve damage consistent with MS after normal scans initially.
Some research indicates that those originally diagnosed with fibromyalgia have anywhere from a 1% to 10% chance of eventually being diagnosed with MS. But again, the fibromyalgia does not directly trigger the development of MS – the symptoms were present all along but not enough initially for a definite MS diagnosis.
The takeaway?
Fibromyalgia won’t actually turn into or transform into MS. But in some cases, what is thought to be isolated fibromyalgia turns out to be the early stages of not-yet-diagnosed MS. This highlights the importance of regular follow-up and vigilance about new or worsening symptoms if you carry a fibromyalgia diagnosis.
Does MS rule out fibromyalgia?
Having MS does not rule out also having fibromyalgia. As mentioned earlier, it is entirely possible to have both diagnoses concurrently. Anywhere from 2-50% of people with MS also meet fibromyalgia diagnostic criteria.
Key points:
- You can have MS and fibromyalgia at the same time – the two are not mutually exclusive.
- Fibromyalgia may actually be more common in people who have MS compared to the general population.
- Symptoms like fatigue, pain, sleep disruption, and depression can be part of both illnesses.
- Even with a confirmed MS diagnosis, new widespread pain and tender points could signal fibromyalgia as well.
Some theorize that having MS may predispose people to getting fibromyalgia as well, perhaps related to chronic inflammation or other factors. Improved awareness of fibromyalgia as a distinct condition has also likely contributed to more dual diagnoses.
Getting properly diagnosed
Given the potential for misdiagnosis or a delay in diagnosing MS, these steps can help ensure prompt and accurate diagnosis:
- Keep a detailed log of symptoms – Track your signs, severity and timing to help spot patterns.
- See a neurologist – They specialize in conditions like MS and appropriate diagnostics.
- Discuss all your symptoms – Even ones you think are unrelated or insignificant.
- Ask about diagnostic testing – Especially MRI to look for nerve damage and lesions.
- Seek a second opinion – If your diagnosis is unclear or symptoms get worse.
- Follow up regularly – Repeat testing if symptoms change or progress.
Since MS and fibromyalgia have considerable overlap, getting properly diagnosed can be a challenging and gradual process. Stay actively involved in your care – ask questions, discuss all your symptoms, and request referrals to specialists if needed.
Conclusion
MS and fibromyalgia share some similar symptoms but are two distinct conditions. Fibromyalgia lacks the nerve damage central to MS, although its diffuse aches and pains can appear reminiscent of MS to an untrained eye. While fibromyalgia is often mistaken for MS initially, the development of more definitive neurological symptoms over time along with positive MRI findings can rule in MS as the cause.
If you carry a diagnosis of fibromyalgia but experience new symptoms consistent with MS, be sure to return to your doctor for evaluation. Some cases of fibromyalgia do eventually turn out to be MS. Getting the proper diagnosis allows for optimal treatment to slow progression and manage this incurable autoimmune disease.