Conditions Mistaken For Fibromyalgia
CONDITIONS THAT MAY BE MISTAKEN FOR (OR OVERLAP WITH) FIBROMYALGIA
Fibromyalgia is a tricky beast. It is often mistaken for other conditions and, just as if that doesn’t make it complicated enough, it often coexists with other conditions, making it especially nightmarish in the sense that it is very complicated and difficult to diagnose. After working with fibromyalgia for so long, a doctor will usually become familiar with the conditions mistaken for (or coexisting with) fibromyalgia. Interestingly enough, I have noticed that patients with these conditions usually respond very well to the same treatment I use for fibromyalgia. A common cause would explain the similarities between these conditions, and would also explain why a somewhat similar treatment plan should prove successful in treating them, despite their obvious differences.
RSD/CRPS (Reflex Sympathetic Dystrophy/Chronic Regional Pain Syndrome)
Of all the conditions we treat, we are probably most passionate about RSD/CRPS. Of the most painful conditions known to man, this one has to top out as the most painful one on the chronic pain scale. It most often will start in a limb, after a seemingly not too uncommon injury or invasion to the body of some sort. (Think fracture, bunion surgery, ankle sprain, knee surgery, or even an injury to the nail.) Instead of the injury recovering, patients report that their pain intensifies at an alarming rate.
Patients new to our office with this condition will often report their pain to be as high as one hundred on the ten scale, and it is largely untouched by pain medications such as opiates. While no specific statistics are available, it is not, in my experience, uncommon for patients suffering from RSD/CRPS to consider suicide…not because they don’t want to live, but because they don’t want to hurt anymore.
The most common symptom of RSD is chronic pain, frequently described by patients as burning or stinging. We are not talking mild pain either, but more that of the blowtorch variety, all the time. Patients also suffer from extreme skin sensitivity, so that even clothing, the brush of a sheet, or the wind on their skin is unbearable. The humidity may make it worse. Ditto sunshine, cold, or hot temperatures.
Other symptoms include swelling, profuse sweating, nail changes, skin rashes (frequently mistaken for fungus or allergies), and color and temperature abnormalities at or near the injury site. Patients may also experience muscle spasms, weakness, tremors, extreme fatigue, problems sleeping, frequent infections, cardiac complications, digestive problems, fever, headaches, migraines, spinal problems, and severe pain when eating. The hallmarks of this disease are sweating, color changes, temperature changes, and cold sensitivity. This may lead to the limb contracting and to bone loss, easily identifiable by a bone scan.
In some people, the disease is confined to the affected area, but in as many as 70 percent of patients it spreads to adjacent parts of the body or crosses over to affect the same area of the opposite limb. It may also spread to areas unrelated to the injury, such as the trunk, internal organs, optic nerves, and scalp.
We consider this condition terrifying and rather creepy. Why? There is the obvious and constant threat of the RSD spreading. These patients live in fear of needing surgery or injuring another body part, which could cause that to happen. Even an innocent needle prick can cause a whole new symptom site to develop.
In addition, these patients are set up to develop RSD/CRPS before they get injured, but they don’t know it. They are walking around like a ticking time bomb, innocently undergoing, for instance, foot or knee surgery, all along not knowing that this “perfect storm” is waiting to stir inside of them, unleashing its terrifying pain and suffering.
Although it’s not known exactly how many people have RSD worldwide, it is estimated that as many as eight million suffer from the disease in the United States alone, and that it complicates as many as 5 percent of all injuries. Typical age of onset is the mid thirties, yet children and the elderly also develop the disorder. Just like fibromyalgia, it affects women more often than men.
The “S” in RSD stands for sympathetic. It is remarkable how this whole part of the autonomic nervous system is neglected in the treatment of that condition. The sympathetic nervous system plays an important role in the development of fibromyalgia, and this is also the case in RSD/CRPS, in our opinion most often caused by an old upper cervical injury (like a whiplash injury) that may or may not be coupled with spinal stenosis.
As a matter of fact, we treat the neurological symptoms of RSD/CRPS much the same as fibromyalgia, with marked success. The involvement of the sympathetic nervous system also explains the cardiac and digestive problems that RSD/CRPS patients often develop. Remember, when the sympathetic nervous system is stuck on “on,” the heart is racing, and the parasympathetic nervous system running digestion is MIA.
People who suffer from RSD/CRPS will often develop fibromyalgia, and people who already suffer from fibromyalgia may be at a higher risk than the normal population to develop RSD/CRPS. For this reason, it is important to be familiar with the signs and symptoms of RSD/CRPS, as treatment within the first three months is crucial and it is difficult for doctors to diagnose. Current conventional treatment includes ketamine infusions (ketamine is a horse tranquilizer) or ketamine-induced comas, which have the same effect on the nervous system as hitting CTL, ALT, and DEL together on your keyboard to reboot your computer (this treatment is not FDA-approved and only available in Mexico and Germany), spinal cord stimulators, some rehabilitation, and pain management.
In our clinics we balance and correct the autonomic dysfunction, thereby normalizing the sympathetic nervous system, coupled with other treatments like frequency-specific microcurrent (more about that to follow later).
RSD/CRPS pain will usually start in one limb, where it is more widespread in fibromyalgia, although it is not unusual for fibromyalgia to only be symptomatic on one side of the body. Think of the pain from fibromyalgia as that of a deep bruise and RSD/CRPS as a severe burn or the feeling that you get when you scrape the skin off of your knees. People with fibromyalgia also usually suffer more intense fatigue, although this is not a golden rule.
CHRONIC FATIGUE SYNDROME
As you may guess, the name of this syndrome says it all. When you suffer from this you are chronically, debilitatingly tired, and no readily apparent underlying medical cause can be found. Sleep becomes an obsession, but in a cruel twist, does not relieve your fatigue. This syndrome is usually only considered to be an “official” diagnosis once you have been fatigued for six consecutive months or more.
CFS patients may also suffer from headaches, a weakened immune system, depression, increased sensitivity to light, sounds, and smells, digestive issues, and possible cardiac problems (all of which symptoms are also found in those who suffer from fibromyalgia). Physical or mental stress may make this syndrome worse. Patients who suffer from this should have both their adrenal and thyroid function thoroughly tested as described in chapter 8 of our book.
Once again, it is our belief that an unbalanced autonomic nervous system is responsible for the majority of cases of chronic fatigue syndrome, as the parasympathetic (resting and digesting) system is turned off and the sympathetic (fight or flight) systems are “on” all the time. Adrenal support and supplementation are crucial for these patients, as is balancing the autonomic nervous system so that the parasympathetic nervous system is turned back on.
Fibromyalgia is closely related to chronic fatigue syndrome. In an article published in Fibromyalgia AWARE in 2002, a publication of the National Fibromyalgia Association, Charles W. Lapp, MD, an expert and researcher in chronic fatigue syndrome as well as fibromyalgia, stated that “about 70 percent of persons with CFS meet criteria for FM and about 70 percent of persons with FM also meet criteria for CFS.” However, please note that not every patient with fibromyalgia has chronic fatigue, and vice versa.
There are some differences between fibromyalgia and chronic fatigue syndrome. For instance, Substance P (a neurotransmitter that transmits pain signals) is elevated in FM but not CFS.
RNaseL (a cellular antiviral enzyme), a specific biomarker whose presence indicates that the body put up a vigorous fight against some kind of viral attack, is frequently elevated in CFS but not in FM and is now used to test for CFS. However, please note that this biomarker may also be elevated in multiple sclerosis.
Often CFS will be triggered by a flu-like or infectious illness, while FM is more often triggered by some kind of trauma to the body (e.g. a car accident).
Lupus is a chronic inflammatory disease that is actually a collection of autoimmune conditions. These conditions develop when the immune system mistakenly attacks normal, healthy organs, affecting entire body systems. Some of the organs that may be affected include the skin, joints, blood cells, heart, kidneys, and lungs. Lupus affects up to ten times as many women as men. Lupus is more common among African Americans and Asians. Most patients will have times when the disease is active followed by times when the disease is inactive, also referred to as remission.
Lupus may manifest as a systemic disease, or systemic lupus erythematosus (SLE), the most common and most dangerous form. It may also present in a purely cutaneous form known as incomplete lupus erythematosus. Lupus has four main types: neonatal, drug-induced, discoid, and systemic. Lupus may be further divided into further subcategories too complicated to discuss here.
The symptoms of lupus vary from person to person. The most distinctive symptom (and sign) of lupus, a facial rash that resembles the wings of a butterfly across both cheeks, occurs in many but not all cases of lupus. Other symptoms may include swelling, arthritis in the joints, fever, fatigue, weight loss, blood clots, hair loss in spots or around the hairline, mouth sores, indigestion, nausea, stomach pain, heartburn, heart problems, kidney problems, and poor circulation to the fingers and toes. Pregnant women may have miscarriages.
Lupus is treated traditionally with a multi-disciplinary approach, including medications and immune suppression, which may be uniquely tailored based on the patient’s symptoms. In our clinics, we have noticed that the neurological symptoms of lupus respond very well once the autonomic nervous system is balanced. These patients also need massive supplementation, rebuilding of the gut, and immune support. Sadly, lupus only has a 68 percent twenty-year survival rate, and may be very serious in the long term.
Fibromyalgia is often mistaken for lupus and vice versa. Lupus patients will typically not exhibit the same tender points that patients with fibromyalgia do. Lupus patients also will often have the butterfly rash made worse by the sun and visible arthritis in their joints.
Lupus will most often show a positive antinuclear antibody (ANA) test (although this test is not failure-proof), or show certain antibodies pointing to a faulty immune system, called anti-double-strand DNA (anti-dsDNA), anti-Smith (referred to as anti-Sm), or antiphospholipid antibodies. They may also show a false positive blood test for syphilis (meaning they do not really have this infection but appear to.)
Multiple sclerosis (MS) is a chronic, often disabling disease that was previously thought to be caused when the body’s immune system attacks its own central nervous system (CNS), resulting in the myelin sheaths (think of them as insulation) around nerve cells in parts of the brain and spinal cord being damaged, in turn leading to loss of myelin and scarring. These changes affect the ability of nerve cells to communicate, resulting in a wide range of signs and symptoms. These symptoms may be mild, such as numbness in the limbs, or severe, such as loss of vision or paralysis.
The progress, severity, and specific symptoms of MS are somewhat unpredictable and may vary from one person to another. Typical symptoms may include fatigue, loss of vision/hearing, double vision or visual blurriness in the central visual field that affects only one eye, weakness of the arms or legs, neuropathy (tingling, pain or numbness) in the limbs, speech impairment, difficulty balancing, and bowel or bladder incontinence.
A diagnosis is often made after a careful history and neurological exam (the skills of the neurologist are crucial here), a spinal tap, blood tests (to rule out conditions with similar symptoms), MRI (to show lesions), and a neurological test called an evoked potential test (to show nerve damage).
The model for immune system dysfunction leaves one obvious question unanswered: why does the immune system turn on itself in the first place? After all, this seems to be a common occurrence in multiple conditions including MS, fibromyalgia, lupus, and rheumatoid arthritis. All share an immune system gone haywire and now on the prowl, damaging its own body. Since the immune system is governed by the central nervous system, it would make sense that there might be a link between this system and the immune system’s nutty behavior.
A groundbreaking study performed in 2011 using upright MRIs found: “Multiple sclerosis may be bio-mechanical in origin wherein traumatic injuries to the cervical spine result in cervical pathologies that impede the normal circulation of CSF to and from the brain.“50 In layman’s terms, this means that multiple sclerosis may also be caused by injuries to the cervical spine, such as car accidents. While more studies are needed, we find this research eye-opening and very promising indeed. In our work, we have noticed great changes in the neurological symptoms of MS when the upper cervical spine was treated and corrected.
Although the symptoms of fibromyalgia and MS have marked differences, we do find that these conditions may sometimes (especially early on) be misdiagnosed as each other. The tests mentioned above should be able to accurately distinguish MS from fibromyalgia.
Please keep in mind that, especially in a case where someone suffered from past upper cervical trauma, both conditions may exist in one patient.
If you have Lyme disease, or know someone with Lyme disease, hang on to your chair, as we are about to give you a whole new look at this disease.
The most accepted and universal belief is that Lyme disease (Lyme Borreliosis) is an infectious tick-borne disease caused by at least three species of bacteria belonging to the genus Borrelia. Early symptoms may include fever, fatigue, headaches, or depression. A characteristic circular skin rash called erythema migrans (EM) appears around the bite. Left untreated, later symptoms may involve the heart, joints, and central nervous system. In most cases, the symptoms are eliminated by antibiotics, if treated early. However, delayed or inadequate treatment can lead to more serious symptoms, which may be disabling and difficult to treat.
Lyme disease is divided into three stages. First is early localized infection, where the infection has not yet spread throughout the entire body. During this stage, roughly 80 percent of patients will develop the characteristic “bulls-eye” rash at the site of the bite. The second stage is the early disseminated infection, when the infection spreads through the bloodstream within days to weeks after the onset of the initial local infection. This happens in only one in three hundred to four hundred cases, where again only 10 to 15 percent of patients may subsequently develop neurological symptoms such as meningitis (an infection of the membranes around the brain and spinal cord), shooting pains, and palsy of the face (where the muscles in the face become paralyzed).
Late disseminated infection (stage III) may occur after several months, when a small percentage of patients (about 5 percent) go on to develop severe and chronic symptoms that affect many parts of the body. This may include the brain, nerves, eyes, joints, and heart. Other serious symptoms may include “frank” psychosis, arthritis, vertigo, and bladder problems.
The current theory about Lyme Borreliosis was formulated in 1977. At that time, Allen C. Steere, MD, and his colleagues, who were studying rheumatology at Yale University (he is now a professor at Harvard), discovered a “new disease” called Lyme Borreliosis after substantial prospective trials. In 1983, the first international conference on Lyme disease took place at Yale University. However, in 2012, Dr. Steere stated that long-term symptoms seen in Lyme disease were, in his opinion, caused more by an immune system failure rather than an infection, and would not benefit from antibiotics.
The problem with the current Lyme disease theory is that not all people bitten by an infected tick become sick with Lyme disease. Therefore, it stands to reason that the immunity of the host must have something to do with it, and all the problems can’t be caused by bacteria alone (we come full circle, once again back to the immune system). It follows then that part of a well-rounded treatment program should be to strengthen the body and immune system from the inside.
Treatment steps for lyme disease
It is our opinion that unless the infection is less than two weeks old, it should not be treated with antibiotics. Please find a health care practitioner knowledgeable in Lyme disease who can guide you through the following treatment steps:
1) Get tested for heavy metal toxicity.
2) Detoxify your body of all toxins.
3) Improve the overall health of your body with diet, supplementation, and specific treatments aimed toward improving the immune system.
Lab testing will rule in or rule out Lyme disease in most cases.
Tests include the Borrelia-DNA via PCR (polymerase chain reaction), which may be used to diagnose an acute infection in the first few weeks, but has proven to be rather inaccurate after that. If a suspected infection is older, an enzyme-linked immunoassay (ELISA) test to look for IgG and IgM antibodies (which may give false negatives early on) or a Western blot test may be used.
DIGESTIVE DISORDERS SUCH AS IBS (IRRITABLE BOWEL SYNDROME), DIVERTICULITIS, CELIAC DISEASE, CROHN’S DISEASE AND GLUTEN INTOLERANCE
Think of your gut not as a system to be broken down into parts and organs that may individually break down, but as a whole system where every part is connected to every other part, affecting your entire health, mood, longevity, and well-being.
Your digestive system is usually treated as separate parts working independently of each other, only to be tested when they malfunction or break down, through laboratory work or scopes. After this extensive testing, you will usually find yourself stamped with a disease name, told to avoid certain foods, given medication, or operated upon. The gut is a dynamic, powerful, intricate system, where the health of every part affects the health of every other part as well as the health and immunity of the entire body that it nourishes.
One of the main areas of the body that do not communicate with the nervous system in the autonomic dysfunction seen in most cases of fibromyalgia is the digestive system. Remember, the digestive system is controlled by the parasympathetic (or resting and digesting) nervous system. Think of the parasympathetic nervous system as the housekeeper or captain. Any miscommunication between this area and the nervous system will eventually lead to a multitude of problems, like yeast overgrowth, an imbalance in good bacteria, indigestion, malabsorption of nutrients, and possible damage of structures.
While we think of our intestines as merely a factory where nutrients are extracted from food and waste expelled from our bodies, there is so much more to them. It is a little-known fact that most of the body’s serotonin (at least 90 percent) is synthesized and stored in the intestines. We even have a “second brain” in our intestines. Known as the enteric nervous system, the second brain consists of neurons embedded in the walls of our gut, which measures about thirty feet (or nine meters) end to end from the esophagus to the anus. Know how you get “butterflies in your stomach”? It is connected to that nervous system. We actually do feel emotions in our guts.
The health of the gut is very closely linked to the health of the nervous system. Just like the larger brain in the head, researchers say, this system sends and receives impulses, records experiences, and responds to emotions. Its nerve cells are bathed in and influenced by the same neurotransmitters. The gut can upset the brain just as the brain can upset the gut.
Depression and your gut
When your gut becomes damaged or inflamed, whether from emotional stress, candida, or toxins, undigested food particles and toxins enter your bloodstream through openings in your damaged gut (also called a leaky gut), where they are attacked by your immune system, resulting in the release of cytokines and inflammation in different parts of your body and brain. Cytokines are small proteins used as messengers by the immune system and are released in response to inflammation or inflammatory conditions. Cytokines have a powerful effect on brain chemistry and function and have been linked to depression and brain fog.
The following may cause digestive symptoms (especially in patients suffering from fibromyalgia):
- Autonomic (parasympathetic) nervous system dysfunction, turning “off” digestion and the immune system in the gut
- Overuse of antibiotics causing an imbalance in good vs. bad bacteria
- Candida overgrowth resulting from a weakened immune system, heavy metal toxicity, or not enough good bacteria in the gut
- A poor diet low in fiber, acidic in nature, and high in sugar and saturated fats
- Medications adversely affecting the gut
- Weakened digestive enzymes, resulting in food not being completely digested
- Food sensitivities or allergies
The health of your digestive system is directly linked to the health of your immune system. Almost 70 percent of the immune system resides in your intestinal tract.This branch of the immune system, made up of billions of friendly bacteria and yeast, is responsible for many functions including proper nutrient absorption, production of vital nutrients (produced by the bacteria in your gut), detoxification and alkalization of the body, and last but not least, one of the main weapons your body uses in fighting against bad bacteria.
While we do not have the luxury of space to discuss every digestive problem or diagnosis in detail, we feel strongly that the digestive system of every patient suffering from fibromyalgia must be treated as if it is not well.
Interstitial cystitis (IC) or painful bladder syndrome (PBS) is a chronic inflammation of the bladder wall that causes nagging pain and severe discomfort. Symptoms often include a sense of urgency and increased frequency of urination. While a healthy adult urinates on average about six times a day, a person with IC may urinate up to seventy times in twenty-four hours, including several times at night, interrupting their sleep.
Inflammation associated with IC causes the lining to scar and the bladder to become stiff and less elastic, which may affect the way the bladder can expand. In about 90 percent of IC cases, there are pinpoint spots of bleeding visible in the lining. In up to 10 percent of cases, ulcers known as Hunner’s patches may form on the bladder wall. As if this condition isn’t uncomfortable enough, it may also worsen during menstruation and can cause intercourse to be painful for both sexes.
A large survey of six thousand seven hundred and eighty-three patients with IC/PBS found that 40 percent of patients with IC also suffered from allergies, while 30 percent suffered from irritable bowel syndrome.
Cranberry extract (not juice) has proven to be somewhat successful, as well as a supplement called D-mannose. D-mannose is a type of sugar that has been shown to relieve IC/PBS. It is theorized that D-mannose might treat the deficiency caused by a genetic defect that causes abnormal breakdown and production of mannose or that D-mannose might prevent certain kinds of bacteria from sticking to the walls of the urinary tract and causing infection. (This supplement can be ordered at mercola.com.)
Interestingly enough, as if following a trail of breadcrumbs, the newest research again points to the autonomic nervous system as a direct cause of IC/PBS, where it is shown that people with IC/PBS also exhibit an overactive sympathetic nervous system.
TEMPOROMANDIBULAR DISORDER (TMD)
TMD (temporomandibular disorder) refers to a group of usually painful conditions that affect the joints of the jaw (temporomandibular joint or TMJ). It may also affect the nerves of the head and face and the associated muscles used in movement of the jaw and neck.
The symptoms of TMD include limited movement or locking of the jaw, clenching or grinding of the teeth (especially at night), a “tired” feeling in the face, limited ability to open the mouth very wide, clicking, popping, or grinding noises in the joints of the jaw, difficulty chewing, a warm or inflamed feeling in the muscles of the jaw, swelling of the face, radiating pain in the face, neck, or shoulders, a sudden, major change in the way the upper and lower teeth fit together, and unexplained headaches or facial pain that may be dull, aching, or constant.
As you may guess, once again, studies have clearly linked autonomic nervous system dysfunction to TMD.Therefore, it is crucial when addressing this disorder that the underlying neurological cause be treated, and not merely the symptoms, whether by biomechanical, chemical, or surgical intervention.
Trigeminal neuralgia (also known as tic douloureux) is a nerve disorder that causes sharp, sudden, searing, electric-shock-like facial pains and affects about one out of every fifteen thousand people, although it is much more common among those who also suffer from fibromyalgia. The pain comes from a cranial nerve called the trigeminal nerve and usually affects one side of the lower face and jaw, although symptoms may appear near the eyes, ears, nose, jaw, or lips. Many experts say trigeminal neuralgia is the most unbearably painful human condition, and for this reason, it is tragically also known as “the suicide disease”, just like RSD/CRPS, or fibromyalgia in severe cases.
Trigeminal neuralgia has been linked with autonomic nervous system dysfunction.54 In addition, at least one study has linked it to upper cervical trauma such as whiplash injuries. Medically, this condition is treated with medications or surgery. We believe that this condition must be approached in such a way that the autonomic nervous system dysfunction is balanced and corrected. In addition, we correct any upper cervical misalignment present and rehabilitate the trigeminal nerve in our treatment approach.
RESTLESS LEG SYNDROME
Restless leg syndrome (RLS) is a neurological disorder characterized by unpleasant sensations in the legs (and sometimes other parts of the body such as arms, trunk, or head), and an uncontrollable or overwhelming urge to move them. People with RLS may constantly move their legs (or other affected parts) to minimize or prevent these sensations.
Symptoms may include throbbing or a pulling and crawling sensation occurring primarily at night. Resting or lying down actually worsens these sensations, making it particularly disruptive to sleep and rest. The sensations range in severity from uncomfortable to irritating to painful. RLS is very common and may affect up to 10 percent of the population, especially the fibromyalgia population. Medically, this condition is usually addressed through medications. At least one study has found a definitive link between sympathetic nervous system dysfunction and RLS.