*Last updated May 2023 by Eric Chan, ND

Fibromyalgia and multiple sclerosis are completely separate conditions, with distinct diagnostic and treatment modalities. However, it is surprisingly common especially in the early stages of both diseases to have patients wonder if they may have been misdiagnosed. Understandably, the question of “Do I have MS or fibromyalgia?” can come up in both patients as both illnesses often have muscular pain, nerve type pain, and especially fatigue as part of the symptom picture.

While fibromyalgia is often considered a pain syndrome or central sensitivity syndrome withoutt a direct inflammatory cause, MS is an inflammatory syndrome affecting the myelin sheath of nerves. Inflammatory conditions may, however, trigger central sensitivity syndromes including fibromyalgia. In some cases, direct testing for cytokines can help with information-gathering and can provide quantification of the degree of immune dysregulation present. Such cytokine testing is sometimes considered to quantify post-viral fatigue as well.

Early on, before more obvious signs of neurological deficit occur in MS, there can be much confusion as there can be profound fatigue in patients, and they may be just starting to develop pain symptoms. Click on the linked article for the way we would approach different naturopathic investigation and treatment options for fatigue. While generalized pain, or some component of muscle or nerve pain, can occur in around 50% of MS patients, it is a defining symptom in all patients with fibromyalgia. The early MS patient can have pain, but generally can develop other symptoms as well due to damage to the protective coating / insulation of the nerve sheath. This can include symptoms that cause:

  • balance and dizziness problems

  • autonomic nervous system dysfunction including bowel and bladder changes

  • specific abnormalities in gait due to motor pathways being affected, balance being affected, and spasm of the muscles

  • visual changes due to inflammation of the optic nerve

  • tremor

  • speaking changes

  • swallowing difficulties

In patients who have fibromyalgia (or an underlying condition that is causing a fibromyalgia presentation), there are also symptoms above the usual pain which can overlap with MS patients also having these symptoms:

  • cognitive impairment and “brain fog”

  • fatigue, often disabling

  • psychiatric changes (depression)

  • numbness and tingling / nerve pain

  • heat intolerance

  • weakness of muscle strength

Typically, the presence of numerous of the first group of symptoms would lead a patient’s doctor to more strongly consider the MS diagnosis. A fibromyalgia patient without the above would be less suspicious for MS, but individual work up by the doctor would help to investigate the possibility. Objectively, MRI is used to help with the diagnosis of MS. MRI in MS shows areas of damage in the brain, and patterns are elucidated to see if they match what is typically seen in MS.

In fibromyalgia, only more specialized MRI seems to give abnormalities. This can include brain MR-PET scan imaging, which can show increased inflammation in different areas of the brain, or increased glial cell activity. It can show increased activities in areas of the brain that would be responsible for hypersensitivity to pain.

Thus, MRI can be used to differentiate the conditions quite often.

MS would be managed under the care of a neurologist specialist, and naturopathic care can play two roles. One would be supportive for the symptoms of fatigue, sometimes with treatments as an adjunct for the symptom of fatigue, and dietary therapy in some cases. The second would be investigative, to see if there is a modifiable factor that might be contributing to the picture of MS, including the possibilities of infections, toxins being present.

Fibromyalgia is typically managed by a primary care practitioner such as a family MD, or a specialist such as a rheumatologist, or a naturopathic doctor. Agents are often used such as antidepressants, nerve pain agents, and sleep supports. A naturopathic doctor such as myself would consider similar therapies, and I have also seen research as well as clinical change in my own patients with ozone therapy.

If you are a patient interested in options for fibromyalgia or multiple sclerosis, please contact the office and ask to book an appointment with Dr Eric Chan, ND. Blood work over the previous 2 years, other lab and imaging reports should be brought in and can be discussed at the visit, as well as further investigative options as adjuncts.