Pain and Fatigue: Is it really Fibromyalgia, or is it something else?

Chronic, widespread pain and achiness, debilitating fatigue – most would get a diagnosis of fibromyalgia syndrome (FMS). But, before making that diagnosis, it is important to rule out other disorders that masquerade as fibromyalgia. Research shows that of people diagnosed with FMS, up to 66% may actually have another diagnosis.

In classic FMS, people experience pain in both upper and lower parts of the body, both sides and torso. If you have pain just in your neck and back, you do not have fibromyalgia. Pain is real, not psychosomatic. Patients have a pain processing defect, with the brain magnifying sensations that in other people may not seem painful.

“The hallmark symptom that differentiates FMS from most other medical conditions is the pronounced tenderness to even the mildest … physical touch.” (Schneider et al, J Manipulative Physiol Ther. 2006, 29:493). This extreme sensitivity, called allodynia, indicates central nervous system (brain) sensitization to stimuli, not an abnormality in the rest of the body.

In addition to widespread pain, classic FMS patients also complain of sleep disorders and insomnia, anxiety and/or depression, irritable bowel and irritable bladder syndromes. There is frequently a history of trauma, whether physical, emotional, or sexual.

One should only make the diagnosis of fibromyalgia after ruling out other disorders that can cause similar symptoms. There are many of these disorders, including hypothyroidism, mitochondrial disorders, anemia, Lyme disease, medication side effects, nutritional deficiencies, food intolerances, cancer, multiple sclerosis, to list a few.

Hypothyroidism: Symptoms include fatigue, pain, weight gain, depression, brain fog. Hypothyroidism is treated with thyroid hormone replacement therapy, and an investigation into why you have hypothyroidism should be done.


Mitochondrial disorders: Mitochondria are the microscopic energy factories in the cells that convert carbohydrates and fats into energy. What interferes with their function? Toxins like glyphosate, petroleum products; heavy metals like mercury, lead, cadmium, arsenic; nutritional deficiencies like magnesium and the B vitamins to name a few. Symptoms of mitochondrial disorders include fatigue, brain fog, and muscle soreness.


Musculoskeletal disorders: Multiple trigger points, joint dysfunction, muscle imbalance, musculoskeletal malalignments and posture problems can all cause pain, and chronic pain is exhausting!


What kinds of lab testing should you consider? I recommend the following screening tests:

  • Complete blood count (CBC) and differential
  • Thyroid function tests (free T4, free T3, TSH, thyroid antibodies, reverse T3)
  • Ferritin
  • 25 hydroxy Vitamin D
  • Comprehensive metabolic panel
  • High sensitivity C-reactive protein (hsCRP)
  • Lyme testing
  • Rheumatic factor, CCP
  • Saliva cortisol panel or dried urine cortisol panel
  • Urine organic acids


Chiropractors and physical therapists are best trained to assess the musculoskeletal system and can greatly help in confirming your diagnosis. However, it is important to find a practitioner who understands the possible causes of chronic pain and fatigue and will help to identify specific causes of pain.

For more information on fibromyalgia, and what you can do about your symptoms, I recommend “The Fibro Fix” by Dr. David Brady ( ). It will be released in July 2016. There are also excellent resources on his website. And, if you read this in time, you can listen to over 30 experts in the area of chronic pain and fatigue in a free online summit, the Fibro-Fix Summit , airing from June 20-27, 2016. If you miss it, you can still purchase the recordings at a later date.


To your health,

Patty Powers, MD