After 37 years treating Lyme disease, I’ve seen men and women originally diagnosed with fibromyalgia find symptom relief once given antimicrobial treatment. The symptom overlap between these conditions creates diagnostic challenges that can lead to missed or delayed diagnosis when infection is the underlying cause.

Symptom Overlap Between Fibromyalgia and Lyme Disease

Fibromyalgia and Lyme disease share multiple symptoms:

• Muscle pain
• Fatigue
• Sleep disturbances
• Gastrointestinal complaints
• Difficulty concentrating
• Headaches
• Temperature, light, and sound sensitivities

Women are disproportionately diagnosed with fibromyalgia. According to the National Institutes of Health, between 80% and 90% of people diagnosed with fibromyalgia are women.

Limited Effectiveness of Fibromyalgia Treatments

Fibromyalgia treatments are not always effective in eliminating symptoms. Studies have found that serotonin-norepinephrine reuptake inhibitors, Duloxetine (Cymbalta) and Milnacipran (Savella), were only 30% and 50% respectively more effective than placebo in reducing fibromyalgia pain.

Pregabalin (Lyrica), the anticonvulsant drug used for neuropathic pain, was more effective than placebo in reducing pain and improving sleep in a meta-analysis of 3,808 fibromyalgia patients. However, “only a minority of patients achieve moderate or substantial pain relief.” It remains unclear whether Cymbalta, Savella, or Lyrica will reduce other important manifestations of fibromyalgia including cognitive and affective presentations.

Diagnostic Challenges

It remains difficult to rule out Lyme disease in fibromyalgia patients with the limitations of current testing. The symptoms of fibromyalgia including fatigue, insomnia, and myalgias are commonplace in Lyme disease. The trigger points described in fibromyalgia are typically referred to as synovitis, bursitis, and sacroilitis in Lyme disease.

Evidence of Overlap

Patients may suffer from both fibromyalgia and Lyme disease. Research demonstrates this overlap:

• In one study, 4 out of 27 individuals (15%) in a chronic neurologic Lyme disease series also presented with fibromyalgia
• Three of 25 patients (12%) with active Lyme disease seen in a rheumatology-based Lyme clinic were also diagnosed with fibromyalgia
• Four of nine fibromyalgia patients (44%) had abnormal CSF fluid analysis with elevated protein levels, slight pleocytosis, or intrathecal antibody production to Borrelia burgdorferi

Clinical Takeaway

After 37 years treating Lyme disease, I’ve observed that patients presumed to suffer from fibromyalgia often have symptoms identical to those with Lyme disease—and many respond to antimicrobial treatment. The benefits of antibiotic therapy in these patients are typically the same as those who suffer from confirmed Lyme disease. When fibromyalgia symptoms resist standard treatment, infection should be considered, particularly in patients with outdoor exposure history or those living in endemic areas.

Frequently Asked Questions

Can Lyme disease be misdiagnosed as fibromyalgia?
Yes. Lyme disease and fibromyalgia share symptoms including muscle pain, fatigue, sleep disturbances, and cognitive difficulties, leading to diagnostic confusion.

Can someone have both Lyme disease and fibromyalgia?
Yes. Studies show 12-15% of Lyme disease patients also meet fibromyalgia criteria, and some fibromyalgia patients have abnormal spinal fluid findings.

Should fibromyalgia patients be tested for Lyme disease?
Testing should be considered when fibromyalgia treatments fail, symptoms appeared suddenly, or patients have outdoor exposure history in endemic areas.

Related Reading

Lyme Disease Misdiagnosis: Why It Happens and What Patients Need to Know
Why Does Lyme Disease Mimic MS or Fibromyalgia?
Chronic Pain and Lyme Disease
Lyme Disease Fatigue

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