Is your fibromyalgia patient a candidate for Lyme disease treatment?

If you have been disappointed to find your fibromyalgia patient is not getting better, you may conclude your patient is a candidate for Lyme disease treatment. The medical conditions share similar symptoms, making an accurate diagnosis challenging.

muscle painFibromyalgia and Lyme disease symptoms can include muscle pain, fatigue, sleep disturbances, gastrointestinal complaints, difficulty concentrating, headaches and temperature, light and sound sensitivities.

Women are also more likely to be diagnosed with the condition. According to the National Institutes of Health, between 80% and 90% of people diagnosed with fibromyalgia are women.

The treatments, unfortunately, are not always effective in eliminating symptoms. Studies have found that serotonin-norepinephrine reuptake inhibitors, Duloxetine (Cymbalta) [1] and Milnacipranz (Savella) [2] were only 30% and 50% respectively more effective than placebo in reducing the pain of fibromyalgia.

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.” [3] It remains unclear whether Cymbalta, Savella, or Lyrica will reduce other important manifestations of fibromyalgia including cognitive and affective presentations.

It also 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 [4] are commonplace in Lyme disease. The trigger points described in fibromyalgia [5] are typically referred to as synovitis, [6-8] bursitis, [9] and sacroilitis in Lyme disease (LD).

Your patient may suffer from both fibromyalgia and Lyme disease. In one study, 4 out of 27 individuals (15%) in a chronic neurologic Lyme disease series also presented with fibromyalgia. [10] Three of 25 patients (12%) with active LD seen in a rheumatology based LD clinic were also diagnosed with fibromyalgia. [11] Four of nine fibromyalgia patients (44%) had abnormal CSF fluid analysis with elevated protein levels, slight pleocytosis, or intrathecal antibody production to Bb. [12]

In my clinical practice, I’ve seen men and women who were originally diagnosed with fibromyalgia, but who found symptom relief once given an antimicrobial regime. The symptoms of patients presumed to suffer from fibromyalgia were typically the same as patients who suffered from Lyme disease. The benefits of antibiotic treatment were also typically the same as patients who suffered from Lyme disease.

References:

  1. Bradley LA, Wohlreich MM, Wang F et al. Pain response profile of patients with fibromyalgia treated with duloxetine. Clin J Pain, 26(6), 498-504 (2010).
  2. Vitton O, Gendreau M, Gendreau J, Kranzler J, Rao SG. A double-blind placebo-controlled trial of milnacipran in the treatment of fibromyalgia. Hum Psychopharmacol, 19 Suppl 1, S27-35 (2004).
  3. Straube S, Derry S, Moore RA, McQuay HJ. Pregabalin in fibromyalgia: meta-analysis of efficacy and safety from company clinical trial reports. Rheumatology (Oxford), 49(4), 706-715 (2010).
  4. Cassisi G, Sarzi-Puttini P, Alciati A et al. Symptoms and signs in fibromyalgia syndrome. Reumatismo, 60 Suppl 1, 15-24 (2008).
  5. Wolfe F, Smythe HA, Yunus MB et al. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum, 33(2), 160-172 (1990).
  6. Steere AC, Malawista SE, Snydman DR et al. Lyme arthritis: an epidemic of oligoarticular arthritis in children and adults in three connecticut communities. Arthritis Rheum, 20(1), 7-17 (1977).
  7. Steere AC, Snydman D, Murray P et al. Historical perspective of Lyme disease. Zentralbl Bakteriol Mikrobiol Hyg [A], 263(1-2), 3-6 (1986).
  8. Milewski MD, Cruz AI, Jr., Miller CP, Peterson AT, Smith BG. Lyme arthritis in children presenting with joint effusions. J Bone Joint Surg Am, 93(3), 252-260 (2011).
  9. Jennings F, Lambert E, Fredericson M. Rheumatic diseases presenting as sports-related injuries. Sports Med, 38(11), 917-930 (2008).
  10. Logigian EL, Kaplan RF, Steere AC. Chronic neurologic manifestations of Lyme disease. N Engl J Med, 323(21), 1438-1444 (1990).
  11. Sigal LH. Summary of the first 100 patients seen at a Lyme disease referral center. Am J Med, 88(6), 577-581 (1990).
  12. Dinerman H, Steere AC. Lyme disease associated with fibromyalgia. Ann Intern Med, 117(4), 281-285 (1992).

 


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Ann Prow
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I was diagnosed with Fibromyalgia at Mayo Clinic only to be diagnosed with Lyme years later. I missed my opportunity to get an early diagnosis of Lyme disease has affected all my organ s and my life. In my opinion, everyone who has been diagnosed with Fibromyalgia should be tested for Lyme correctly to be sure and treated with Doxycycline to prevent lifelong illness!

Maryann
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Maryann

How long does it take to get an appointment with you? The doctor here in PA is a year. Band 41 is positive. I’ve had extreme fatigue for a year and my fibromyalgia pain is much worse. I’ve recently been diagnosed with celiac. I’m sick of being sick!

Samantha
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Samantha

Hi I was diagnosed with fibromyalgia last year, I have tried different medication but they have not helped with the pain, I did however ever for 5 years suffer from hemifacial spasms, and one evening in a&e I got asked if I had been bitten by a tick, which to my knowledge I haven’t, I suffer from a gastro problem and been put on medication for it, but I have tried to miss a day but the pain returns, I do not get acid or heartburn, but get a pain when I eat or drink something hot in between the… Read more »

Dr. Daniel Cameron
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There is no blood test for fibromyalgia. The trigger points typical of fibromyalgia are called synovitis, bursitis and sacroilitis in Lyme disease. The symptoms of fibromyalgia and Lyme disease overlap. The test for Lyme disease remain problematic. It doesn’t hurt to ask you doctor a second time. Our office in the Northeastern USA.

Giuliana
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Giuliana

I was recently diagnosed with fibromyalgia. I was tested for Lyme and came back negative (western blot). Igg bands 41 and 45 were present. Coukd I have lyme even though test said negative?

Dr. Daniel Cameron
Guest

Lyme disease and fibromyalgia look alike. The there is no lab test for fibromyalgia. The tests for Lyme disease are not very sensitive. The pain in the larger joints are called trigger points in fibromyalgia and synovitis, bursitis or sacroilitis in Lyme disease.

Raina
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Raina

Thank you so much for writing this! It was informative and even gave me some hope. I am printing it to take to my doctor who basically said there was nothing she could do to help me with my severe ongoing Fibromyalgia symptoms. Might I suggest a link to have a printer friendly version that includes your extensive list of research that you provided at the bottom? Thank you again for you kind mannerism, your wisdom, and the easy to understand explanations.

Dr. Daniel Cameron
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Thanks. There should be an acrobat download icon on each blot to allow you to download the article.

Darlene Blower
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Darlene Blower

Is there hope for someone who has suffered (greatly) for potentially as long as 20 years. I have every condition/ailment listed and have tried cymbalta (NO help), savella (NO help), and Lyrica, which was the first one I tried, which was not only NO help but I suffered sever side effects from. I have also tried neurontin (gabapentin) and a whole host of other medications. The only medications that help me are pain medications and I don’t want to do that but I suffer greatly. I don’t want to live the rest of my life taking narcotics but agreed to… Read more »

Dr. Daniel Cameron
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It would not hurt to be evaluated for Lyme disease even after 20 years. The chronic neurologic Lyme disease group described by Logigian in the 1990 New England Journal of Medicine were ill up to 14 years.