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).


Subscribe
Notify of
guest

14 Comments
Inline Feedbacks
View all comments
Greg
2 years ago

Hi Dr. Cameron , I’m curious as to what test or tests prove someone has lyme disease. I have positive igg 18 and 41, 2 gene mutations , and cd57+nk cells absolute count of 17 along with other ranges off. I had a tick removed from my scalp when I was in shelter island in the early 80’s.

Rhoda Morris
Rhoda Morris
2 years ago

Diagnosed with fibromyalgia 12yrs ago then Lyme 9yrs ago. Port a cath with Lyme protocol. Symptoms got worse. Only on one pain med ( side effects of other meds very bad) Never had drug sensitivity before) Used to be very active and loved outside. Just a breeze hitting my skin feels like a bad burn. Altered diet, do yoga as often as my body allows. Am very discouraged. Any new info on Treating theses two joy taking diseases. Am exhausted. Was forced to retire. Help, please. I can remember being happy. Am exhausted from pretending I am OK. Thank you for educating. Used to be in medical field, always heard’ this ones got fibro’’ While pointing to his head, implying the patient was crazy. Is fibro or chronic Lyme taught in medical school at all? Thank you for caring, Rhoda Morris( former O.R. RN.)

Ann Prow
5 years ago

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!