Lyme Disease and Fibromyalgia: How to Tell the Conditions Apart

Fibromyalgia represents a challenge for both patients and doctors. Its symptoms come with no outward signs, and those affected usually wait years to receive an accurate diagnosis. And although Lyme disease and fibromyalgia have different origins, similar symptoms mean these illnesses are frequently mistaken for one another. For anyone struggling with chronic pain and fatigue, knowing the differences between Lyme disease and fibromyalgia can help ensure you receive proper medical care and remain an informed patient throughout your treatment.

What is fibromyalgia?

Fibromyalgia is a chronic and often debilitating condition that’s believed to originate from the central nervous system. It’s characterized by widespread pain without an apparent cause, chronic fatigue, and can include cognitive problems.

Because there are no outward signs of fibromyalgia, the condition has had a slow progression of understanding by the medical community. The exact cause of fibromyalgia is still unknown, and there is currently no cure. Patients often go years with unexplained symptoms before being diagnosed, and many struggle to find compassion and understanding before and after diagnosis.

What is Lyme disease?

Lyme disease is caused by Borrelia bacteria, and is contracted from the bite of an infected blacklegged tick (also known as a deer tick) or western blacklegged tick. Initial signs of Lyme disease include:

  • Expanding red rash in a bull’s-eye pattern
  • Flu-like symptoms including muscle aches, fever, fatigue, chills

For people who have a confirmed tick bite in Lyme-endemic areas, diagnosis can be straightforward. But it’s not always obvious when you’ve been bitten by a tick. Young ticks called nymphs can transmit Lyme disease to people, and are small enough (about the size of a pin-head) to go unnoticed while attached. Another complicating factor is that the characteristic bull’s-eye rash does not appear in all cases of Lyme disease.

If Lyme isn’t diagnosed in the early stages, its symptoms can progress months or years after the initial infection. Later symptoms include:

  • Numbness and tingling
  • Cognitive problems
  • Heart palpitations and chest pains
  • Shooting nerve pain
  • Severe headaches and stiff neck
  • Swollen joints
  • Facial paralysis

How is Lyme disease diagnosed and treated?

A combination of patient history, physical exam, and blood testing are usually used to diagnose Lyme disease.

  • According to the CDC, a two-tiered system of blood testing is considered the standard for diagnosis.
  • Cases that are caught early may result in negative blood tests, as the body hasn’t yet created antibodies to fight the bacteria.
  • Flu-like symptoms and a bull’s-eye rash may be enough to diagnose Lyme even if blood tests are negative.
  • Once diagnosed Lyme disease is treated with a series of oral or IV antibiotics.

Why might Lyme disease and fibromyalgia be confused?

Lyme disease is often referred to as a “great imitator” because its symptoms mimic so many other conditions. In areas where Lyme is not endemic, patients with symptoms like muscle pain and fatigue may be investigated for conditions like fibromyalgia, chronic fatigue syndrome, or MS before Lyme disease is considered.

Some cases of fibromyalgia may also be mistaken for Lyme disease. While a negative blood test generally rules out Lyme disease, the possibility of false negatives leads some people to be treated for suspected Lyme without a confirmed diagnosis.

How can I tell the difference between Lyme disease and fibromyalgia symptoms?

There are many overlapping symptoms between Lyme disease and fibromyalgia. But some general differences can be helpful in distinguishing between the two.

  • History of a ring-shaped rash, tick bites, and spending time in areas where Lyme disease has been reported are all indications that you probably have Lyme.
  • Antibiotics should improve Lyme disease symptoms, while they aren’t likely to affect fibromyalgia.
  • Pain in specific tender points is associated with fibromyalgia more than other illnesses. 
  • Stiffness in Lyme disease occurs mainly in the neck and joints. Fibromyalgia usually features more widespread pain.
  • Lyme disease can cause arthritis symptoms and swollen joints, especially in the knees. Fibromyalgia causes pain and stiffness, but doesn’t typically involve swelling or damage to the joints.

How can I prevent Lyme disease?

  • If you’re spending time outdoors in a Lyme-endemic area, wear long pants and sleeves and use insect repellent on exposed skin.
  • Quick removal of a Lyme-infected tick makes you less likely to contract Lyme disease. Perform tick checks after spending time outdoors to look for attached ticks. Change your clothes and shower to wash away any ticks that haven’t attached yet.
  • If you do find a tick, remove it using tweezers. Grasp the tick as close to your skin as possible, and gently pull it straight out. Twisting or grabbing too forcefully may result in partial removal, and can still leave you susceptible to infection.
  • After removing a tick, wash the wound thoroughly and save the tick in a jar to identify the species.
  • Dogs that spend time outdoors can also contract Lyme disease and may carry unattached ticks in their fur. Treat your dogs with tick control medication to keep them safe from Lyme and to prevent them from bringing ticks into your home. If your dog has spent time in the woods with you, remember to include them in tick checks along with the rest of the family.

What about chronic Lyme disease?

Even after treatment with antibiotics, the symptoms of Lyme disease may linger on for months in some people. The cause of these long-term symptoms is the subject of debate in the medical community.

  • Some believe that Lyme disease can become chronic, requiring months or years of antibiotics and supplements to fully eradicate. Proponents of chronic Lyme disease advise visiting “Lyme literate” doctors who take a special interest in treating the disease as a chronic condition.
  • Most of the medical community refers to these lingering symptoms as Post-treatment Lyme disease syndrome (PTLDS). They believe that Lyme disease can cause damage to the immune system and tissues that may take months to heal even after antibiotics have eradicated the bacteria.

Treating Lyme disease and Fibromyalgia

If you’ve received a positive Lyme diagnosis, antibiotics will be prescribed to kill the bacteria, but supportive care may be needed to help deal with lingering symptoms. Fibromyalgia has no cure, but its symptoms can be managed with a variety of drugs including Cymbalta.

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DISCLAIMER: The content in this article is intended for informational purposes only. This website does not provide medical advice. In all circumstances, you should always seek the advice of your physician and/or other qualified health professionals(s) for drug, medical condition, or treatment advice. The content provided on this website is not a substitute for professional medical advice, diagnosis or treatment.