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Fibromyalgia vs. MS: Understanding the Difference

Posted on May 17, 2021
Medically reviewed by
Amit M. Shelat, D.O.
Article written by
Sarah Winfrey

What Are They? | Symptoms | Causes & Risk Factors | Diagnosis | Treatment | Support

There are several connections and similarities between fibromyalgia and multiple sclerosis. These chronic diseases are more common in women and can take a long time to be properly diagnosed. They even share some of the same common symptoms. What’s more, people with fibromyalgia are three times more likely than those without it to develop multiple sclerosis, so it’s possible to have both conditions at once.

Despite these similarities, fibromyalgia and MS are two distinct diseases with their own unique symptoms, causes, and treatments.

What Are Fibromyalgia and Multiple Sclerosis?

Fibromyalgia, also known as “fibro,” is a chronic neurological condition that predominantly affects the nervous system. It causes widespread pain and fatigue, among other symptoms. Unlike multiple sclerosis, fibromyalgia is not an autoimmune disorder. Instead, researchers believe that it affects how the brain and spinal cord process both painful and non-painful signals, amplifying painful sensations.

Multiple sclerosis (MS) is a chronic autoimmune disease. It occurs when the immune system mistakenly attacks the body’s healthy tissues. In people with MS, the body’s defenders (white blood cells) attack the central nervous system, causing inflammation. This leads to a process called demyelination.

During demyelination, the protective coating that normally covers nerves (myelin) is stripped off, leaving nerves vulnerable and reducing their ability to transmit electrical signals. Over time, the deterioration of the myelin sheath can cause a variety of symptoms that affect physical movement, eyesight, and cognitive (mental) functioning.

Members of MyMSTeam often talk about the connection between MS and fibromyalgia. “I’ve had MS for over 20 years — also just diagnosed with fibromyalgia as well,” one member wrote. “When looking at the symptoms for both fibromyalgia and MS, they are similar,” another member said. “How do you know if you have the right diagnosis?”

Symptoms of Fibromyalgia and Multiple Sclerosis

Fibro and MS share some symptoms, including fatigue, depression, and difficulties with focus and concentration.

Fatigue

Fatigue refers to a feeling of tiredness or lack of energy. Fatigue is one of the most common MS symptoms, affecting about 80 percent of people with multiple sclerosis. People with fibromyalgia also frequently report waking up still feeling tired, despite getting enough sleep.

Cognitive Difficulties

People with fibromyalgia often experience cognitive (brain) difficulties, commonly referred to as “fibro fog.” This symptom makes it difficult for a person to focus, pay attention, and concentrate on mental tasks.

Similarly, more than 50 percent of people with MS experience cognitive changes (known as “cog fog” or “brain fog”), which can include problems with memory, focus, paying attention, processing information, forgetting or confusing words, learning and remembering new things, organization, and getting lost in familiar places.

Pain

Widespread pain at key tender points across the body can be an essential symptom used to diagnose fibromyalgia. Fibromyalgia pain is often described as a constant, dull ache. In order to be considered widespread, this pain must be present on both sides of the body, both above and below the waist.

Although pain is not necessary to diagnose multiple sclerosis, about 55 percent of people with MS have experienced significant pain at one time or on a chronic basis. One study on the prevalence of fibromyalgia in people with multiple sclerosis found that chronic pain was present in 66.2 percent of participants. Of those participants, 17.3 percent had pain with fibromyalgia, and 48.9 percent had chronic pain not related to fibromyalgia.

Fibromyalgia Symptoms

Symptoms of fibromyalgia often develop after a major life event, such as surgery, physical trauma, illness, or significant psychological stress. MS symptoms may progress, but fibromyalgia is not considered a progressive disease. Although its symptoms may worsen over time, there is no predictable disease course for fibromyalgia. Most often, people with fibromyalgia experience disease flares (when symptoms become more severe) and periods of remission, when symptoms lessen or disappear.

Multiple Sclerosis Symptoms

Multiple sclerosis proceeds in different patterns or courses depending on how it first appears and then progresses. Each course is a different type of MS. Fibromyalgia is not considered progressive, but some people with multiple sclerosis eventually transition from the most common course of the disease, relapsing-remitting MS (RRMS), to secondary-progressive MS (SPMS) or primary-progressive MS (PPMS) — both of which can lead to progressively worsened neurologic function (greater disability) over time.

Deep dive: symptoms, diagnosis, and treatment for multiple sclerosis

Aside from fatigue, cognitive difficulties, and pain, people with MS may experience:

  • Muscle problems
  • Motor difficulties
  • Changes in physical sensations
  • Vision problems
  • Speech problems
  • Bladder and bowel problems (including incontinence)
  • Emotional changes

How and when these symptoms appear generally depends on the type of MS a person has.

Read more about the symptoms of MS here.

Causes and Risk Factors of Fibromyalgia and Multiple Sclerosis

Researchers don’t know exactly what causes fibromyalgia. They believe that something happens with the nerves and/or the brain receptors so that they signal pain when there is no actual cause for it. People are at a higher risk of being diagnosed with fibromyalgia if they have relatives with the condition, if they get certain infections, if they experience a significant physical injury (like an auto accident), or if they undergo extreme or persistent psychological stress.

As with fibromyalgia, researchers also do not know exactly what causes multiple sclerosis. Unlike fibromyalgia, it is an autoimmune disease — it occurs when the immune system mistakenly attacks the body’s healthy tissues. In people with MS, the body attacks the myelin coating on the nerves in the spinal cord and the brain.

People who may have an increased risk of MS include those who are white, female, between 20 and 40 years old, or have a family history of the disease. Certain viruses, like Epstein-Barr, also make diagnosis more likely, as does living in a temperate climate, having low levels of vitamin D, and smoking. Finally, having other conditions can make a diagnosis of MS more likely (for example, fibromyalgia).

Diagnosing Fibromyalgia and Multiple Sclerosis

Both fibromyalgia and multiple sclerosis can be difficult to diagnose. The initial process for diagnosis is often very similar. A doctor will talk to you about what you’ve been experiencing, asking specific questions along the way to help determine which condition you may have.

A diagnosis of fibromyalgia requires:

  • Three or more months of musculoskeletal pain that is widespread in the body
  • Other symptoms, like cognitive fog, trouble sleeping, and unexplained fatigue
  • A review of the specific locations in the body where you have felt pain, particularly over the last week

Diagnosing multiple sclerosis typically requires taking a magnetic resonance imaging (MRI) scan of the brain and spinal cord. Your health care team may also choose to perform a spinal tap (to check your spinal fluid) and specific tests for your eyes and nerves throughout your body. Although there is no single test to diagnose the condition, overall, your tests must show:

  • Damage in two or more areas of your central nervous system
  • More than one episode when the damage occurred
  • No other explanation for the damage or the symptoms you’re experiencing

Diagnosis for both conditions may also involve other exams, like blood tests, to eliminate other possible conditions and causes of your symptoms.

Treating Fibromyalgia and Multiple Sclerosis

Some of the treatment options for fibromyalgia and MS overlap, and others are specific to one condition or the other.

Treatments Specific to Fibromyalgia

Many people diagnosed with fibromyalgia find that the condition improves when they take an antidepressant. Some also take a pain reliever, particularly when their pain is severe. They may also try anti-seizure medications, which can reduce certain kinds of pain. Occupational therapy and counseling can also help people with this condition to live well with it, although these treatments don’t reduce physical pain.

Read more about treatments for fibromyalgia here.

Treatments Specific to Multiple Sclerosis

There are many treatment options for MS that can help you through a particular flare-up and slow down the progression of the condition. These are continually being tested and updated, so work with your neurology expert to make sure you are pursuing the treatments that will work the best for you.

Read more about treatments for multiple sclerosis here.

Treatments for Fibromyalgia and Multiple Sclerosis

Physical therapy (PT) is recommended for people diagnosed with both fibromyalgia and MS. PT can help you improve strength and stamina, and can reduce the impact of pain and other symptoms on daily life.

People with both conditions may also benefit from lifestyle changes, like:

  • Exercising regularly
  • Eating a balanced diet
  • Getting plenty of consistent sleep
  • Finding a way to relax — getting a massage or acupuncture, practicing meditation, doing yoga, or something else that works for you

Whether you have MS, fibromyalgia, or both, it’s important to understand your symptoms, get an accurate diagnosis, and find the effective treatments that you need to thrive. Work with your rheumatologist, neurologist, and other doctors to find the treatment plan that’s right for you.

Meet Your Community

Living with chronic conditions like fibromyalgia and multiple sclerosis can be challenging. The good news is that you don’t have to go it alone.

MyMSTeam is the social network for people living with MS and their loved ones. On MyMSTeam, members regularly offer support and share their stories with others who understand life with multiple sclerosis.

Do you have fibromyalgia and multiple sclerosis? Share your experiences in the comments below, or by posting on MyMSTeam.

All updates must be accompanied by text or a picture.
Amit M. Shelat, D.O. is a fellow of the American Academy of Neurology and the American College of Physicians. Review provided by VeriMed Healthcare Network. Learn more about him here.
Sarah Winfrey is a writer at MyHealthTeam. Learn more about her here.

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