MS Vs Fibromyalgia – What’s the Difference?

Multiple sclerosis (MS), like fibromyalgia, is a chronic health condition that is more commonly diagnosed in women than men¹.

Although the two conditions share some similarities, clinically they are very distinct and are treated differently. So, how do you know if you have fibromyalgia or MS?

We’re going to unpack the differences and the similarities of multiple sclerosis (MS) and fibromyalgia and share the key things that you need to know, including how to know whether you have MS or fibro.

Symptoms

There is some crossover of symptoms between fibro and MS. For example, both conditions can cause:

• fatigue
• numbness and tingling sensations
• muscle stiffness
• cognitive challenges, such as difficulties thinking, which people with fibromyalgia often call "fibro fog" or "brain fog"
• inflammation in the body.

However, there are also a number of differences.

MS is usually diagnosed when a person is between 20 and 40 years old² – a little earlier than the typical fibro diagnosis. It can show up differently in different people, and symptoms sometimes come and go. Common symptoms of MS, that are not typical for fibro include^3,4:

• muscle weakness and spasms
• difficulties with coordination, balance and walking
• vision problems, such as blurred vision
• learning difficulties
• incontinence (bladder control problems).

On the other hand, if you are experiencing symptoms such as sensitivity to bright lights, loud noises, or very light touch, such as the touch of breeze from a fan, those are probably symptoms of fibromyalgia and not MS.

Different types of MS

Relapsing-remitting MS (RRMS) is the most common, accounting for 80-90% of cases. In RRMS, people experience phases of their symptoms coming, worsening or even developing new ones (relapsing), and going (remitting). The phases can happen without warning and last for a few days or even a few months.⁵

Primary progressive MS (PPMS)⁶ accounts for most other cases of MS, with secondary progressive MS (SPMS)⁷ accounting for a very small minority. In these types of MS, there are usually no relapse phases and instead the symptom progression tends to get gradually worse over time.

In comparison to this, fibromyalgia is primarily a chronic pain condition, so if ongoing pain is your primary concern, it's possible that fibro is the cause. If so, you might also have other symptoms such as fatigue, brain fog, and sleep and mood disturbances. Your symptoms might get worse over time, but can also be improved with appropriate treatment.

Fibro flare-ups tend to last a few days or weeks and by tracking symptoms and activities, many people with fibro can predict and manage their triggers to reduce the amount of flare-ups that they have and the severity of their flare-ups.

Causes

MS is an autoimmune neurological disorder, in which a person’s own immune system attacks the myelin of nerve fibers – a layer of protein and fatty substances that protects nerve fibers. When the myelin is damaged, the nerves can’t send electrical impulses as quickly or as efficiently as they should.⁸

This damage can happen throughout the central nervous system, including in the brain and spinal cord, which is why MS presents with a variety of symptoms.

It’s not clear what exactly causes MS, although it is likely to be a mixture of genetic and environmental factors.

The jury is still out on whether or not fibro is an autoimmune disorder, with some researchers arguing the case for and others arguing the case against.

Some people with fibro do have some damage to their small nerve fibers, but this is not the sole cause of fibro, and many people don’t have this damage at all. Instead, fibro is likely a result of central sensitization – a process by which a person’s central nervous system becomes over sensitized and begins to identify danger and generate pain for situations that are not physically dangerous to the body.

Genetics can play a part in fibro, but for the majority of people it is their environmental factors and experiences that sparked their symptoms.

Have you faced trauma or adversity in your life? If so, read more about fibro, because studies have found that a large number of people with fibro attribute a specific physical trauma, such as an accident, illness or part of pregnancy and childbirth, to the onset of their symptoms. Another large proportion of people identified specific psychological traumas to be the cause of their condition, such as a significant bereavement or traumatic incident.

Diagnosis

Fibromyalgia is diagnosed by ruling out other potential causes of a person’s symptoms, whereas MS can be seen on a scan and diagnosis is very straightforward. Both often include different blood tests to check for other possible conditions.

For MS, a neurologist can do specific tests, including an MRI scan, observations of your eyes and vision, muscle strength, coordination, balance and reflexes.⁴

For fibromyalgia, there is no definitive test and doctors rely on patient-collected data a lot more. This includes self-reported information around how often the person experiences pain, where it is in the body and how intense it is. So, if you are seeking a diagnosis it's a good idea to start tracking your symptoms.

If not MS or fibro, what is it?

If you find that your symptoms don't fit either fibromyalgia or MS, what else could it be?

Lots of chronic conditions can have similar symptoms to each other, making it hard to diagnose the cause. Always check with your doctor for individual advice and support, but some of the other conditions that could be causing your symptoms include:

• arthritis – joint inflammation
• lupus – autoimmune disease
• Lyme disease – bacterial infection
• migraines – severe headaches with associated sensory and stomach symptoms
• optic (eye) disease
• sarcoidosis – growth of inflammatory cells
• other autoimmune diseases.

Treatment

Treatments for multiple sclerosis and fibromyalgia both focus on alleviating a person’s symptoms and improving their overall quality of life with the condition. This can include psychological therapies such as CBT to help with sleep issues and any mental health or mood troubles, physiotherapy to assist with movement and strength, and medication as needed.

MS is often treated with steroids and medications to assist with muscle spasms.⁹

On the other hand, many people with fibromyalgia take painkillers, but the effectiveness of medication is often limited. The best treatment for people with fibro is a multidisciplinary approach that includes lifestyle changes, such as movement and nutrition, psychological therapies, and pain science education. Because the pain in fibro is widespread and the range of symptoms that someone experiences is varied, the treatments need to reflect this.

If you think that you might have fibro, take our suitability quiz to see if we can help you on your pain-management journey.