Can you Spot the Clinical Differences between Lyme Disease and Fibromyalgia?

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In this blog, you will learn:

  • How Lyme Disease and Fibromyalgia present as very similar diseases
  • How the two diseases can be mistaken for each other
  • How the underlying causes of Lyme and Fibromyalgia are quite different
  • Why it is important to be aware of the potential confusion so that treatment can be targeted to the correct disease and therefore be more effective

Do your clients suffer from chronic pain, fatigue, headaches or joint pain? Do they have Lyme Disease or Fibromyalgia and do you know how to spot the difference? Then this blog is for you, as we present the link between Lyme and Fibro. Please read on for the details! 

Do you get stuck clinically with symptoms of Lyme or Fibro with your patients?  Would you like to have a larger impact on improving pain issues? The key to the treatment of many diseases may just be an individual approach using nutrition, lifestyle and exercise. If you want to improve your patient’s quality of life, you need a customized approach to address each patient’s root causes. Our functional medicine course will teach you how to do this. Look into our functional medicine school ( we will educate you to have a greater impact on improving your client’s lives.

** Please note: If you want the short summary version of this article, then please click here **

What is Lyme Disease (LD) and What is the Connection Between Lyme Disease and Fibromyalgia?  

Lyme Disease is a bacterial infection, caused by Borrelia burgdorferi. Borrelia is a bacterium that is transmitted by an infected black-legged tick.

The typical short term symptoms of Lyme Disease include (CDC, 2021):

  • A bull’s-eye skin rash on the skin at the site of the tick bite. This happens in 70-80% of infected people. It usually appears after 3 to 30 days. The average time for it to appear is 7 days (CDC, 2021).
  • Fever, chills, headache, fatigue, muscle/ joint aches. Swollen lymph nodes may also occur, especially if there is no rash.

Additional symptoms may occur days or months after a tick bite (CDC, 2021):

  • Severe headaches and neck stiffness
  • More bull’s-eye rashes on other parts of the body
  • Facial palsy (loss of muscle tone or droop on one or both sides of the face)
  • Arthritis with severe joint pain/ swelling, particularly in the knees and other large joints.
  • Pain in tendons, muscles, joints, bones
  • Heart palpitations or irregular heart beat
  • Dizziness or shortness of breath
  • Inflammation in the brain and spinal cord
  • Nerve pain, shooting pains, numbness or tingling in the hands or feet
  • Cognitive issues

If left untreated, infection can spread to joints, the heart and the nervous system.  Many people with long term chronic symptoms such as joint pain, cardiovascular issues such as arrythmias and palpitations, chronic fatigue syndrome and pain of all types actually have Lyme disease underlying their illness

At Medicine with Heart, we specialize in treating and resolving Lyme disease. We have written extensively on Lyme Disease. You can read more here in our ‘Lyme & Mold Guide’ and here in our recently published book.

What is Fibromyalgia (FM)?

Fibromyalgia affects 2 - 4% of the adult population (CDC, 2020) and (Ranque-Garnier S, 2019). Fibromyalgia is a condition of widespread pain all over the body. People with FM may have what is called ‘abnormal pain perception processing’. This makes them more sensitive to pain than people without Fibromyalgia.

The cause of FM is thought to be unknown. In many cases, especially when Functional Medicine principles are used, FM can be effectively treated and managed through an individual approach that targets the root causes. Certain conditions such as Lyme Disease can sometimes explain Fibromyalgia. We have seen many people’s Fibromyalgia completely disappear when Lyme Disease was treated. Even our clinic’s founder, Dr. Diane, saw this in herself.

We have written a 3-part blog on FM, which you can find here.

The common symptoms of Fibromyalgia are (CDC, 2020):

  • Pain and stiffness all over the body
  • Fatigue
  • Depression and anxiety
  • Sleep problems
  • Problems with thinking, memory, and concentration
  • Headaches, including migraines

Other symptoms may include (CDC, 2020):

  • Tingling or numbness in hands and feet
  • Pain in the face or jaw, including disorders of the jaw such as TMJ
  • Digestive problems, abdominal pain, bloating, constipation and irritable bowel syndrome

What is striking from these detailed lists of symptoms is that there can be an Overlap of Symptoms between the two conditions

A number of symptoms of LD and FM are quite similar. This is especially true with late-stage LD that isn’t resolved, or with LD that isn’t correctly diagnosed from the start. 

Diagnosing Lyme Disease and Fibromyalgia

A correct diagnosis for Lyme or Fibromyalgia is so important. This is in fact true for any condition. It is only with a proper diagnosis that we can effectively treat a patient’s condition. Some conditions are difficult to diagnose. Lyme or Fibro fall into this category. In some cases, Functional Medicine has a better approach with better lab testing to make the correct diagnosis. We have extensive experience with both LD and FM and strive to correctly assess and treat our patients suffering from pain and other related symptoms.

Lyme Disease

Lyme Disease can be tricky to diagnose. As mentioned, symptoms can look like other health problems. The ticks that spread it can pass other diseases at the same time.

A Lyme diagnosis is made based on symptoms. We look at the physical signs like the bulls-eye rash, although not everybody gets a rash after a tick bite. Other symptoms are assessed. Blood tests are taken. The Western blot test is the most accurate test to diagnose LD. But not all labs are standardized so it is possible to get a positive result from one lab and a negative result from another. We can expertly analyze a Western blot to get the correct diagnosis from it.

Lyme disease is sometimes called ‘The Great Imitator’ because it mimics so many other health conditions. If you think you have been exposed to ticks and your symptoms and labs indicate Lyme, then it can sometimes be a good idea to treat presumptively. This can be true even if the diagnosis is not 100% indicative of Lyme.

If correctly identified early on, most cases of Lyme Disease can be treated successfully with either herbal natural approaches or antibiotics.


Diagnosing FM, in particular, is challenging (Häuser W, 2017). The diagnosis is somewhat subjective, based on symptoms and how the patient describes them to their doctor. FM is undiagnosed in as many as 75% of people with the condition (Maffei ME, 2020). There is not a universally accepted diagnostic gold standard (Häuser W, 2017).

According to a 2020 study, there is no way of objectively testing FM with lab tests (Maffei ME, 2020). FM is a continuum of symptoms and studies agree that it can sometimes be an ambiguous disorder (Maffei ME, 2020).

Often Fibromyalgia is a diagnosis of exclusion. It is diagnosed when many other causes are ruled out. Lyme Disease is often not considered OR inadequate testing is ordered to determine if Lyme Disease is present. If you have been tested for Lyme but have not had a Lyme Literate Doctor test you for Lyme Disease, it is possible that your testing was inadequate.

A patient who has chronic pain should be screened for chronic widespread pain or CWP. This is defined as pain in 4 out of 5 body regions (Häuser W, 2019). People who have CWP should be screened for other FM symptoms like non-restorative sleep and fatigue (Häuser W, 2019). A complete medical history and physical exam can help confirm a FM diagnosis.

It is also important to rule out other diseases that can look like FM. Basic laboratory testing is recommended to do this (Häuser W, 2019). Things to rule out include Rheumatoid Arthritis, depression, Multiple Sclerosis, other autoimmune conditions and bacterial infections such as LD.

The Causes or Mechanisms of Action

Despite the sometimes-similar symptoms, the MOAs of these two conditions are very different:

  • Lyme Disease is caused by the bacteria Borrelia burgdorferi and Borrelia mayonii. These are carried by black-legged ticks. To contract Lyme Disease, an infected tick must bite you and then transfer the infection into your bloodstream. Lyme is a bacterial infection.
  • The cause of Fibro is much less clear and could involve genetic, hormonal or other factors. Gut health may play a role too. But the primary MOA is thought to be a dysfunction of pain sensitization. Sensory signals in the central nervous system are abnormally processed, which can lower the threshold of pain and amplify the sensations from normal signals. This can lead to the feeling of chronic pain (see more in our FM blog here).
  • Fibromyalgia is often triggered by a stressful event, including an infection, trauma (due to an accident, serious injury or divorce) or major surgery. FM can actually be triggered by an infection like Lyme disease (Wormser GP, 2015).

What is the Link?

Similar Symptoms & Mis-Diagnosis

FM can be mis-diagnosed as Lyme Disease. Lyme Disease can become chronic with chronic generalized pain as a key symptom. This stage of Lyme Disease can be mistaken for FM (Ranque-Garnier S, 2019).

Conversely, FM symptoms can be mis-diagnosed. Symptoms like persistent musculo-skeletal pain, fatigue, cognitive difficulties and headaches can be incorrectly diagnosed as untreated or chronic Lyme Disease when it is in fact Fibromyalgia (Hsu V, 1993). Chronic post-treatment Lyme Disease can present with symptoms that are very similar to post-infectious Fibromyalgia (Ranque-Garnier S, 2019)

Lyme Disease can trigger Fibromyalgia

To add to the confusion, Fibromyalgia sometimes is triggered and develops after Lyme Disease. It can be triggered by both early and late-stage Lyme Disease (Wormser GP, 2015). Approx. 10% of patients with untreated Lyme may develop a poorly defined Fibromyalgia-like illness, post Lyme Disease.

Chronic post-Lyme Disease looks a lot like FM (Häuser W, 2017). The symptoms are fatigue, musculo-skeletal pain and cognitive issues that last 6 months or more after antibiotic treatment for Lyme is completed (Häuser W, 2017). It can happen in 5–15% of patients who have been treated for Lyme Disease (Ranque-Garnier S, 2019). In one 2019 study on people with post Lyme, 30% received a Fibromyalgia diagnosis, 13% a chronic fatigue syndrome diagnosis and 43% did not get an official diagnosis (Ranque-Garnier S, 2019).

In these cases of Lyme Disease triggering Fibromyalgia, antibiotics do not help with the FM symptoms (Radolf JD, 2021).

How do we differentiate between LD and FM?

How do we untangle symptoms and identify a case of chronic Lyme Disease vs post-infectious Fibromyalgia?

We need to be sure to do a thorough exam, the correct labs and a deep analysis of the overlapping symptoms. There are other things to look at that can help to get a correct diagnosis. These include:

  • A history of a bulls-eye rash, a tick bite or spending time in areas where Lyme Disease has been reported are good indicators that it could well be Lyme.
  • Antibiotics should improve Lyme Disease symptoms, while they don’t help in the case of 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. In Fibromyalgia, it is usually 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.

In our clinic, we have expertise in treating a range of complicated, difficult-to-diagnose conditions like Fibromyalgia and Lyme Disease. We look for the root causes in our patients to identify what could be causing the symptoms. We regularly treat and resolve Lyme, chronic infections and other complex conditions in patients in our Functional Medicine clinic.

** Please stay tuned for our next Blog!  **

As always, please get in touch with us. If you or someone you know is struggling with pain, fatigue or other issues, Lyme or Fibromyalgia, contact our clinic today. We can work on any issue(s) and improve your health. Book a free health evaluation call with us today, to see how we can help you with your concerns. We can answer your questions and help you book an initial consult with one of the functional medicine doctors in our clinic.

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