Upper body “Fibromyaglia” Misdiagnosis

Cervical (neck) disc disease can mimic or cause Fibromyalgic symptoms. Certain porportion of post whiplash “Fibromylagia” will fit here.

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Dr. Smythe for Univeristy of Toronto wrote in 2005 about the C5-6 and C6-7 syndromes – subtle radiculitis (neck sciatica – nerve root irritation) that can activate multipe triggers in the upper body and give the illusion of fibromyalagia. Please see writeup here

A potentially reliable sign of this, I recently discovered, was anterior cervical pain. Dr. John McFadden investigated 200 cases of patients with neck pain and widespread pain “Fibromyalgia”. He found localized tenderness in the anterolateral cervical (neck) spine. When he xrayed the cases to see where the tenderness was, the xray marker was on the disc at that level:

His articles:

Fibromyalgia of Intervertebral Disc Origin: A Report of 200 Cases

article

further article here

Comment – He says to palpate upper disc levels and use that as a baseline for tenderness in comparison for lower levels. The tender areas are covered by the scalene muscles and I have found it helpful to take the tenderness out of them using functional release (counterstrain) before concluding the pain is of disc origin:

Head flexed and perhaps slightly sidebent to same side. Find position where less than 25% usual pain. If you hold in that position for 90 seconds, pains should temporarily remit from that spot in muscle. Then you can tell how much is pain on dics/vertebral body.

If pain seems of discogenic origin, then cervical steroid epidural (which can be greatly augmented by later local etanercept injection) would be beneficial. I have previously discussed that, as well as an inflatable cervical traction device that gives beneficial neck traction for disc disease.

Anyone with experience with this mis-diagnosis?

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3 Responses to Upper body “Fibromyaglia” Misdiagnosis

  1. sharon says:

    I have all of this: FM, heiated disc’s in my cervical, thoraic, and lower back, and TMJ. Pain in all the places you show and talk about.

  2. Hi Dr. McFadden,

    I am now the Executive Director for the National Fibromyalgia Association located in Anaheim, California. I saw your article on Google this morning and thought I would just write a quick note to see how you are doing.

    Have your seen Dr. Andrew Holman’s paper on MRIs of FM patients with heads in extension? He has more than 1500 MRIs of FM patients – 80 to 85% have some kind of cervical spinal cord compression. He is now doing a control study to see if there is a stastical difference between healthy people and FM patients. He is located in Renton, Washington.

    Just thought you might be interested – and of course Dr. Dan Heffez has two papers on FM and cervical myelopathy published in European Spine – you can find them on-line.

    Hope things are doing well for you.

    Rae

    Thanks, It got mentioned in blog article on neck and arm pain here

    and in a blog article on FM tragic misdiagnosis hereĀ 

    guess I’ll have to link things better :)

    admin

  3. Pingback: Pain Medical Musing » Blog Archive » Shoulder Pain Patient Needs Help - Any Suggestions?

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