Fibromyalgia and CRPS – Can you have both?

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August 9, 2018 - By M G Rana, MD.

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Difference between fibromyalgia and CRPS

Fibromyalgia has a tendency to come and go into remission for weeks, sometimes months, at a time. It is much rarer for that to happen with CRPS. Unlike patients with fibromyalgia, those with CRPS tend to exhibit changes in skin color and temperature at the site of the original tissue injury. In some cases, skin in the affected limb may be hot, red and dry, whereas other times it may be cold, blue and sweaty. Most patients also describe a lack of strength, difficulty moving the affected body part, muscle spasm and tremors, as well as abnormal limb posture.

Can you have the two diseases at the same time?

Can the two diseases be confused? Can you have the two diseases at the same time? Yes and yes. As you can read by the descriptions below there are similarities in the symptoms but the causes are much different. There are also other differences such as; while Fibromyalgia can be quite painful there still exists no other chronic pain syndrome that touches RSD/CRPS in its intensity;

Fibromyalgia can come and go into remission for weeks or months at a time while it is much rarer for that to happen for RSD/CRPS. There are others but you get the idea. They are still often confused in a diagnosis by some Doctors as many see so little of either. The other problem that occurs is that many RSD/CRPS patients develop Fibromyalgia and end up with both to some degree. There is even a theory being put forth that as the Fibro intensifies, the RSD lessens. There is a research underway to examine the mitochondrial DNA link on the maternal side of families where there are multiple instances of many of these diseases; RSD/CRPS, Fibromyalgia, MS, etc.

Difference in cause

Although the pain of fibromyalgia usually is not preceded by an injury to the involved tissue, whereas that of the complex regional pain syndrome usually starts at a site of prior trauma or surgery, both disorders may share a common mechanism pathologic sensitization of brain mechanisms that integrate nociceptive signals and both apparently respond to treatment with ketamine, an anesthetic-analgesic agent whose actions include blockade of N-methyl-d-aspartate receptors. Ketamine’s widespread illegal use as a recreational agent probably precludes developing it as a general treatment of centrally mediated pain disorders; however, its efficacy suggests that related, to-be-discovered agents could be useful.

What is CRPS?

A few years ago, Paige Howitt went into a routine surgery for her knee. Shortly afterward, she began feeling an intense pain radiating from the site of the surgery. As the weeks went by, the pain began to spread and grow more intense. Though she didn’t know it at the time, she was suffering from a condition called “complex regional pain syndrome (CRPS).”

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CRPS is a rare condition that can affect people who have recently suffered some trauma to the body. In Paige’s case, it was surgery. But CRPS can also affect people who have had strokes, heart attacks, or serious injuries. We don’t know for certain what causes people like Paige to develop CRPS, but the answer probably lies in the nervous system.

What are the features of CRPS?

It can be difficult for doctors to make a firm diagnosis of CRPS early in the course of the disorder when symptoms are few or mild. There are a number of features that may suggest CRPS I and II:

>severe pain, often out of proportion to the initial injury
>increased skin sensitivity
>swelling
>excessive sweating or dryness of skin
>skin feeling warm or cold
>skin colour red or blue
>either extra or less hair growth in the area
>brittle finger nails
>muscle spasm, muscle contractures and difficulty coordinating and moving.

These features can spread so that the pain takes on a glove-like (hand/arm) and sock-like (leg) pattern of spread.

Diagnosing both fibromyalgia and CRPS

Diagnosing both fibromyalgia and CRPS can be difficult as symptoms of each condition mimic many other conditions. Diagnosis of fibromyalgia includes a three-month history of widespread pain in at least 11 of 18 tender point sites, which are not the same as trigger sites. Tender points hurt only when pressed.

With fibromyalgia, fatigue is almost always present and can be extreme at times. Sufferers tend to wake with body aches and stiffness and, while pain tends to improve during the day, it often increases again during the evening. Cold, damp weather, anxiety and stress can aggravate symptoms. Most fibromyalgia patients have an associated sleep disorder, as their deep level sleep is interrupted by constant bouts of awake-like brain activity.

The long-term pain of CRPS is usually confined to one limb, although it can spread to other areas of the body. The skin of the affected body part can become extremely sensitive to touch, so much so that just a slight touch, bump or even a change in temperature can provoke intense pain and affected areas can become swollen, stiff or undergo fluctuating changes in color or temperature.

Significant connection between the two conditions

But in spite of the differences, there may be a significant connection between the two conditions. As with CRPS, the pain of fibromyalgia is probably rooted in the nervous system. Researchers in Australia have recently proposed a possible explanation for both conditions that could explain this connection. Essentially, the idea is that inflammation in the nervous system causes the nerves to transmit pain signals to the brain.

Once nerve cells are damaged, the immune system begins sending cells to the nerves to repair them. As the nerve cells heal, they become more sensitive in response to these immune cells. That’s why injuries can seem to grow more painful overtime before healing. Usually, the nerve cells eventually stop being over sensitive and the pain goes away.

But in cases of CRPS and fibromyalgia, the nerve cells may get stuck in the hypersensitive stage. The immune system continues sending cells to the nerves and triggering the pain response.

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