Is Your Fibromyalgia Primary or Secondary? The Shocking Truth

Fibromyalgia is a condition that affects millions of people worldwide, causing widespread pain, fatigue, and a range of other symptoms that can impact daily life.

For years, fibromyalgia has been categorized into two main types: primary (PFM) and secondary (SFM). But is there a meaningful difference between these two types? Or could they be more similar than we once thought?

In this article, we’ll explore what distinguishes primary and secondary fibromyalgia, examine the latest research challenging these distinctions, and discuss how a new approach—polysymptomatic Distress (PSD)—may be the key to better understanding and managing fibromyalgia symptoms.

What is Primary Fibromyalgia (PFM)?

Primary fibromyalgia (PFM) is the most common form of fibromyalgia, where the condition appears independently and is not linked to any other underlying illness. People with PFM typically experience:

• Widespread muscle pain that can be constant or fluctuate.
• Fatigue that doesn’t improve with rest, leaving people feeling constantly drained.
• Sleep disturbances, such as difficulty falling or staying asleep, can worsen other symptoms.
• Cognitive issues, often called “fibro fog,” can affect memory, concentration, and mental clarity.

Doctors diagnose PFM based on the presence of these symptoms and using criteria like the 2016 diagnostic criteria, which look for a combination of widespread pain and other key symptoms lasting for at least three months.

What is Secondary Fibromyalgia (SFM)?

Secondary fibromyalgia (SFM) occurs when fibromyalgia develops as a result of another underlying chronic condition, like rheumatoid arthritis (RA), lupus, or other autoimmune diseases. SFM often presents similar symptoms to PFM but can be more complicated due to the presence of the primary condition.

Symptoms of SFM can include:

• Widespread pain is similar to PFM but often exacerbated by the underlying condition.
• Fatigue and cognitive challenges may be more intense due to the additional health issues.
• Other symptoms overlap with the underlying disease (e.g., joint pain in RA) or result from the condition’s treatments.

The presence of another chronic illness makes diagnosing SFM more complex, and it can often be confused with the flare-ups of the primary disease, which adds complexity to treatment.

Key Differences Between Primary and Secondary Fibromyalgia

Traditionally, the difference between primary and secondary fibromyalgia has been based on their origins:

• Primary fibromyalgia is considered an independent condition.
• Secondary fibromyalgia is thought to be caused or aggravated by another health issue, such as rheumatoid arthritis.

But these differences don’t always tell the whole story. Both forms of fibromyalgia share many of the same symptoms, and the treatment approach can overlap significantly. A recent study by Wolfe et al. (2018) challenges the idea that primary and secondary fibromyalgia are truly different in how they affect patients.

Recent Research Findings: Are PFM and SFM Different?

In 2018, researchers conducted a study titled “Primary and Secondary Fibromyalgia Are The Same: The Universality of Polysymptomatic Distress.“

The study aimed to investigate whether the symptoms of primary and secondary fibromyalgia were truly different or if they could be seen as part of a spectrum of symptoms with a common underlying cause. Here’s what the study found:

• Polysymptomatic Distress (PSD): The researchers introduced a concept called Polysymptomatic Distress (PSD), which measures the total burden of symptoms a person experiences. The study revealed that when adjusted for PSD values, primary and secondary fibromyalgia were remarkably similar in terms of symptom severity. The differences that did exist, such as slightly higher disability scores in secondary fibromyalgia, were relatively minor.
• Key symptoms like widespread pain, fatigue, and quality of life scores were nearly identical in patients with primary and secondary fibromyalgia, even when adjusted for their overall symptom burden (measured by PSD).
• Higher PSD scores correlated with more severe symptoms across the board, whether the fibromyalgia was classified as primary or secondary. This finding suggests that focusing on the overall severity of symptoms (PSD) might be more important than distinguishing between the two forms.

In essence, this research challenges the conventional belief that primary fibromyalgia and secondary fibromyalgia should be treated as entirely separate conditions. Instead, it suggests that they both belong to the same spectrum of illness and are both influenced heavily by the overall level of distress experienced by the patient.

Understanding Polysymptomatic Distress (PSD)

Polysymptomatic Distress (PSD) is a comprehensive measure of the range and intensity of symptoms experienced by a person with fibromyalgia. This scale looks at multiple factors, including:

• Pain intensity and distribution
• Fatigue
• Cognitive dysfunction (fibro fog)
• Sleep disturbances
• Quality of life measures

Researchers found that higher PSD scores are associated with greater symptom severity and more abnormal physical and mental health statuses, regardless of whether the fibromyalgia is primary or secondary.

Essentially, PSD is a more accurate indicator of how severe the condition is than the traditional classification of fibromyalgia as primary or secondary.

Clinical Implications: What This Means for Patients and Healthcare Providers

So, why does this matter for people living with fibromyalgia? Here are some key takeaways:

Symptom Management: Since the study found little difference in symptom burden between primary and secondary fibromyalgia, treatment approaches can likely be similar for both groups. This means that healthcare providers can focus more on the severity of a patient’s symptoms rather than trying to categorize their condition as primary or secondary.

Personalized Treatment: By using PSD scores, doctors can more effectively tailor treatment plans based on symptom severity. Whether a person has primary or secondary fibromyalgia, treatments such as pain management, exercise, cognitive therapy, and medications can be adjusted according to their specific needs rather than their diagnosis alone.

Improved Diagnosis: Focusing on symptom severity rather than categorizing the type of fibromyalgia could lead to better and more consistent diagnoses. It may also eliminate some of the challenges associated with diagnosing secondary fibromyalgia, where symptoms often overlap with other chronic conditions.

Why Primary vs. Secondary Fibromyalgia May No Longer Matter as Much

The findings from the study challenge the traditional binary classification of fibromyalgia and highlight the universality of polysymptomatic distress. As a result, healthcare providers may start focusing less on whether fibromyalgia is primary or secondary and more on individual symptom profiles and severity scores. This approach could lead to:

• More accurate symptom tracking
• Improved patient outcomes
• A more holistic view of fibromyalgia that includes the full range of physical and emotional health challenges

Managing Fibromyalgia: Regardless of Type

No matter whether fibromyalgia is classified as primary or secondary, the core of managing the condition remains the same:

• Medications: Pain relievers, antidepressants, and anti-seizure medications can help manage symptoms.
• Lifestyle changes: Regular exercise, stress reduction, and proper sleep hygiene can alleviate some of the daily struggles of living with fibromyalgia.
• Cognitive-behavioral therapy (CBT): CBT and other psychological therapies can help manage the emotional toll of living with a chronic condition like fibromyalgia.

The key is to focus on individual symptom severity, manage stress, improve quality of life, and work closely with healthcare providers to create a personalized care plan.

Conclusion

While we’ve traditionally thought of primary and secondary fibromyalgia as two distinct conditions, recent research shows that the differences between the two may be minimal. What truly matters is the overall Polysymptomatic Distress (PSD), which provides a more comprehensive picture of a person’s condition.

By focusing on the severity of symptoms rather than categorizing fibromyalgia into types, we can improve diagnosis, treatment, and quality of life for people living with fibromyalgia.

As our understanding of fibromyalgia continues to evolve, it’s clear that a more individualized and nuanced approach to care is the future of fibromyalgia treatment.