Fibromyalgia and Ehlers-Danlos Syndrome

Difference Between Fibromyalgia and Ehlers-Danlos Syndrome

Fibromyalgia and Ehlers-Danlos Syndrome are two distinct yet often misunderstood medical conditions. Fibromyalgia is characterized by widespread musculoskeletal pain, tender points, fatigue, and sleep disturbances, primarily involving the nervous system. In contrast, EDS is a group of genetic connective tissue disorders, featuring hypermobile joints, skin Hyperelasticity, and various potential complications.

Despite sharing some overlapping symptoms like fatigue and chronic pain, these conditions have distinct diagnostic criteria and require different treatment approaches, making accurate differentiation crucial for effective management.

What is Fibromyalgia?

Fibromyalgia is a chronic medical condition characterized by widespread musculoskeletal pain, tenderness, and heightened sensitivity to pain. It is often accompanied by symptoms such as fatigue, sleep disturbances, and cognitive difficulties. While the exact cause of fibromyalgia remains unclear, it is believed to involve abnormalities in the way the nervous system processes pain signals, leading to an increased perception of pain.

Figure 01: Fibromyalgia

Fibromyalgia can significantly impact a person’s quality of life and often requires a multifaceted approach to management, including medications, physical therapy, and lifestyle modifications, aimed at alleviating pain and improving overall well-being.

Causes of Fibromyalgia

The exact cause of fibromyalgia is not fully understood, and it is considered a complex and multifactorial condition. Researchers believe that fibromyalgia may be influenced by a combination of genetic, environmental, and physiological factors.

Here are some factors that may contribute to the development of fibromyalgia:

    • Genetic Predisposition: There is evidence to suggest that genetics play a role in fibromyalgia. People from families where this disease runs in their blood could be more prone to contracting it themselves.
    • Abnormal Pain Processing: One of the leading theories is that fibromyalgia involves abnormalities in the way the central nervous system processes pain signals. This results in an increased sensitivity to pain and a heightened perception of pain, even from non-painful stimuli.
    • Physical Trauma or Injuries: Some individuals report the onset of fibromyalgia symptoms after physical trauma, such as an accident or surgery. This suggests that physical injuries or stressors may trigger the condition in susceptible individuals.
    • Infections: In some cases, viral or bacterial infections have been linked to the development of fibromyalgia or the worsening of its symptoms.
    • Hormonal Changes: Hormonal fluctuations, particularly in women, may influence the onset or exacerbation of fibromyalgia symptoms. Changes in estrogen levels have been explored as a potential factor.
    • Sleep Disturbances: Poor sleep quality or disorders like sleep apnea can contribute to fibromyalgia symptoms. Sleep disturbances may also exacerbate pain sensitivity.
    • Psychological Factors: While fibromyalgia is not a psychological disorder, psychological factors such as stress, anxiety, and depression can worsen symptoms and make pain management more challenging.

Fibromyalgia is a complex condition with varying factors contributing to its development in different individuals. Research into its causes is ongoing, and healthcare providers typically focus on managing symptoms and improving quality of life for those living with fibromyalgia. Treatment often includes a combination of medication, physical therapy, lifestyle adjustments, and psychological support.

Symptoms of Fibromyalgia

Fibromyalgia is characterized by the following primary symptoms:

    • Widespread Pain: Chronic, widespread musculoskeletal pain throughout the body, often described as aching, burning, or stabbing.
    • Tender Points: Specific areas of the body that are exceptionally sensitive to pressure and touch, commonly used for diagnosis.
    • Fatigue: Persistent, unexplained fatigue that is often severe and interferes with daily functioning.
    • Sleep Disturbances: Sleep problems, including difficulties falling asleep, staying asleep, and experiencing restorative sleep, leading to daytime drowsiness.
    • Cognitive Issues: Cognitive difficulties often referred to as “fibro fog,” which can include memory problems, difficulty concentrating, and mental confusion.
    • Stiffness: Morning stiffness and muscle stiffness that can make movement uncomfortable, especially after periods of inactivity.
    • Headaches: Frequent tension-type headaches or migraines.
    • Irritable Bowel Syndrome (IBS): Gastrointestinal symptoms such as abdominal pain, diarrhea, constipation, or bloating may occur in some individuals.
    • Sensory Sensitivities: Increased sensitivity to noise, light, temperature, and other sensory stimuli.

Fibromyalgia symptoms can vary in intensity and may come and go over time. Additionally, individuals with fibromyalgia may experience other associated symptoms and conditions, making the management of the condition complex and individualized. Diagnosis typically involves a comprehensive evaluation by a healthcare professional to rule out other conditions with similar symptoms and to assess the extent of the symptoms.

What is Ehlers-Danlos Syndrome?

Ehlers-Danlos Syndrome (EDS) refers to a group of rare genetic connective tissue disorders that affect the body’s collagen production, leading to a range of symptoms and potential complications. Collagen is a crucial protein that provides strength and elasticity to various tissues in the body, including the skin, joints, blood vessels, and internal organs.

Ehlers-Danlos Syndrome
Figure 02: Ehlers-Danlos Syndrome

EDS is characterized by hypermobility of the joints, skin Hyperelasticity (stretchy skin), easy bruising, and a variety of other symptoms, which can vary depending on the specific type of EDS a person has. There are different subtypes of EDS, each with its own unique features and genetic causes. EDS can result in a wide range of health problems and may require specialized medical care and management tailored to the individual’s specific subtype and symptoms.

Causes of Ehlers-Danlos Syndrome

Ehlers-Danlos Syndrome (EDS) is primarily caused by genetic mutations that affect the structure and production of collagen, a crucial protein in the body responsible for providing strength and elasticity to various tissues, including skin, joints, blood vessels, and internal organs. EDS is a group of rare genetic disorders, and the specific genetic mutations can vary depending on the subtype of EDS.

Here are the primary causes of EDS:

    • Genetic Mutations: EDS is predominantly an inherited condition, and it is caused by mutations in specific genes that encode for collagen or collagen-related proteins. These mutations can result in abnormal collagen production or function, leading to the characteristic features of EDS.
    • Autosomal Dominant Inheritance: The most common subtypes of EDS, such as Classical EDS (cEDS) and Hypermobile EDS (hEDS), follow an autosomal dominant inheritance pattern. This means that a person with one affected parent has a 50% chance of inheriting the mutated gene and developing the condition.
    • Autosomal Recessive Inheritance: Some rarer subtypes, such as Vascular EDS (vEDS), follow an autosomal recessive inheritance pattern. In these cases, an affected individual inherits two copies of the mutated gene, one from each parent.
    • Sporadic Mutations: In some instances, EDS can occur due to spontaneous, non-inherited mutations (de novo mutations) in individuals with no family history of the condition. These cases are less common but can still lead to EDS.
    • Genetic Heterogeneity: EDS encompasses multiple subtypes, each associated with mutations in different genes. For example, hEDS is often linked to genes like COL3A1, while cEDS is associated with mutations in COL5A1 or COL5A2. The specific gene mutations determine the subtype and presentation of EDS.

There is a wide range of clinical variability among individuals with EDS, even within the same subtype. The severity and symptoms of EDS can vary significantly, and genetic testing is typically required for a definitive diagnosis and to identify the specific genetic mutations involved. Genetic counseling is often recommended for individuals with EDS or those at risk of carrying EDS-associated genetic mutations. Treatment and management of EDS focus on addressing the specific symptoms and complications associated with each subtype.

Symptoms of Ehlers-Danlos Syndrome

Ehlers-Danlos Syndrome (EDS) can manifest with a variety of symptoms that vary depending on the specific subtype.

Common symptoms and features of EDS include:

    • Joint Hypermobility: Excessive joint flexibility or hypermobility, which can lead to joint dislocations or frequent joint pain.
    • Skin Hyperelasticity: Stretchy, fragile skin that is prone to easy bruising and scarring.
    • Easy Bruising: A tendency to develop bruises with minimal trauma.
    • Joint Pain: Chronic joint pain, especially in hypermobile joints.
    • Chronic Fatigue: Persistent, unexplained fatigue that can affect daily functioning.
    • Gastrointestinal Issues: Problems like irritable bowel syndrome (IBS) or gastritis may occur in some individuals.
    • Fragile Blood Vessels: Thin and fragile blood vessels, increasing the risk of vascular complications in some subtypes (e.g., Vascular EDS).
    • Mitral Valve Prolapse: A heart condition where the valve doesn’t close properly, leading to potential heart-related symptoms.
    • Skin Abnormalities: Skin that easily tears or forms widened scars (atrophic scarring).
    • Delayed Wound Healing: Wounds may take longer to heal due to collagen-related issues.
    • Autonomic Dysfunction: Dysautonomia symptoms, such as problems with blood pressure regulation and temperature control, may occur in some subtypes.

EDS is a group of disorders, and not all individuals with EDS will experience all of these symptoms. The severity and specific symptoms can vary widely between individuals and subtypes. Accurate diagnosis and management of EDS often require a comprehensive evaluation by a healthcare professional with expertise in connective tissue disorders. Treatment aims to address specific symptoms and may include physical therapy, pain management, and preventive measures to reduce the risk of complications.

Comparison Table of Fibromyalgia and Ehlers-Danlos Syndrome

Below is a comparison table highlighting key differences between Fibromyalgia and Ehlers-Danlos Syndrome (EDS):

Characteristic Fibromyalgia Ehlers-Danlos Syndrome (EDS)
Nature of Condition Neurological and musculoskeletal disorder Genetic connective tissue disorder
Primary Symptom Widespread musculoskeletal pain Joint hypermobility, skin issues
Pain Distribution Widespread body pain, tender points Specific joint pain, may affect multiple body systems
Diagnostic Criteria Based on pain and tender points, exclusion of other conditions Clinical assessment, genetic testing for specific subtypes
Inheritance Not inherited, but some genetic factors may play a role in susceptibility Typically inherited (autosomal dominant or recessive), sporadic cases
Genetic Basis Not primarily genetic; possible genetic predisposition Caused by genetic mutations affecting collagen production
Joint Hypermobility Not a defining feature Common in most EDS subtypes
Skin Elasticity Typically normal Stretchy and fragile skin
Easy Bruising Less common Common
Fatigue Common, often severe Common, varying in severity
Cognitive Issues (Fibro Fog) Common, memory problems, concentration difficulties Not a typical symptom
Sleep Disturbances Common, including insomnia and unrefreshing sleep Sleep issues may occur but are not a defining feature
Treatment Approach Pain management, lifestyle modifications, medications Symptom-focused management, physical therapy, preventive measures
Prognosis Chronic but not life-threatening Variable, depending on EDS subtype and complications

Importance of distinguishing between Fibromyalgia and Ehlers-Danlos Syndrome

Distinguishing between Fibromyalgia and Ehlers-Danlos Syndrome (EDS) is of paramount importance for several reasons:

  1. Tailored Treatment: Each condition requires a different treatment approach. Accurate diagnosis ensures that individuals receive appropriate interventions, improving the effectiveness of treatment and symptom management. Treating a person for the wrong condition can lead to inadequate symptom relief and unnecessary medical expenses.
  2. Preventing Misdiagnosis: Fibromyalgia and EDS have overlapping symptoms, such as chronic pain and fatigue. Misdiagnosis can delay proper treatment and management, as well as lead to unnecessary medical tests and treatments. Identifying the correct condition helps avoid this confusion.
  3. Preventing Complications: EDS can involve connective tissue fragility, joint instability, and vascular issues in some subtypes, which may require specific preventive measures or interventions. Accurate diagnosis allows for the early identification and management of these potential complications.
  4. Genetic Counseling and Family Planning: In EDS, some subtypes are inherited, and genetic counseling can help individuals and families understand the risk of passing the condition to future generations. Distinguishing between EDS subtypes and other conditions is crucial for appropriate family planning decisions.
  5. Research and Advocacy: Accurate diagnosis contributes to a better understanding of the prevalence and impact of both conditions. This information can lead to increased awareness, research funding, and improved support for individuals living with these conditions.
  6. Patient Support and Education: Clear diagnosis helps individuals access appropriate support groups, patient education resources, and advocacy organizations dedicated to their specific condition. This can be crucial for managing their condition effectively and connecting with others who share similar experiences.
  7. Mental Health and Well-Being: Accurate diagnosis can alleviate the frustration and anxiety often associated with prolonged uncertainty about the cause of symptoms. Knowing the correct diagnosis empowers individuals to seek the right treatment, manage expectations, and engage in self-care effectively.
  8. Healthcare Resource Allocation: Properly diagnosing and managing these conditions helps healthcare systems allocate resources more efficiently by targeting treatments and interventions where they are needed most.

Distinguishing between Fibromyalgia and EDS is essential for ensuring that individuals receive the appropriate care and support they need. It enables tailored treatment, prevents misdiagnosis and complications, supports genetic counseling and family planning, contributes to research and advocacy efforts, improves mental well-being, and optimizes healthcare resource allocation. Accurate diagnosis is a fundamental step in enhancing the quality of life for individuals living with these conditions.

How to Diagnosis of Fibromyalgia and Ehlers-Danlos Syndrome

Diagnosing both Fibromyalgia and Ehlers-Danlos Syndrome (EDS) can be complex, as these conditions present with various symptoms that overlap with other medical conditions. Accurate diagnosis typically requires a thorough evaluation by healthcare professionals with expertise in these disorders.

How to Diagnosis of Fibromyalgia and Ehlers-Danlos Syndrome
Figure 03: How to Diagnosis of Fibromyalgia and Ehlers-Danlos Syndrome

Here’s how diagnosis is typically approached for each condition:

Diagnosis of Fibromyalgia:

  1. Clinical Evaluation: Healthcare providers start by conducting a comprehensive clinical assessment, which includes:
    • An accurate medical history to gain an in-depth knowledge of a patient’s ailments and how they impact everyday life is necessary in providing effective healthcare services.
    • A physical examination to check for tender points and assess muscle and joint pain.
  2. Exclusion of Other Conditions: Since fibromyalgia symptoms can resemble those of other conditions, healthcare providers will often perform tests to rule out other underlying medical problems. Common tests may include blood tests, imaging studies, and sometimes, even referrals to specialists.
  3. Fibromyalgia Criteria: Diagnosis is based on specific criteria established by the American College of Rheumatology (ACR). These criteria include:
    • At least three months have passed since you experienced pain.
    • Tenderness in at least 11 of 18 designated tender points when pressure is applied.
  4. Assessment of Associated Symptoms: Providers will assess other common symptoms of fibromyalgia, such as fatigue, sleep disturbances, and cognitive issues, to confirm the diagnosis.

Diagnosis of Ehlers-Danlos Syndrome:

  1. Clinical Evaluation: Diagnosing EDS typically begins with a thorough clinical assessment by a healthcare provider, often a geneticist or a specialist familiar with connective tissue disorders.
  2. Family History: A detailed family history is important, as EDS can be inherited. Information about family members who may have similar symptoms or a known diagnosis of EDS is valuable.
  3. Physical Examination: The healthcare provider will conduct a physical examination to evaluate for characteristic signs of EDS, which may include joint hypermobility, skin elasticity, and signs of vascular fragility (if applicable).
  4. Genetic Testing: In some cases, genetic testing may be recommended to confirm the diagnosis and determine the specific subtype of EDS. Genetic testing is particularly useful when there is uncertainty or when specific subtypes with known genetic mutations are suspected.
  5. Other Diagnostic Tests: Depending on the subtype and symptoms, additional tests may be necessary, such as imaging studies to assess joint or organ involvement, or cardiovascular monitoring in the case of vascular EDS.
  6. Exclusion of Mimicking Conditions: Like fibromyalgia, EDS symptoms can resemble those of other disorders. Healthcare providers may conduct tests to rule out conditions with similar presentations.

Both conditions often require a multidisciplinary approach involving rheumatologists, geneticists, physical therapists, and other specialists to confirm the diagnosis and develop an individualized treatment plan. Accurate diagnosis is crucial as it guides appropriate management and support for individuals living with these conditions.

Treatment for Fibromyalgia and Ehlers-Danlos Syndrome

Treatment for both Fibromyalgia and Ehlers-Danlos Syndrome (EDS) is typically focused on managing symptoms and improving the quality of life of individuals affected by these conditions. It’s important to note that the treatment approaches differ significantly due to the distinct nature of each condition.

Treatment for Fibromyalgia:

  1. Medications: Several medications may be prescribed to manage fibromyalgia symptoms, including:
    • Pain relievers: Over-the-counter pain medications or prescription drugs like tramadol.
    • Antidepressants: Certain antidepressants, such as duloxetine and amitriptyline, can help with pain and sleep.
    • Antiseizure drugs: Medications like pregabalin can help manage nerve pain.
  2. Physical Therapy: Physical therapy, including exercises and stretches, can improve muscle strength, flexibility, and physical function. It can also help reduce pain.
  3. Cognitive-Behavioral Therapy (CBT): CBT can be beneficial for individuals with fibromyalgia, as it can help them cope with pain, manage stress, and improve their emotional well-being.
  4. Lifestyle Modifications: Lifestyle changes can be beneficial and may include:
    • Regular exercise: Low-impact aerobic activities like swimming or walking.
    • Sleep hygiene: Developing good sleep habits.
    • Stress management: Techniques such as relaxation and mindfulness.
  5. Dietary Adjustments: Some people find that dietary changes, such as reducing caffeine intake and avoiding certain trigger foods, can help alleviate symptoms.
  6. Pain Management Techniques: Modalities like acupuncture, massage therapy, and heat therapy may provide relief.

Treatment for Ehlers-Danlos Syndrome:

Treatment for EDS varies depending on the specific subtype and the symptoms a person experiences. Here are some general approaches:

  1. Symptom Management: The focus is on managing specific symptoms and complications associated with EDS. For instance:
    • Physical therapy: Strengthen muscles and reinforce joints for maximum results.
    • Orthopedic interventions: Bracing or orthopedic devices to support unstable joints.
    • Pain management: Medications or other pain relief methods tailored to individual needs.
  2. Genetic Counseling: For individuals and families with EDS, genetic counseling can help assess the risk of passing the condition on to future generations.
  3. Cardiovascular Monitoring: In some subtypes like Vascular EDS (vEDS), regular cardiovascular monitoring and preventive measures are crucial due to the risk of arterial and organ complications.
  4. Dietary Management: Dietary adjustments may be necessary to accommodate gastrointestinal issues common in some EDS subtypes.
  5. Hydration and Skin Care: Adequate hydration and careful skin care are important to prevent skin fragility issues and minimize scarring.
  6. Physical and Occupational Therapy: These therapies can help individuals adapt to and manage daily activities effectively.
  7. Surgical Interventions: In severe cases, surgery may be necessary to address complications like joint dislocations or vascular issues.

It’s essential for individuals with EDS or fibromyalgia to work closely with their healthcare providers to develop comprehensive treatment plans tailored to their specific needs and symptoms. These conditions are often managed over the long term, and treatment plans may need adjustments as symptoms change or new issues arise.

What are the similarities between Fibromyalgia and Ehlers-Danlos Syndrome?

Fibromyalgia and Ehlers-Danlos Syndrome (EDS) are distinct medical conditions, but they share some similarities, which can sometimes make it challenging to differentiate between them.

Here are some commonalities:

  1. Chronic Pain: Both conditions are associated with chronic pain, which can affect various parts of the body. Individuals with Fibromyalgia often experience widespread musculoskeletal pain, while people with EDS may have joint pain, especially in hypermobile joints.
  2. Fatigue: Fatigue is a common symptom in both Fibromyalgia and some subtypes of EDS. This fatigue can be severe and debilitating, impacting daily functioning and quality of life.
  3. Sleep Disturbances: Both conditions can lead to sleep problems. Fibromyalgia often results in difficulties falling asleep, staying asleep, or achieving restorative sleep. In EDS, sleep disturbances may be related to pain, joint issues, or other symptoms.
  4. Overlap of Symptoms: Fibromyalgia and certain EDS subtypes can have overlapping symptoms, such as cognitive difficulties (sometimes referred to as “fibro fog” in Fibromyalgia) and gastrointestinal issues. These shared symptoms can complicate diagnosis.
  5. Psychological Impact: Both conditions can have a significant psychological impact on individuals, leading to anxiety, depression, and stress. The chronic nature of these conditions and the challenges in managing symptoms contribute to the psychological burden.
  6. Misdiagnosis: Due to symptom similarities, individuals with either condition may initially be misdiagnosed or experience delays in obtaining a correct diagnosis. This underscores the importance of a thorough medical evaluation by specialists familiar with these conditions.
  7. Multidisciplinary Care: Both conditions often require a multidisciplinary approach to management. Healthcare providers, such as rheumatologists, physical therapists, and pain specialists, may be involved in the care of individuals with Fibromyalgia and some EDS subtypes.

These similarities exist, Fibromyalgia and EDS are fundamentally different conditions with distinct underlying causes and diagnostic criteria. Differentiating between them is crucial for ensuring that individuals receive the appropriate treatment and management tailored to their specific condition. Healthcare providers skilled in these areas can conduct comprehensive assessments to make an accurate diagnosis and develop personalized care plans.


Fibromyalgia and Ehlers-Danlos Syndrome (EDS) are complex medical conditions with distinct characteristics. Fibromyalgia is primarily a neurological and musculoskeletal disorder characterized by widespread pain, while EDS is a genetic connective tissue disorder known for joint hypermobility and skin fragility.

Though they share some symptoms like chronic pain and fatigue, accurate diagnosis is crucial for tailored treatment and prevention of complications, given their different underlying causes and management strategies. Multidisciplinary care and support are essential for improving the quality of life of individuals living with these conditions and addressing their unique needs.

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