Chronic Widespread Pain: It’s Not Just Lyme or Fibromyalgia

Chronic widespread pain means pain that affects many parts of the body and lasts more than 3 months. Many people think of fibromyalgia or Lyme disease first, but there are many other possible causes. Some newer medical discoveries show that small nerve damage or autoimmune issues can also be behind this kind of pain — and in some cases, there are treatments.

Chronic Widespread Pain: It’s Not Just Lyme or Fibromyalgia

What Causes Chronic Widespread Pain?

Finding the cause of chronic widespread pain is like doing detective work. Doctors must look at the full picture — symptoms, blood tests, scans — to figure out the real issue.

1. Inflammatory Causes

If tests show inflammation (high CRP or ESR), the cause might be:

• Rheumatoid arthritis: Morning joint stiffness, especially in the hands and feet.

• Polymyalgia rheumatica: Pain in shoulders and hips, mostly in older adults.

• Psoriatic arthritis: Spine and joint pain, sometimes with skin psoriasis.

• Lupus, vasculitis, and other autoimmune diseases: Often cause muscle and joint pain, fatigue, fever, and rashes.

Infections can also cause this type of pain, like:

• Endocarditis (heart infection)

• HIV

• Lyme disease (though inflammation markers may be normal in late stages)

2. Neurological Causes (No Inflammation)

When pain is linked to nerve problems, it may feel like burning, tingling, or extreme sensitivity to touch. Common causes include:

• Diabetic neuropathy

• Vitamin B12 or B6 deficiency

• HIV or Lyme disease

• Toxic or medication-related nerve damage

• Small fiber neuropathy: a newly recognized condition affecting tiny pain nerves

3. Muscle-Related Pain (No Inflammation)

Some muscle pain comes from:

• Medication side effects (e.g., statins, some arthritis drugs)

• Thyroid problems (both high and low)

• Metabolic disorders like McArdle’s disease

• Exercise-triggered muscle breakdown (rhabdomyolysis)

4. Joint Pain Without Inflammation

Sometimes joints hurt without inflammation. This could be:

• Tendinitis from certain antibiotics (like fluoroquinolones)

• Complex regional pain syndrome (after injuries or certain meds)

• Enthesitis (pain where tendons meet bones), seen in early spondyloarthritis or psoriatic arthritis — often confused with fibromyalgia

5. Bone Pain Without Inflammation

Deep bone pain may come from:

• Osteomalacia (Vitamin D deficiency)

• Osteoporosis (fragile bones, common in older adults)

• Bone cancer or metastases

• Myeloma: A blood cancer that may not always show inflammation in blood tests

What If All Tests Are Normal?

If there is no inflammation, and tests don’t show a clear cause, doctors may consider fibromyalgia.

What Is Fibromyalgia?

Fibromyalgia is a condition with:

• Pain all over the body

• Extreme tiredness

• Trouble sleeping

• Brain fog or memory issues

• Mood problems like anxiety or depression

People with fibromyalgia often say they “hurt everywhere,” but especially in the neck, shoulders, back, and hips. Pain may feel like burning, stiffness, or deep aching. Some areas are very tender to the touch.

Symptoms often get worse with stress, cold weather, or lack of sleep. Rest helps a bit, but some people still feel exhausted after sleeping. Despite the pain, medical exams usually come back normal — which makes it hard to diagnose.

Doctors use symptom checklists to help identify fibromyalgia, but it can still be confused with other conditions, especially early arthritis or tendon pain.

A New Condition: Small Fiber Neuropathy

Researchers have recently discovered that small nerve fiber damage may be behind some cases of chronic widespread pain. These tiny nerves control pain signals, heart rate, blood pressure, digestion, and more. When they are damaged, it can cause strange and painful sensations — sometimes without showing up on normal nerve tests.

This condition may explain some mysterious cases of pain and could respond to treatments used for autoimmune diseases.

What Should You Do If You Have Widespread Pain?

1. See your doctor and describe all your symptoms.

2. Ask for tests to rule out inflammation, nerve problems, infections, and hormone issues.

3. If all results are normal, fibromyalgia or small fiber neuropathy might be the answer.

4. Treatment can include:

   • Pain relief (heat, gentle exercise, medications)

   • Stress management

   • Sleep improvement

   • Nutritional support

   • Physical therapy

   • Cognitive-behavioral therapy (CBT)

Medical Sources

• CDC – Fibromyalgia🔗

• NIH – Chronic Pain Overview🔗

• Cleveland Clinic – Small Fiber Neuropathy🔗

• Mayo Clinic – Widespread Pain🔗

• American College of Rheumatology – Fibromyalgia Diagnosis🔗