Diagnosing Fibromyalgia

Fatigue, sleep struggles, and brain fog are just a few of the common symptoms of FM

Typical fibromyalgia symptoms are associated with a myriad of other common conditions, such as arthritis and lupus, which makes diagnosing the disease complex. According to the National Fibromyalgia & Chronic Pain Association, it is estimated that an accurate diagnosis of fibromyalgia can take up to five years on average.

Fibromyalgia patients often pass traditional tests and look relatively healthy on the outside, which sometimes leads both doctors and patients to become frustrated as they go through exhaustive costs and time spent investigating the disorder. Symptoms can also come and go over time, and vary with each patient, which continues to hamper a timely diagnosis. Further, assessment is dependent on the physician’s knowledge of the disorder.

There is no singular test to diagnosis fibromyalgia, according to the Mayo Clinic, so communicating your symptoms with your doctor is extremely important. Be prepared to detail your medical history and undergo a thorough physical examination, which will both play huge roles in getting a proper assessment.

What Type of Doctors Diagnose Fibromyalgia?

While fibromyalgia (FM) is not a form of arthritis (it does not cause inflammation or damage to joints, muscles, or tissues) your primary care doctor may advise you to see a rheumatologist, as the condition can cause chronic pain and fatigue similar to arthritis, according to the American College of Rheumatology (ACR). A rheumatologist can help to detect the disease by ruling out other rheumatic conditions.

For long-term care, however, one does not need to follow up with a rheumatologist. Your primary care physician can provide all the necessary care and treatment for FM. Learn more on our fibromyalgia treatment page.

A History of Diagnostic Criteria

The most prominent symptom of FM is widespread, persistent pain lasting more than 3 months. The term “widespread” is defined as pain on both sides of the body, as well as above and below the waist, considered the four quadrants of the body. Tenderness, stiffness, fatigue, trouble sleeping, and cognitive difficulties represent other signs that one may be suffering from this condition.

In 1990, the ACR developed general guidelines for diagnosing FM through the use of “tender points,” according to the National Fibromyalgia Association. The organization’s research showed that, in addition to the widespread pain factor, patients must show tenderness at 11 or more of the 18 tender points when specific pressure is applied (see image below). In addition, according to the National Fibromyalgia & Chronic Pain Association, axial skeletal pain (cervical spine, anterior chest, thoracic spine or low back pain) must be present and lasting for at least three months.

However, problems arose with this initial tender point exam. First, since pain associated with fibromyalgia can come and go, patients may have 11 of the necessary tender points, but have only 8 later on in the diagnosis, for example. In addition, many family physicians did not know how much specific pressure to put on each point, according to the Mayo Clinic. Therefore, recent revisions (2010) to these criteria by the ACR eliminated the tender point examination. Now, according to the Arthritis Foundation, two scales are used:

  • A Widespread Pain Index (WPI) lists 19 areas of the body where fibromyalgia patients typically have pain
  • A Symptom Severity (SS) scale helps to rank a patient’s severity of symptoms, such as fatigue, sleep, cognition, and other physical symptoms on a scale of 0 to 3.

According to the National Fibromyalgia & Chronic Pain Association, out of these two scales grew a 42-question symptom questionnaire in which the number of symptoms checked off, along with answers to other pertinent diagnostic questions, is assessed to determine an accurate FM diagnosis. This, included with the physician ruling out no other health problems that would explain the pain and other FM symptoms, leads to more evidence of a clear fibromyalgia diagnosis.

Ruling Out Other Conditions

While blood tests and x-rays cannot detect fibromyalgia in patients, they may be requested to rule out other mimicking conditions (eg, rheumatoid arthritis, lupus, hypothyroidism, and polymyalgia rheumatica are other “copycats,” according to the ACR). With these tests, doctors can review a number of factors to better pinpoint your disorder, including:

  • a complete blood count
  • erythrocyte sedimentation rate
  • thyroid function tests
  • and vitamin D levels.

During a physical examination, doctors will look carefully at your muscles, joints, and neurological properties. If sleep apnea, for example, is suspected, a sleep study may be advised. Other health problems that may co-exist with FM include irritable bowel syndrome, frequent headaches, face or jaw pain, anxiety and/or depression, and frequent or painful urination, according to the Mayo Clinic.

Potential triggers include trauma or post-traumatic stress disorder and genetics. Another theory, according to the NYU Langone Medical Center, is that people with fibromyalgia have reduced levels of the neurotransmitter serotonin, and that this decrease in serotonin increases one’s sensitivity to pain.

Learn more on our fibromyalgia causes page.

-Additional reporting by Steven Aliano

Updated on: 06/20/18
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