Question

Fibromyalgia Diagnosis

How is fibromyalgia diagnosed?

A Answers (10)

  • AMehmet Oz, MD, Cardiology, answered

    To diagnose fibromyalgia, your doctor may have to play Dick Tracy, investigating and eliminating other suspects before pointing to fibro as the perp. He or she must carefully consider symptoms, and rule out other diseases that might cause those symptoms. After all, the primary symptoms of fibro -- pain, fatigue when you wake up, difficulty concentrating -- can happen for many reasons. Your doctor may do a physical exam to check for "trigger points," or may simply ask you about your symptoms. The American Academy of Rheumatology says that if you have pain in many different areas of your body for at least three months, combined with problems like trouble sleeping and feeling wiped-out, that's evidence of fibromyalgia. Your doctor may also do tests for other conditions such as rheumatoid arthritis that can also mimic fibro symptoms. 


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  • People with FM often see many doctors before being diagnosed. One reason for this may be that pain and fatigue, the main symptoms of FM, also are symptoms of many other conditions. Therefore, doctors often must rule out other possible causes of these symptoms before making a diagnosis of FM. FM cannot be detected by a lab test either.

    A doctor who knows about FM, however, can make a diagnosis based upon two criteria: pain in several different areas of your body for at least three months, and being troubled by other symptoms like fatigue and waking up unrefreshed. 

    If you feel your doctor doesn't know a lot about FM or has doubts about whether it is a "real" illness, see another doctor for a second opinion. Contact a local university medical school or research center for help finding a doctor who has helped others with FM.

    This answer is based on source information from the National Women's Health Information Center.

  • Fibromyalgia is diagnosed using guidelines provided by the American College of Rheumatology. You doctor will begin by assessing your symptoms. If you have been experiencing pain throughout the majority of your body for more than 3 months, you may have fibromyalgia. The next step involves identifying tender points. You doctor will quite simply apply pressure to different parts of your body testing for soreness. If you experience discomfort in at least 11 of 18 tender points, then you will mostly likely be diagnosed with fibromyalgia. To be absolutely sure, your doctor may run some blood tests as well. These can't identify fibromyalgia, but they can be used to rule out other possible causes for your symptoms.

  • ACeleste Cooper, Rheumatology, answered

    Times are changing, but we aren't quite there yet. The preliminary diagnostic criterion intends to do away with the tender point model, which has become the hallmark for diagnosing FM.

    Fibromyalgia is a central sensitization problem thought to be brought on by a dysfunction of the HPA (hypothalamus-pituitary-adrenal) axis and other central nervous system (CNS) disruptions. The criteria considers the effects CNS sensitization, and comorbid conditions, migraine, IBS, irritable bladder, cognitive deficit, RLS, disordered sleep etc.

    However, it does not address the co morbidity of chronic myofascial pain, a peripheral nerve to muscle disease that causes myofascial trigger points (MTrPs). Trigger points are knotted up muscle fibers in a taut (tight) band of muscle. They are EASILY felt unless behind bone or other muscles, or the band of muscle affected is too tight. It is an objective piece of evidence to indicate the presence of FM when other comorbid conditions are present, research suggests possibly all FM patients have them. This is not new to me, but many patients with FM and is why myofascial pain is included in our book, Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection by Celeste Cooper, RN and Jeff Miller, PhD. These MTrPs are peripheral pain generators that lend to sensitization, and keep the FM brain in wind-up. 

    Hashimoto’s thyroiditis may put the patient at greater risk of developing FM. The proposed criteria considers hypothyroidism as a comorbid condition in FM, however, waxing & waning hormones in Hashimoto’s makes it difficult to detect in routine tests. I have suggested to Dr. I Jon Russell, one of the co-authors of the proposed criteria that all patients with normal thyroid panel, but symptoms of thyroid disease, and the ups and downs of thyroid hormones, palpitations one minute, and unable to get out of bed the next, should have thyroid antibodies drawn.

    Doctors that diagnose FM need comprehensive, non-confusing guidelines to diagnose & provide helpful treatments. Exercising a muscle riddled with MTrPs, will only make the pain and dysfunction worse, leading both the patient and the physician down a road of misguided conception.

    You can find a resource list regarding this answer in my blog “Univeiling Myofascial Trigger Points in Fibromyalgia,” http://fmcfstriggerpoints.blogspot.com/2011/03/unveiling-myofascial-trigger-points-in.html

  • ARosendo Collazo, DO, Internal Medicine, answered on behalf of Baptist Health South Florida

    There is no single test for fibromyalgia, the condition marked by widespread chronic pain, heightened sensitivity to pressure and extreme fatigue.

    And since fibromyalgia symptoms can mimic those of other conditions, such as Rheumatoid arthritis, it is often misdiagnosed.

    Among the specific blood tests that your doctor could order is a complete blood count (CBC). This test measures the hemoglobin, red cells, white cells, and platelets. It is useful for finding many common blood disorders -- such as anemia - that can cause fatigue.

    Your doctor may ask for tests -- including kidney and liver tests -- that check blood chemistries. Your doctor will probably want to know the level of cholesterol and other fats in your blood, calcium levels, and more.

    Your doctor may also run thyroid tests to see if your thyroid is overactive or underactive.

    Since it is a syndrome with multiple symptoms, a diagnosis of fibromyalgia may require various tests to rule out other conditions.

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  • ADebra Fulghum Bruce PhD, Healthcare, answered

    A diagnosis of fibromyalgia is determined based on certain signs and symptoms. After doing a patient discussion and physical exam, your doctor may order lab tests. These tests are usually normal as no lab or imaging test can diagnose pain in muscles and soft tissue.

    While there is a lack of joint inflammation and swelling with fibromyalgia, people do have persistent widespread musculoskeletal pain and tender (trigger) points over the neck, back, arms and legs. Along with pain and tenderness, there is fatigue, poor quality sleep and morning stiffness.

    Persistent pain is often felt in different combinations such as all over pain, back or neck pain and pain in the upper and lower extremities.

    Many people with fibromyalgia have other problems such as difficulty concentrating (fibro fog), irritable bowel syndrome with constipation or diarrhea, pelvic pain,  anxiety and depression and restless leg syndrome, among others.

  • To make a diagnosis of fibromyalgia (FM), healthcare providers rely on people's histories, self-reported symptoms, a physical examination and an accurate manual tender point examination. An FM diagnostic blood test from a private company was made available in March of 2013 (Epic Genetics, The Fibromyalgia Test).

    There are two clinical fibromyalgia diagnostic criteria available to help healthcare providers make an accurate fibromyalgia diagnosis:
    • The 1990 American College of Rheumatology (ACR) Fibromyalgia Diagnostic Criteria
    • The 2010 ACR Preliminary Diagnostic Criteria
  • AHealthwise answered

    There are no specific tests that can confirm a diagnosis of fibromyalgia. You will likely have lab tests to make sure that you don't have another condition causing your symptoms. Your doctor will also ask questions about your medical history and do a physical exam.

    Doctors use a set of criteria to diagnose fibromyalgia. Your doctor will look for:

    • Widespread pain that has been present for at least 3 months. Pain is considered to be widespread if it is above and below your waist and on the right and left sides of your body.
    • Pain and tenderness at 11 or more of 18 specific spots. The pain usually occurs only when the areas are pressed. Experts call these tender points. But you may also hear them called trigger points. (Some people may have fewer than 11 tender points but still may have fibromyalgia.)

    A person may not meet these criteria but may still have fibromyalgia. That is why diagnosis can be so difficult.

    © Healthwise, Incorporated.

  • AJacob Teitelbaum, Integrative Medicine, answered

    There are two separate diagnostic criteria for fibromyalgia.  The outdated method requires examining 11 of 18 tender points. This criteria is being phased out because most physicians simply to not know how to do a proper tender point exam. Instead, new criteria uses a mix of the key symptoms of widespread pain, nonrestorative sleep, and cognitive dysfunction ("brain fog"), plus the presence of a mix of other symptoms.

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  • General: Fibromyalgia is a difficult condition to diagnose. A diagnosis may be based on a pain index, the presence of key symptoms, and a measure of these symptoms and their severity. Testing may be done to rule out other conditions that may be associated with or have similar symptoms to fibromyalgia, such as cancer, cervical and low-back degenerative disease, chronic fatigue syndrome, depression, HIV infection, hypothyroidism, irritable bowel syndrome, Lyme disease, rheumatoid arthritis, and sleep disorders.

    American College of Rheumatology guidelines: The American College of Rheumatology has established guidelines for diagnosing fibromyalgia. According to these guidelines, patients must have aching pain throughout the body for at least three months. Patients must also have at least 11 parts of the body (out of a total possible of 18) that are unusually sensitive when mild-to-firm pressure is applied. The tender-point sites include: fibrous tissue or muscles of the arms (elbows), buttocks, chest, knees, lower back, neck, rib cage, shoulders, and thighs.

    Blood tests: While there is no lab test to confirm a diagnosis of fibromyalgia, blood may be drawn to rule out other conditions that may have similar symptoms. A test called an erythrocyte sedimentation rate (ESR) test measures the rate at which red blood cells settle to the bottom of a test tube containing blood. The ESR is increased when inflammation is present. The level of creatine kinase (a normal muscle enzyme that leaks out and is released into the bloodstream when muscle is damaged) may also be tested. Levels of creatine kinase are increased when there is widespread and ongoing destruction of muscle. Blood tests that are used to diagnose rheumatoid arthritis test for the presence of rheumatoid factor or anti-cyclic citrullinated peptide (anti-CCP) antibody in the blood. A blood test to identify autoimmune antibodies (antinuclear antibodies) is helpful in ruling out systemic lupus erythematosus (lupus).

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