What criteria must I meet to be diagnosed with fibromyalgia?

To receive a fibromyalgia diagnosis, the American College of Rheumatology (ACR) has identified criteria to help doctors. You must have a history of widespread pain for at least three months. The pain may be in the left or right side of your body and above or below the waist. Also, the pain may be in the neck, front of the chest, middle of the back, and/or lower back. Along with this widespread pain, you must have pain in 11 of 18 trigger point sites. These are areas of localized tenderness that are far more painful or tender than the surrounding areas. Trigger points are often present at tendons, in the soft tissues over bones and in the muscles. 

Since 1990, the gold standard criteria for diagnosing fibromyalgia has been the 18 tender points established by the American College of Rheumatology (ACR). Fibromyalgia is characterized by the sensation of pain when even light pressure is applied to these points. Just enough pressure to turn the nail white when you press against one of these points can be very painful for someone with fibro, while people without fibro won't even raise an eyebrow. If 11 or more of these tender points are painful, and have been so for three months or more, that is a good indication for a diagnosis of fibromyalgia. Not many primary care physicians use the tender points test, though, so the ACR has developed a different approach. This symptom severity (SS) criteria, which is based on questions your doctor asks about your symptoms, has been shown to correlate highly to the tender points system.

Only your doctor can diagnose whether you have fibromyalgia. 

There are guidelines that can be very helpful in the diagnosis of fibromyalgia. In 1990, the American College of Rheumatology published the following criteria: 

• Widespread pain above and below the waist, on both the right and left sides of your body, and in the axial skeleton (your skull, spine, rib cage, and the bones in your throat and ears) for at least 3 months
• Tenderness or pain in 11 of the 18 “tender points” on your body

Based on these guidelines, your doctor may perform a tender point exam. Your doctor will ask how long you have been having pain. Then he or she will apply pressure to these 18 points and count how many you find tender. Finding pain when pressure is applied to these tender points is how many doctors diagnose fibromyalgia. 

In 2010, the American College of Rheumatology published a new set of preliminary guidelines. These guidelines include a widespread pain index that assesses the number of painful body regions, and a scale that assesses the severity of symptoms such as fatigue, sleep problems, comprehension problems, and others in the body. 

By using one or both of these sets of guidelines, along with tests to rule out other conditions, it is possible for your doctor to make a fibromyalgia diagnosis. So if you think you may have fibromyalgia, talk to your doctor about what steps you can take toward an accurate diagnosis. 

If you are experiencing chronic widespread pain and tenderness and are diagnosed with fibromyalgia, talk to your doctor about your treatment options. Prescription treatment, such as LYRICA, is one option you and your doctor may consider to help relieve fibromyalgia pain. In clinical studies, LYRICA was proven to provide significant relief from fibromyalgia pain compared with a placebo, so patients felt better and could do more.* 

*Individual results may vary. 

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 chronic myofascial pain (CMP/MPS) in FM and research suggests possibly all FM patients have them. This is not new to me, and is why myofascial pain is covered extensively in our book. These MTrPs are peripheral pain generators that bombard the brain with pain messages keeping the central nervous system sensitized. 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. 

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 had the honor of discussing this with Dr. I Jon Russell, one of the co-authors of the proposed criteria. I believe it prudent that patients with a normal thyroid panel, but symptoms of thyroid disease, (the ups and downs of thyroid hormones, palpitations one minute, and unable to get out of bed the next), should have thyroid antibodies drawn.

For now the tender point model is being used to diagnose fibromyalgia. See a complete account of the tender point model at http://www.thesethree.com/fibromyalgia/tender-points.php
And symptoms at http://www.thesethree.com/fibromyalgia/fibromyalgia-symptoms.php

All blogs, posts and answers are based on the work in Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection by Celeste Cooper, RN, and Jeff Miller, PhD. 2010, Vermont: Healing Arts press