How is fibromyalgia diagnosed?

While doctors usually have specialized lab tests or X-rays to help make a correct medical diagnosis, there is no test that will confirm you have fibromyalgia. In making the fibromyalgia diagnosis, your doctor will do a physical examination to check for painful trigger points. The doctor will then talk to you about your specific symptoms, your medical history, and your family medical history. The doctor may run tests to rule out more serious problems such as rheumatoid arthritis or lupus. You help the diagnosis by describing in detail the exact pain you feel in the trigger point areas. In addition, it is important that your doctor know about all your fibromyalgia symptoms such as fatigue, sleep problems, depression, fibro fog, irritable bowel syndrome, and other problems.

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. 

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 to help relieve fibromyalgia pain. Prescription treatment, such as LYRICA, is one option you and your doctor may consider.

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.

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.

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

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