How do doctors differentiate between fibromyalgia and other conditions?

Dr. Michael Roizen, MD
Internal Medicine
Fibromyalgia is tough to diagnose. People may go from doctor to doctor for many years seeking answers only to be treated for chronic pain or depression. To make a diagnosis, your doctor may order a few basic lab tests to rule out more serious medical problems. Your doctor may order a complete blood count (CBC), a test to check your thyroid levels, a test for Lyme disease, a test for arthritis, a test for lupus, and tests for your prolactin and calcium levels (parathyroid abnormalities). Your doctor may do a test to check for rheumatoid factor and for pain sensitivity. People with fibromyalgia have tender or trigger points on the body that extend from the knees to the neck. When a doctor touches these trigger points, it may cause great pain. If someone has pain at 11 of these 18 trigger points, fibromyalgia may be the diagnosis. 

Because there is no test for fibromyalgia, this condition is usually diagnosed after excluding other conditions. Any condition that has pain as a component of the condition must be excluded first and the presenting symptoms vary from patient to patient.

Jacob Teitelbaum
Integrative Medicine

This takes a thorough evaluation. Nutritional deficiencies, hormonal deficiencies, history of triggering infections or trauma, and especially autoimmune diseases need to be looked for along with the fibromyalgia. The pattern of symptoms determines whether there is a mix of problems present that include fibromyalgia or other illnesses.

Basically, if you have widespread pain associated with severe insomnia, you probably have fibromyalgia even if other conditions are present. If you do not have difficulty sleeping, you likely do not have fibromyalgia.

Dr. Mehmet Oz, MD
Cardiology (Cardiovascular Disease)
Fibromyalgia is such a great mimic that it could probably headline its own show in Vegas. It can mimic other diseases, such as thyroid disease (hypothyroidism), polymyalgia rheumatica, lupus, and rheumatoid arthritis. When you come to the doctor with symptoms such as pain and trouble sleeping, he or she may do certain tests to find out if one of these other conditions is causing your symptoms. For example, if you had hypothyroidism, your blood levels of TSH (thyroid stimulating hormone) would show it; if you had polymyalgic rheumatica, a test for ESR (erythrocyte sedimentation rate) would tell the tale. Similarly, rheumatoid arthritis and lupus both cause inflammation in the joints, which a doctor can test for. Knowing what you don't have can be part of determining whether you do have fibromyalgia.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.