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Tests and Diagnosis for Fibromyalgia

By Nancy Baxi, M.D. ; Updated August 14, 2017

Fibromyalgia is difficult to diagnose since its symptoms are similar to other illnesses. Fibromyalgia is known as a diagnosis of exclusion, meaning other conditions that are plausible need to be investigated and ruled out by a medical-care professional.

In 1990, formal criteria were developed to diagnose fibromyalgia using the number and location of tender spots on the body called “trigger points”. However, in 2010, diagnostic criteria changed as research revealed an association between this condition and the nervous system’s hypersensitivity to pain.

Old criteria

In 1990, the American College of Rheumatology created the following criteria for the diagnosis of fibromyalgia: 1. The patient has a history of widespread pain present for at least three months on both sides of the body. 2. There are at least 11 out of the 18 defined trigger points/tender spots present on the body.

New criteria

In 2010, as patients reported and research had increasingly shown that fibromyalgia was more complicated than just having tender points, The America college of Rheumatology developed new criteria for a fibromyalgia diagnosis:

  1. Number of tender points out of 19 defined areas of the body
  2. Symptoms lasting at least three months at a similar level
  3. Level of severity of the following symptoms:
  4. Fatigue
  5. Waking unrefreshed
  6. Cognitive (memory or thought) problems
  7. No other health problem that would explain the pain and other symptoms

Rule out other diseases

Your doctor will want to do a good history and physical to evaluate each symptom and rule out other diseases. He/she should examine the areas that are tender to you making sure there is nothing else causing the pain. There are no labs or X-rays that can diagnose fibromyalgia, but sometimes these tests are useful to rule out other diseases, for example, thyroid abnormalities or muscle problems.

Some diseases a medical practitioner may test for include: postural orthostatic tachycardia syndrome (POTS), stomach and bowel problems, panic disorder, depression, post-traumatic stress disorder, attention deficit hyperactivity disorder (ADHD), hyper- or hypo-thyroidism, muscle problems, sleep apnea, cervical spine abnormalities, systemic lupus erythematosis (SLE), polymyalgia rheumatica, rheumatoid arthritis, chronic fatigue syndrome and myofascial pain syndrome.

As you can see, there are a myriad of things that can mimic symptoms of fibromyalgia, making it difficult to diagnose right away. This investigation may be quick or it may take a while, depending on your symptoms. It helps if you have a doctor who is familiar with fibromyalgia.

If nothing fits, the doctor should consider fibromyalgia. The physician can use the criteria as a guide, as well as to get an idea of how “hypersensitive” a patient is, or how “altered” the patient’s pain processing is.

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