Diagnosis of Fibromyalgia
If you have persistent symptoms of severe widespread pain and exhaustion, yet your blood tests and imaging studies are not showing a pathological process, you may have fibromyalgia syndrome or chronic fatigue syndrome. Both are serious chronic illnesses that have specific criteria for diagnosis. The diagnosis of these conditions does not tell what is causing the condition, and that is the most important thing to understand. The most confusing concept for most people to understand is that each person with these symptoms can have different, individual physiological processes causing their condition. Physiological processes that are usually overlooked or misunderstood by our symptom oriented healthcare system. Understanding these complex processes, and knowing how to measure and interpret diagnostic tests to establish the mechanisms of these processes, is of utmost importance for each individual patient.
Also, you should be aware that the distinction between fibromyalgia and chronic fatigue syndrome is very subjective, and up to 70% of fibromyalgia patients meet the diagnosis for chronic fatigue syndrome.
Fibromyalgia Syndrome (FMS)
Routine lab tests do not detect the widespread pain of fibromyalgia. Instead, the diagnosis is made by a physical exam that takes about five minutes. When light pressure is applied to the surface of the muscles throughout the body, patients with fibromyalgia find this painful, especially at the tender points used for diagnosis. As you can see this is not a very sophisticated approach to the complex problem of fibromyalgia.
To meet the fibromyalgia criteria for diagnosis, patients must have:
A. Widespread pain in all four quadrants of their body for a minimum of three months
B. At least 11 of the 18 specified tender points
The 18 sites used for the fibromyalgia diagnosis cluster around the neck, shoulder, chest, hip, knee, and elbow regions. The finger pressure that must be applied to these areas during a “palpation” exam is roughly equivalent to the amount that causes the finger nail bed to blanch or start to become white. Over 75 other tender points have been found to exist, but are not used for diagnostic purposes.
While many chronic pain syndromes display symptoms that overlap with fibromyalgia, the 1990 American College of Rheumatology (ACR) multi-center criteria study (published in the February 1990 issue of Arthritis and Rheumatism) evaluated a total of 558 patients, of which 265 were classified as controls. These control individuals weren’t your typical healthy “normals.” They were age and sex matched patients with neck pain syndrome, low back pain, local tendonitis, trauma-related pain syndromes, rheumatoid arthritis, lupus, osteoarthritis of the knee or hand, and other painful disorders. These patients all had some symptoms that mimic fibromyalgia, but the trained examiners were not foiled—they hand-picked the fibromyalgia patients out of the “chronically ill” melting pot with an accuracy of 88%. Fibromyalgia is not a wastebasket diagnosis!
Although the above diagnosis focuses on tender point count, a consensus of 35 fibromyalgia experts published a report in 1996 saying that a person does not need to have the required 11 tender points to be diagnosed and treated for fibromyalgia (Wolfe F, et al. J Rheumatology 23(3):534-9, 1996). This criteria was created for research purposes and many people may still have fibromyalgia with less than 11 of the required tender points as long as they have widespread pain and many of the commonly associated symptoms below.
- irritable bowel (e.g., diarrhea, constipation, etc.)
- sleep disorder (or sleep that is unrefreshing)
- chronic headaches (tension-type or migraines)
- jaw pain (including TMJ dysfunction)
- cognitive or memory impairment
- post-exertional malaise and muscle pain
- morning stiffness (waking up stiff and achy)
- menstrual cramping
- numbness and tingling sensations
- dizziness or lightheadedness
- skin and chemical sensitivities
Do you think you have fibromyalgia?
If you think you have Fibromyalgia or Chronic Fatigue Syndrome order the Fibromyalgia DVD on the Home page …and watch the patient testimonials on the Testimonial page.