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Fibromyalgia is defined by the American College of Rheumatology as chronic (three months or more) widespread pain and pain on palpation of 11 of 18 tender points. Common associated symptoms include sleep problems, fatigue, cognitive impairment and mood disturbances. Even though it is recognized as a legitimate clinical entity, experts think it continues to be underdiagnosed or misdiagnosed.

If you suspect you may have this condition, discuss your symptoms with your primary care physician. Your primary physician may refer you to other medical professional for further evaluation. For example, you may be referred to a rheumatologist, who specializes in disorders affecting the joints, muscles, tendons, ligaments and bones. Even with the right doctor, fibromyalgia can be difficult to diagnose. Many of its symptoms are variable, so they're not always there, and many are common across numerous medical conditions. There is also no specific medical test for fibromyalgia.

As noted above, the American College of Rheumatology criteria for fibromyalgia require that a person has had widespread pain above and below the waist, on both sides of the body, and in the axial skeleton, for at least three months, as well as pain on palpation of at least 11 of 18 specific tender point sites. However, many doctors diagnose fibromyalgia with fewer than 11 tender points as long as the pain is chronic and widespread. Furthermore, most patients have tenderness that is not limited to the designated tender point sites. You can view an illustration of common tender points in fibromyalgia at http://www.nlm.nih.gov/medlineplus/ency/imagepages/9758.htm.

In addition to the pain, sleep problems and fatigue are common in patients with fibromyalgia... They may also experience a variety of other associated symptoms, including the following:

• Cognitive disorders, most often short-term memory lapses and difficulty concentrating

• Unusual sensitivity to cold, especially in the hands and feet, often accompanied by color changes, numbness, and tingling; this condition is known as Raynaud's phenomenon (also called Raynaud's syndrome)

• Urinary complaints, including a strong urge to urinate, frequent urination and pain in the bladder.

• Painful menstrual periods

• Heightened sensitivity to noises, bright lights, odors and touch

• Painful sexual intercourse

• Stiffness, particularly in the early morning, after prolonged sitting or standing, or with changes in temperature or relative humidity

• Increased headaches or facial pain, including frequent migraine, tension or vascular headaches, or pain behind the eyes or around the jaw. Some people with fibromyalgia suffer from temporomandibular joint (TMJ) syndrome, which involves limited jaw movement, clicking, popping or snapping sounds while opening and closing the mouth, and headaches and pain within the facial or jaw muscles or around the ears.

• Light-headedness and/or balance problems. Abdominal discomfort, which can include abdominal pain, bloating, constipation and/or diarrhea (irritable bowel syndrome)

• Paresthesia (numbness or tingling), often in the hands or feet

• Skin problems, including rashes, blotchy or itchy skin

Depression often accompanies fibromyalgia. Recent studies suggest that depression and fibromyalgia may share a pathophysiological link. An estimated 50 percent of people with fibromyalgia experience depression or anxiety at some point in their lives.

However, despite the association, not everyone with fibromyalgia will experience depression or anxiety. If you have fibromyalgia and are also depressed or anxious, treating the depression or anxiety can help free your energy to manage the disease. But even if you don't have depression, antidepressants may be prescribed for pain relief and to help you sleep.

Your doctor will diagnose you based on your symptoms, a complete medical exam and tests to rule out other conditions such as lupus, rheumatoid arthritis or hypothyroidism.