How is fibromyalgia diagnosed?

Ask the Expert

Q:

How is fibromyalgia diagnosed?


A:

Diagnosing fibromyalgia has been controversial because there are no specific laboratory tests to identify the disorder. Until recently, many health care professionals thought fibromyalgia was primarily caused by psychological factors. In recent years, health care professionals have come to understand that psychological factors do not necessarily cause fibromyalgia but rather may contribute to an increased risk for disability associated with fibromyalgia.

Because diagnosis can be difficult, it may take several years to correctly diagnose. Fortunately, with increased awareness of the disorder, many people are getting diagnosed earlier than in the past, which may improve long-term outcomes.

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 professionals 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. 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. These criteria were designed to standardize classification for participants in clinical trials, and some health care providers find them difficult to understand and use. The American College of Rheumatology has also developed preliminary diagnostic criteria for diagnosing fibromyalgia that do not require tender point exams. Instead, these criteria involve using combined numerical scores that reflect severity of pain and other symptoms. These criteria may include a combination of chronic, widespread pain and other commonly associated symptoms such as fatigue and sleep disturbance.

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

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