Fibromyalgia

How to Diagnose Fibromyalgia

How to Find the Source of Your Aches, Pains and Fatigue

You know something is wrong with you because your body is constantly aching, especially in your muscles.  Even when you have been able to sleep for most of the night, you often wake up tired with no energy.  If you’ve had these symptoms for a while, the constant pain and fatigue can be draining, often leaving you feeling hopeless.  In order to start feeling better, you need to see a doctor in order to get an accurate diagnosis for this classic fibromyalgia symptom.

The Symptoms of Fibromyalgia

Fibromyalgia is often a hard condition to accurately diagnose because usually sufferers do not have the same overlapping symptoms.  Even though the primary symptoms are consistent with this condition, many of the other symptoms are also shared with other diseases and medical conditions.  Some medical conditions can also coexist with fibromyalgia.

Primary Fibromyalgia Symptoms

A primary symptom is one that is always associated with a medical condition.  In fibromyalgia patients, the primary symptoms include:

  • Widespread Pain
  • Extreme Fatigue
  • Tender Points
  • Sleeplessness

How to Diagnose Fibromyalgia

Widespread Pain

The most prevalent primary condition associated with fibromyalgia is widespread pain.  Although the pain is felt all over the body, the pain can be concentrated in the patient’s muscles.  The muscles will often feel tight, they will ache and the patient may have muscle spasms. The pain is often described as a shooting, stabbing pain and the severity of the pain can vary.

There are factors that can aggravate the pain fibromyalgia patients suffer.  Temperature changes, particularly cold, humid weather can cause pain flare-ups. Pain can also worsen when patients feel anxious, when they don’t get restorative sleep or if they feel stressed.

Extreme Fatigue

Patients with fibromyalgia can experience bouts of extreme fatigue.  Even if a patient has had a full night’s sleep, they may still wake up feeling tired and have very little energy.  Feeling as if they have no energy can make it difficult to keep up with their daily routine including going to work and make a social life seem impossible.  Being in constant pain exacerbates the fatigue symptoms.

Tender Points

Tender points, also called pain points, are tender areas surrounding the joints of the body that hurt when touched.  The area of pain is usually very small and it isn’t very deep under the skin.  Tender points are very sensitive and when touched, they can cause the patient to pull back from the inflicted pain.  These pain areas of the body are located all over the neck, back, chest, elbows, buttocks, hips and knees.

How to Diagnose Fibromyalgia

Sleeplessness

People who suffer from fibromyalgia often have sleep problems that interfere with getting deep, restorative sleep.  Deep, restful sleep helps the body rest and heal, but if that restorative sleep cannot be achieved, patients will always feel tired and their energy levels will be low.  Fibromyalgia patients’ sleep is often disrupted by bursts of aware-like brain activity that makes sleeping well difficult to do.

Other Fibromyalgia Symptoms and Conditions

There are several other symptoms that patients can have that complicate fibromyalgia and makes the condition more difficult to diagnose.  These symptoms or conditions generally vary from patient to patient.  A few of the other symptoms are specific to women. Some of the more common symptoms or overlapping conditions include:

  • Irritable bowel syndrome
  • Numbness and tingling
  • Restless legs
  • Headaches and/or migraines
  • Painful periods
  • Temperature sensitivity
  • Memory impairment/lack of concentration
  • Depression
  • Anxiety
  • Stress

When a patient visits their physician before they are diagnosed with fibromyalgia, it is important that all symptoms and conditions are noted so the doctor can make a connection to fibromyalgia.  Without the entire picture, this condition can easily be confused with other conditions like lupus or Lyme disease.

Symptom Descriptions

When telling their doctor about their symptoms, patients should be as detailed as possible.  If possible, they should take note of their symptoms so none are missed. When noting their symptoms, they should also be prepared to answer specific questions about them, such as:

Length of Time – It is important for a doctor who is trying to diagnose fibromyalgia to know how long the symptoms have lasted or when the patient first started to notice them.  Patients should be factual when describing their symptoms and try not to elaborate about them too much.

Changes to Symptoms – Patients should also tell their physician what causes symptoms to get better or to worsen.  For instance, if they notice the cold makes them feel worse or if rest helps their symptoms get better.

What has been Tried – If patients have tried treatments, they should tell their physicians which ones and if they worked.

It is important to openly discuss the symptoms with a physician so they get a complete picture in order to make an accurate diagnosis.  Patients should not be shy about asking questions as it can help them to know what to expect after their condition has been diagnosed.  Anything that isn’t understood should be thoroughly explained and patients should also tell their doctor how their symptoms affect their day-to-day lives

Diagnosing Fibromyalgia

The name fibromyalgia did not exist until 1976, but it wasn’t until another 10 years or so that fibromyalgia was reconsidered as a diagnosable condition.  The criteria for diagnosing this medical condition was introduced in 1990. Until the late 1980s, many patients were told by physicians that their pain was psychosomatic, meaning it was all in their heads.

Pain Criteria

As the pain of fibromyalgia is the most common symptom, there are criteria to determine if the pain is associated with fibromyalgia.

  • The widespread body pain must have lasted for at least three months with a consistent level of pain.
  • The pain is located throughout the body and must exist within all four quadrants of the body, which are above and below the waist, as well as on both the left and right sides.
  • There is tenderness in at least 11 of the 18 tender points commonly associated with fibromyalgia.
  • To test tender points, the doctor will gently press on each point with their fingers.  People may also experience:
  • Hyperalgesia – This is increased pain when contacted that would be normally painful.
  • Allodynia – A painful response when touched in an area that is not normally painful.
  • The diagnostic criteria do not include any symptoms not related to pain.

2010 Criteria for Fibromyalgia

The criteria use to help diagnose fibromyalgia was updated in 2010.  They take into account more symptoms and include a way to monitor the severity of the patient’s symptoms.  The criteria are more flexible and the researchers that came up with the new method claim that it is approximately 88% accurate.

Similar to the previous method, the possibility of other medical conditions causing a patient’s symptoms must be ruled out.  Also, pain symptoms still must have been present for at least three months.  The updated criteria has two methods of assessment; the widespread pain index, WPI, and the system severity, SS, scale score.

The WPI lists 19 areas of the body and patients tell the doctor in which areas they have had pain in the last week.  One point is assigned for each area in which pain was present, making the WPI score 0 to 19.

For the SS score, patients use a scale from 0 to 3 to rank specific symptoms.  The symptoms include:

  • Fatigue
  • How refreshed they feel upon waking
  • Cognitive symptoms, such as depression
  • Physical symptoms like headaches, numbness, tingling, etc.
  • The score for each symptom are added up for a total of 12.

To be diagnosed with fibromyalgia, the patient needs either:

WPI of at least 7 and a SS scale score of 5, or  WPI of 3 – 6 and a SS scale score of 9 or higher.

Tests for Diagnosing Fibromyalgia

Along with pain criteria, there are several tests that can be used to help diagnose fibromyalgia.  Even doctors familiar with the condition can have trouble making an accurate diagnosis without testing.  To help with the diagnosis, they will usually conduct tests designed to eliminate other causes for a patient’s symptoms.

The tests ordered can differ from patient-to-patient as each patient may experience fibromyalgia pain differently.  Each patient has different ways of presenting their symptoms and accompanying symptoms often vary between patients.

How to Diagnose Fibromyalgia

Blood Tests

Although most laboratory tests are generally useless for diagnosing fibromyalgia, there is a blood test that has been developed to help with the diagnosis.  The test is called FM/a and it supposedly helps to identify markers produced by immune system blood cells in patients who have fibromyalgia.  While there are claims it has a 99% accuracy rate, this test isn’t usually done because there isn’t enough scientific evidence to show to prove the accuracy claims.

If laboratory tests are ordered, they are done to eliminate other medical conditions that could be more serious, such as cancer.  A patient’s primary physician may order a CBC, a complete blood count, which is done to measure red and white blood cells, hemoglobin and platelets.  This test can also detect many common blood disorders, such as anemia that can cause fatigue.

Other laboratory tests will detect high cholesterol levels, which is the amount and types of fat in the blood, calcium levels and other blood tests.  They may also request kidney and liver tests to check blood chemistries, as well as a thyroid test to see if it is over- or underactive.  Problems with the thyroid can also affect fatigue, anxiousness and concentration.

Inflammation Test

A blood test can also be conducted in order to test for levels of inflammation in the body.  A test is done to check the red blood cell sedimentation rate, which in rheumatoid and other similar types of arthritis the sedimentation rate is abnormal.  It can also be abnormal if there are certain infections in the body.  However, the red blood sedimentation rate is normal in cases of osteoarthritis and fibromyalgia.

Antibody Tests

The patient’s physician may also test the rheumatoid and anti-CCP antibodies.  These two tests are used to help diagnose 50% to 80% of rheumatoid arthritis cases.  A test may also be done to look for the anti-nuclear antibody, ANA.  ANA shows up as abnormal in the blood.  This antibody is also present when a patient has systemic lupus.

Like fibromyalgia, lupus is more common in women than in men and it can cause pain and fatigue.  Fibromyalgia is often misdiagnosed as lupus because they share similar symptoms.

X-rays may also be done to eliminate arthritis as the cause for a patient’s pain as they can spot changes in the body that indicates arthritis.  The x-rays in patients who have fibromyalgia will not show any changes.

How to Diagnose Fibromyalgia

Neurological Tests

There is new evidence that links the brain with fibromyalgia, so neurological tests are often ordered to help diagnosis the medical condition.  Other neurological conditions have similar symptoms, so it is important to eliminate them to accurately diagnose fibromyalgia.  Cervical spinal stenosis and Arnold Chiari malformation need to be eliminated to help diagnosis fibromyalgia.

Fibromyalgia patients often say the onset of their symptoms came after whiplash or some other neck injury, so a detailed neurological exam should be done.  A MRI and a neurological physical examination will be done to check the cervical spine to eliminate other neurological problems and narrow down the diagnosis to fibromyalgia.

Many fibromyalgia patients are overlooked as possible neurological candidates because the results are considered too soft to indicate a comorbid neurological condition.  The results of the physical neurological tests are often also considered too soft to consider a neurological source for fibromyalgia.

Common Misdiagnoses Associated with Fibromyalgia

Many symptoms associated with fibromyalgia often are shared with other medical conditions or diseases.  Both widespread pain and fatigue can be symptoms that overlap with other conditions.  Some of the other symptoms shared by other medical issues are:

  • Memory problems
  • Headaches and/or migraines
  • Sensitivity to temperature, light or noise
  • Irritable bowel syndrome
  • Urinary problems
  • Sleeplessness
  • Numbing or tingling in the extremities

Any combination of these symptoms could indicate serious conditions like:

  • Hypothyroidism
  • Sleep apnea
  • Lupus
  • Rheumatoid arthritis
  • Some types of cancer

Along with these conditions having symptoms similar to fibromyalgia, there can also be a secondary condition that coexists with it.  Obstructive sleep apnea, arthritis and Lyme disease are just a few of the medical issues that a patient can have along with fibromyalgia.

How to Diagnose Fibromyalgia

Finding the Right Doctor

A primary physician is the best doctor to begin with on the journey of making an accurate fibromyalgia diagnosis.  They will do the initial examination, take note of their patient’s symptoms and then make referrals to specialists that will help nail down the proper diagnosis.  The primary physician will refer their patient to either a neurologist or a rheumatologist to have additional tests conducted to confirm the initial diagnosis.

Doctors that Specialize in Treating Fibromyalgia

Finding the right type of fibromyalgia doctor is important for help controlling the symptoms of the condition since it does not have a cure.  A doctor that specializes in fibromyalgia should take the condition and your care seriously.

Some doctors still don’t consider fibromyalgia to be a real medical condition and suggest patients see a psychologist or psychiatrist to treat them.  While these professionals can be a part of a fibromyalgia treatment plan, it is important that the patient be treated medically as well.

Doctors that specialize in treating fibromyalgia patients include:

Rheumatologists – They specialize in treating diseases and conditions of the bones, joints and muscles.  They can treat fibromyalgia, rheumatoid and osteoarthritis, gout, lupus, back pain, osteoporosis, bursitis and tendonitis.

Pain Management Specialists – These doctors usually have board certification in pain management and they can be neurologists, anesthesiologists, physiatrists, psychiatrists, physical therapists or chiropractors.

Neurologists – These doctors treat disorders of the central nervous system, including the spine and brain.  They can treat fibromyalgia, neuropathy and reflex sympathetic dystrophy.

Psychologists – They help diagnose and treat problems that can be associated with pain like depression, anxiety and stress.

Orthopedists – These doctors specialize in diagnosing and treating, including surgical repairs, of injuries to bones.  They also treat problems with joint tissues, such as ligaments, tendons and cartilage.

Due to the conditions that can coexist with fibromyalgia, a patient may see more than one type of specialist for treating their symptoms.  It isn’t unheard of for a patient to have three or four specialists at once, depending on their condition and symptoms.

While this can sometimes create a communication problem between the doctors, a patient must keep on top of their condition and make sure information is shared amongst their doctors.  Doing so can help prevent dangerous medication interactions and delays in treatments or testing.

Generally, a rheumatologist or neurologist will make the final diagnostic determination for fibromyalgia.  Then they will come up with a treatment plan customized for their patient to help reduce symptoms of pain, fatigue, sleeplessness and to treat any overlapping medical issues.

Questions to Help Find Specialists

Patients should do their homework when they are choosing a specialist, if they don’t just go where their primary doctor recommends.  Of course, you may be forced to choose a specialist from the insurance network that you belong to, but you can still do some homework to choose from the best ones that are in your network.  Here are some questions that you may wish to ask in order to choose a specialist to diagnose and treat your fibromyalgia

Is the specialist board certified? – A board certified specialist means they have the proper training in the field that they are in and have completed the coursework required of that specialty.  It also indicates they have passed the rigorous tests that are required to get certification in that field.

Where did the doctor attend medical school? – That information can be found online by looking up the doctor’s information or your health insurance company may have it as well.

Does the specialist have academic experience like research, writing papers or teaching? – A specialist who is also in academia will often be more up-to-date on new research and new treatments for fibromyalgia and other conditions in their specialty.

Where does the specialist have hospital privileges? – Patients should check to make sure the specialist has privileges at the hospitals within the medical network of their insurance carrier.  If not, then they may have to choose a different specialist or they could end up with an uncovered medical bill.

The Importance of Finding the Right Doctor

Finding the right specialist can be the difference between getting an accurate fibromyalgia diagnosis and being misdiagnosed with another, more serious medical condition.

The quicker a fibromyalgia patient is diagnosed, the quicker their treatment can begin to help reduce their symptoms of pain, fatigue, sleeplessness and the other symptoms the patient may have.  Unfortunately, there are still doctors that believe fibromyalgia is a psychosomatic condition, which can delay a diagnosis by months, if not years.  It is also important to keep looking for a doctor who will listen to their patients and find out from them what other conditions they have in order treat the symptoms.

Living with chronic pain can be taxing and interfere with day-to-day life.  Some patients with fibromyalgia have had to quit working or change their occupations because the pain and fatigue are so overwhelming.  By reducing pain and fatigue symptoms, some patients will be able to resume some of their normal activities and may even return to work.

It is also important to get treatment for any symptoms of depression that a patient may have because depression can be a serious problem for those with fibromyalgia.  Patients can become depressed because their activities have curtailed and their social life may have had to change drastically.  However, with therapy and medication, if needed, the patient can live a more positive and happier life.

Statistics show that anywhere from 6 to 11 million Americans have been diagnosed and live with fibromyalgia.  By finding the right doctor and receiving a quick diagnosis, patients can live with this condition without it taking over their lives.

Further reading:

Diagnosis: http://www.fmcpaware.org/diagnosis

Diagnosing Fibromyalgia: http://www.fibrocenter.com/diagnosing-fibromyalgia.aspx

Fibromyalgia Diagnosis: http://www.healthline.com/health/fibromyalgia-diagnosis#Criteria2

Comments

comments

Leave a Comment