Diagnosing Fibromyalgia

Fibromyalgia Diagnosis: Understand the Process

When it comes to Fibromyalgia syndrome or FMS, the trickiest part for any individual is ascertaining if indeed they do suffer from the condition.

Because FMS is such a complicated and still not entirely understood illness, there is no easy diagnostic process. The term fibromyalgia is derived from the Latin word for fibrous tissue (fibro) and the Greek words for muscle (myo) and pain (algia).

Unlike many other illnesses, there are no laboratory tests or foolproof methods of actually diagnosing FMS. Unfortunately, this means that many sufferers go for years without having the syndrome being successfully diagnosed.

Often doctors will make several other diagnoses beforehand – and this is quite a common trajectory as FMS symptoms mimic several other illnesses.

A process of elimination

FMS is characterized by widespread pain, cognitive disruption, and chronic fatigue. The initial FMS indicators are considered to be pain which lasts for 3 months, the presence of fatigue and there is no clear underlying cause for such problems.

These three major symptoms, however, are also present in many other, more commonly diagnosed illnesses.

Sometimes doctors will even shy away from the diagnosis of fibromyalgia because the syndrome is still considered to be quite a controversial diagnosis – and many medical practitioners will still be found to rebut the existence of FMS.

Nevertheless, the first step to your doctor being able to determine whether or not you do indeed suffer from FMS is to eliminate the possibility of other similar illnesses.

These can include:

  • Rheumatic diseases: disorders like arthritis, lupus, Sjogren’s syndrome, and several other illnesses that plague the joints can cause aches, pains, and stiffness similar to that associated with FMS.
  • Neurological disorders: anything like multiple sclerosis that affects your central nervous system can result in the numbness and tingling which presents in a similar fashion to FMS.
  • Mental health problems: depression and anxiety disorders can also cause aches and pains as well as constitute lethargy and general cognitive disruption.
  •  Structural defects: any problems with your body’s skeletal or muscular system, such as scoliosis, may present issues with your body’s ability to process pain.

Once your doctor has eliminated as many possible problems from this list of the four major categories of illness that could mimic FMS, it is time to proceed to the means of actually addressing the possibility of Fibromyalgia.

The tender point examination system

There are two systems of diagnosing FMS, with the tender point examination having been heavily criticized in recent years.

Derived in 1990 by the American College of Rheumatology, this examination makes use of a system of 18 tender points on the body which are particularly sensitive to pressure. These are localized areas of pain located near joints which often become inflamed.

For a diagnosis of FMS to be made, 11 of 18 tender points must be painful when pressed (see illustration).

While this method has had varying results, some claim that it is only 75% effective in detecting FMS, mostly because pain levels can fluctuate greatly on a day to day basis.

Usually, such a diagnosis will need to be made by a rheumatologist who will test each of the paired tender points. Nowadays, however, even neurologists are branching out in treating FMS.

Diagnosing Fibromyalgia

New diagnostic criteria

Since 2010, a newer system of diagnosing FMS has emerged. This system does away with tender point examinations and instead makes use of a widespread pain index coupled with a symptom severity scale.

The widespread pain index is a list of 19 different areas on the body, where the patient may have experienced pain in the last week.

For each area where pain has been experienced, you assign a score of 1 point, with a possible total of 19 points should you have experienced pain in every area. These areas are as follows:

  • Shoulder girdle left
  • Shoulder girdle, right
  • Upper arm left
  • Upper arm right
  • Hip (buttock, trochanter) left
  • Hip (buttock, trochanter), right
  • Jaw left
  • Jaw, right
  • Upper back
  • Lower back
  • Upper leg left
  • Upper leg, right
  • Neck
  • Chest
  • Abdomen
  • Lower arm left
  • Lower arm, right
  • Lower leg left
  • Lower leg, right

For symptom severity, the patient assigns a score of 0 to 3 to the following possible symptoms:

  • Fatigue
  • Unrefreshing sleep
  • Cognitive disruption or problems
  • Somatic symptoms in general (these include headaches, physical weakness, irritable bowel syndrome, bladder/urination issues, nausea, dizziness, numbness/tingling or hair loss)

The totals of the severity symptoms are then added up with a possible maximum of 12 points, where 0 = no problem, 1 = slight or mild problems, generally mild or intermittent, 2 = moderate, considerable problems, often present and/or at a moderate level, and 3 = severe: pervasive, continuous, life-disturbing problems.

Finally, your doctor can compare your scores on both lists to determine your possibility of FMS. For a diagnosis of FMS, you need to score at least a 7 on the widespread pain index AND at least a 5 on the severity symptom scale.

Alternatively, you could also score between 3 and 6 on the widespread pain index AND at least a 9 on the symptom severity scale.

The diagnostic process

When it comes to diagnosing FMS, always bear in mind that its diagnosis is a complicated process which is by no means foolproof.

There is no way of being entirely certain of whether or not an individual suffers from FMS because the illness affects everyone differently.

All you can do is find a patient-doctor who is willing to run through all of these possible diagnoses with you.