Figuring Out Fibromyalgia

Fibromyalgia diagnosis involves excluding other conditions

/ Author:  / Reviewed by: Robert Carlson, M.D

Fibromyalgia, a condition characterized by widespread pain and fatigue, can be tricky to diagnose.

According to the Mayo Clinic, “The pain associated with fibromyalgia often is described as a constant dull ache, typically arising from muscles," along with pain in specific areas, called tender points.

Fibromyalgia patients often experience fatigue and other conditions like anxiety, depression, sleep disorders, irritable bowel syndrome and headaches.

The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMSD) reports that around five million adult Americans are living with this disorder, most of whom are women.

According to NIAMSD, treating the condition may require a team approach, with professionals like family physicians, physical therapists and rheumatologists all working with the patient.

The symptoms of fibromyalgia can overlap with many other health issues, often making it difficult for these patients and their doctors to arrive at a diagnosis.

Despite the difficulties, diagnosing the disorder is important. With proper diagnosis, patients can be properly treated and their health and quality of life improved. 

Diagnostic Criteria

According to NIAMSD, guidelines for diagnosing fibromyalgia include “a history of widespread pain lasting more than 3 months, and other general physical symptoms including fatigue, waking unrefreshed, and cognitive (memory or thought) problems.”

“Widespread” pain means pain that affects all four quadrants of the body, i.e., both above and below the waistline plus both the right and left sides of the body. There are also 18 possible tender points on the body for doctors to consider.

Ruling Out Other Causes 

Fibromyalgia is not a disorder that can be discovered through lab tests or scans. The exact cause of the condition is still unknown.

According to the Mayo Clinic, one theory is that “fibromyalgia appears to be linked to changes in how the brain and spinal cord process pain signals and how the body handles stress signals."

Fibromyalgia cannot can be physically observed by doctors. But, this doesn’t mean that tests won’t be performed in the process of diagnosing the condition.

Because the nature of fibromyalgia symptoms is such that they are common to a variety of other conditions, a diagnosis of fibromyalgia is often only made after ruling out other potential conditions.

According to the Mayo Clinic, there are several common culprits causing fibromyalgia-like symptoms.

Rheumatic diseases like lupus or rheumatoid arthritis can initially develop with general aches and pains that might be mistaken for fibromyalgia.

Mental health issues like depression or anxiety can also lead to the aches, pains and fatigue associated with fibromyalgia.

The Mayo Clinic reports that neurological disorders can also be at play, saying, “In some people, fibromyalgia causes numbness and tingling, symptoms that mimic those of disorders such as multiple sclerosis and myasthenia gravis.”

In an interview with dailyRx News, Alexandra Reimann, ND (Doctor of Naturopathic Medicine), said that she strongly recommends that all other causes of a patient’s symptoms be ruled out before a diagnosis of fibromyalgia is given.

“Very often in my practice I find that nutrient deficiencies and food sensitivities are the underlying trigger to a feed forward inflammatory process,” said Dr. Reimann. “As we remove the offenses and correct the deficiencies (vitamin D and magnesium very commonly), patients feel better and can avoid or begin to discontinue the medications prescribed for fibromyalgia (which only work for around 10 percent of people).”

The Mayo Clinic reports that as doctors try to arrive at a diagnosis, a variety of blood tests may be performed, including blood counts and thyroid function tests.

In this process of excluding other potential conditions, doctors might also examine the muscles, joints and neurological systems closely and in some cases, recommend sleep exams.

Considering Triggers & Opening Up

Doctors may want to consider factors that could potentially trigger fibromyalgia. These potential triggers can serve as additional clues pointing to the condition.

“In some cases, fibromyalgia symptoms begin shortly after a person has experienced a mentally or physically traumatic event, such as a car wreck,” explains the Mayo Clinic. “People who have post-traumatic stress disorder appear to be more likely to develop fibromyalgia, so your doctor may ask if you've experienced any traumatic events recently.”

It is helpful for patients and doctors to have an open dialogue and thoroughly discuss the patient’s symptoms and history. This can help ensure a proper diagnosis, so that the correct source of the patient’s pain can be determined and treated effectively.

Dr. Reimann also stressed the importance of doctor-patient conversations when it comes to a fibromyalgia diagnosis.

“The best advice I could give to patients is to ask their doctors questions,” Dr. Reimann told dailyRx News. “Leave no stone unturned before resorting to medication.”

Though the road to a fibromyalgia diagnosis can be lengthy, the process is improving as researchers and doctors learn more about the condition.

NIAMSD is sponsoring research to improve the understanding and diagnosis of fibromyalgia, including a study looking at pairs of twins in which one twin has the condition and the other does not.

The hope is that such studies will lead to the discovery of physical differences in fibromyalgia patients, eventually helping doctors diagnose this condition.

Review Date: 
May 23, 2013