Exams and Tests to Diagnose Fibromyalgia

It is very difficult to diagnose fibromyalgia, unfortunately. There isn't one exam or test that a doctor can use in order to definitively say, "Yes, you have fibromyalgia." Diagnosing fibromyalgia is more a process of elimination because there are several other conditions that have similar symptoms, including rheumatoid arthritis, chronic fatigue syndrome, and lupus.

It may take some time between when you first notice symptoms and when you're actually diagnosed with fibromyalgia, and that may be frustrating. Try to stay patient and remember that your doctor is working hard to find the right cause of your pain and other symptoms. Making the right diagnosis makes treatment much more effective.

Fibromyalgia Criteria
In 1990, the American College of Rheumatology developed the criteria for classifying fibromyalgia—basically, the criteria for diagnosing it. They said that there are two main symptoms that must be present in order to diagnose fibromyalgia:

• Widespread pain (usually lasting for more than three months)
• Tenderness at 11 or more of the 18 specific tender points (often confused with trigger points, which are associated with chronic myofascial pain)¹

Many doctors consider these general guidelines; as you probably know, fibromyalgia is a very variable condition, so it's a challenge to establish definitive diagnostic guidelines. For example, what if a patient has experienced long-term widespread pain and has pain in 10 of 18 tender points, in addition to other possible symptoms of fibromyalgia such as extreme fatigue? Is it all right to say that patient has fibromyalgia?

You can see the difficulty in even defining how to diagnose fibromyalgia, but an experienced, thorough doctor will be able to consider the spectrum of your symptoms and work towards a diagnosis.

Fibromyalgia Diagnostic Process: What May Happen
Your doctor will take a complete medical history, asking you about any other conditions you have and what runs in your family.

You'll also have to detail your symptoms: where it hurts, how it hurts, how long it hurts. Diagnosing fibromyalgia is very dependent upon your report of the symptoms, so it's best to be as specific and accurate as possible. You may want to keep a pain diary (a record of all your symptoms) so that it's easier to share information with your doctor during the appointment.

Because fibromyalgia has many possible symptoms and co-existing conditions, try to be a thorough as possible when talking about what you've been experiencing. Tell your doctor if you've been having trouble sleeping, if you feel tired a lot of the time, if you've had any headaches, etc. Review the symptoms of fibromyalgia and note down if you've experienced any of those.

The doctor will also palpate (which means that he/she will apply light pressure with the hands) the 18 tender points. If you have fibromyalgia, at least 11 of those points will be painful as the doctor gently pushes down on them.

Other Possible Tests
As mentioned above, the symptoms of fibromyalgia can be very similar to other conditions, such as rheumatoid arthritis, hypothyroidism, and ankylosing spondylitis. Your doctor will want to rule out any other conditions, so he or she may order various tests.

Remember, these tests aren't to diagnose fibromyalgia; they're to eliminate any other possible conditions.

The doctor may order:

• Anti-nuclear antibody (ANA) test: Anti-nuclear antibodies are abnormal proteins that can be in your blood if you have lupus, a condition with symptoms similar to fibromyalgia). The doctor will want to see if your blood has these proteins in order to rule out lupus.
• Blood count: By looking at your blood count, your doctor may be able to see another cause for your extreme fatigue, such as anemia.
• Erythrocyte sedimentation rate (ESR): An ESR test measures how quickly red blood cells fall to the bottom of a test tube. In people with rheumatic disease (such as rheumatoid arthritis), the ESR or "sed rate" is sometimes higher. The red blood cells fall quickly to the bottom of the tube, which suggests that there is inflammation in the body.
• Rheumatoid factor (RF) test: In many patients with an inflammatory condition (such as rheumatoid arthritis, which has symptoms similar to fibromyalgia), a higher level of the rheumatoid factor can be identified in the blood. A higher level of RF doesn't guarantee that your pain is caused by rheumatoid arthritis (RA), but doing an RF test will help your doctor explore the possibility of an RA diagnosis.
• Thyroid tests: These tests will help the doctor rule out thyroid problems.

Final Note
Again, diagnosing fibromyalgia can take awhile. Your job as a patient is to be proactive in the diagnostic process; be your own advocate.

For example, when your doctor orders a test, ask why. Be sure you understand what the results will tell you and how that test will help figure out your pain. If you don't understand the results or reasoning, keep asking questions until you do.