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 Diagnostic Criteria
- Pain and symptoms based on the total number of painful areas of the body (potentially 18).1
- Unproductive sleep1
- Cognitive difficulty(ies) such as thinking and memory problems1
In 2010, the results of a study were published that updated the diagnostic criteria for fibromyalgia. These revised criteria were also from the American College of Rheumatology.
These new criteria remove emphasis from the tender point examination. As pointed out above, that part of the diagnostic process wasn't always accurate or standardized. Therefore, the 2010 criteria focus more on the widespread pain index (WPI).
There is a 18-item checklist about where and when a patient feels pain. This WPI is combined with a symptom severity scale, and the end result is a new way to classify and diagnose fibromyalgia.2
Fibromyalgia Diagnostic Process: What May Happen
Medical History: Your doctor will take a complete medical history, asking you about any other conditions you have and what runs in your family.
Discuss Your Symptoms: 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.
Physical Examination: The doctor may also palpate (which means that he/she will apply light pressure with the hands) the 18 tender points.
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 on Fibromyalgia Diagnosis
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.