Why is it Difficult to Diagnose Fibromyalgia?
Fibromyalgia is considered a medical mystery. There is no known cause for fibromyalgia, and it can be very difficult to diagnose and treat. There are no lab tests or imaging that can conclusively identify the illness. Fibromyalgia is a set of symptoms that must be assessed on an individual patient, as each patient may have a different experience. The diagnostic period can be lengthy — often up to five years before an individual receives a proper diagnosis of fibromyalgia.
Diagnostic Criteria
In 2010, the American College of Rheumatology (ACR) released new standards for diagnosing fibromyalgia.
To be diagnosed as having fibromyalgia, an individual must:
1) Have experienced pain in all four quadrants of the body (left side, right side, above waist, below waist) for at least three consecutive months.
2) Experience tenderness in at least 11 out of 18 “tender spots”.
Tender spots are eighteen (nine pair) spots on the body, near the joints that are sensitive to applied pressure. These spots are not large areas of pain, but an individual with fibromyalgia does experience pain when the exact spot or area is pushed on.
Fibromyalgia Tender Spots
- Inner knees
- Sides of hips
- Upper hips
- Outer elbows
- Upper chest
- Tops of shoulders
- Between the shoulder blades
- Back of the head
- Front of the neck
This ACR criterion has been criticized by many doctors due to its inflexibility. They argue that individual pain may vary from hour to hour, day to day. This limits the accuracy of a physical exam done on one occasion, as the patient may not be feeling pain at the tender spot at that moment.
Pain and Symptom Assessments
The use of the tender point exam has decreased due to changes in diagnostic criteria. You may instead be assessed using the widespread pain index. This index asks if you have experienced pain in any of 19 areas over the past seven days. These areas include the jaw, chest, lower back, left and right shoulder, abdomen, arms, and legs.
This diagnostic tool also assesses symptoms of fibromyalgia other than pain, such as fatigue and cognitive abnormalities. This tool allows for the patient to give the medical care provider a better understanding of the symptoms present, as well as the severity.
Many doctors suggest that fibromyalgia patients keep a written record or diary of their pain levels, locations of sensitivity and other symptoms. This can be useful when completing medical history forms or answering questions.
Ruling Out Other Possibilities
The two major symptoms of fibromyalgia — pain and fatigue — overlap with other illness, such as HIV, Lyme disease, some types of cancer, degenerative spinal disorders, and hypothyroidism. Healthcare physicians must use diagnostic testing to rule out these illnesses. This process can be lengthy, time-consuming, and expensive.
An individual with fibromyalgia may undergo the following procedures and tests:
- Blood tests to rule out hypothyroidism, HIV, Lyme disease, or Rheumatoid Arthritis
- Computer Tomography (CT) scans and Magnetic Resonance Imaging (MRI) to look for spinal disease or some types of cancer
- Tissue biopsies to test for cancer
- Sleep studies
- Psychological exams
The Bottom Line
The patient suffering from fibromyalgia must understand that no cure exists for this condition, but education and lifestyle changes, including proper medications, healthy diet, and regular physical activity, can help the individual to regain control of his or her life and achieve significant improvement.
