Diagnosing fibromyalgia

Diagnosing fibromyalgia

How will fibromyalgia be diagnosed?

The diagnostic guidelines used to rely heavily on the 18 trigger points. When pressure was firmly applied on these points, at least 11 painful areas would be considered as possible fibromyalgia. Now a ‘trigger point exam’ is merely considered a part of the diagnostic process. A key indication for the disorder is if a person complains of widespread pain for more than 3 consecutive months, and after being sufficiently medically assessed, there is no apparent underlying medical condition that is causing pain, a doctor may diagnose fibromyalgia.

In some instances, a primary healthcare provider may refer a person to several specialists, where they feel most necessary to assess specific symptoms, which collectively will assist in making a diagnosis. For instance, if it appears that you have arthritis, you may be referred to a rheumatologist to confirm this and assess your overall condition.

Your doctor will want to discuss your overall symptoms with you at the beginning stages of your initial consultations. You will be asked to detail any medical ailments or concerns you’ve had in the past, as well as discuss (as much as you know) any that have affected a relative in your family. Your doctor will also ask you a series of questions to gain a clear understanding about your current symptoms. In addition, he/she will ask you about any medications or supplements you are currently taking or have recently taken.

You may be asked if you have recently been through a traumatic event that has affected you either in a mental or physical capacity. Sometimes conditions such as post-traumatic stress disorder (PTSD) or an event such as a car accident can lead to fibromyalgia.

You are also likely to be asked about your sleeping habits and whether or not you feel rested. If you do not, your doctor may ask you to rate how your ill-rested state is affecting various areas of your life, as well as your overall mood.

From there your doctor will conduct a full physical exam. Part of the exam will be to assess your trigger points and the degree of discomfort you are experiencing in each area of the body. Your doctor will also be taking note of your overall appearance and noting anything that may be helpful in making a diagnosis. If you appear to be extremely tired, for instance, you may be asked about your sleeping habits and whether you are experiencing any stress or depressive emotional problems.

A neurological exam may follow a physical to test the responsiveness of muscles and joints in the body, and if necessary, you may be referred to an appropriate specialist to investigate for further assessment.

The basic diagnostic criteria your doctor will use will essentially address the below key areas:

• Has the patient experienced pain in the body for at least 3 consecutive months?
• Are the other symptoms present, such as concentration problems, extreme fatigue and a constant occurrence of waking up feeling ill-rested and tired (especially if a person is getting at least 8 hours of sleep each night)?
• Is there no other possibility of another underlying condition that may be causing any of the symptoms being experienced?

Are there any tests involved?

Since a definite cause of this disorder is yet to be determined, there is currently no single test that can be done to definitively diagnose fibromyalgia. It cannot be detected in your blood or obviously seen on a scan or X-ray. As symptoms fluctuate (come and go) due to changes in how the brain and spinal cord process signals of pain in the body, a diagnosis cannot be done with a single test either. You may be physically assessed by your doctor and feel pain and tenderness in 11 trigger points on the body on one day, and 8 on another, for example. Neither instance can then confirm the disorder, nor rule it out altogether.

Tests may, however, be recommended and together with a collective of findings relating to your group of symptoms, contribute towards a diagnosis. Tests will help your doctor to rule out the possibility of any other known medical condition (such as rheumatic disease, mental health problems or neurological conditions) which may be causing your overall symptoms. Your doctor and other specialists will carefully assess any and every possibility, which can make a diagnosis a long process to go through.

Blood tests which may be recommended include:

• A complete blood count (CBC)
• Thyroid function tests
• Measuring Vitamin D levels
• Erythrocyte sedimentation rate
• Cyclic citrullinated peptide test