How is Fibromyalgia Diagnosed?
Updated: May 2
If Fibromyalgia could be summarized in one word, that word would be PAIN.
Sufferers of Fibromyalgia experience soreness, tenderness, and pain ranging from a throbbing ache to a burning sensation or a feeling like needles are stabbing them.
Fibromyalgia is a chronic condition that leaves people so sensitive that even the slightest touch causes them to feel pain.
The medical translation of the term, Fibromyalgia is “pain in the muscles, ligaments, and tendons.” However, if you have Fibromyalgia, you know that this definition falls far short of explaining the range of effects the condition causes you.
Besides chronic pain, Fibromyalgia is also characterized by overwhelming fatigue, muscle stiffness, sleep disturbance, brain fog, mood changes, headaches, migraines, irritable bowel symptoms, and more.
Fibromyalgia can be extremely difficult to diagnose. There's no specific medical test, no accurate blood test or x-ray, and varying ways to diagnose Fibromyalgia. In addition, the degree of difference in type and frequency of symptoms in people with Fibromyalgia can make a proper diagnosis elusive. Unfortunately, leading to many instances of misdiagnosis.
Searching for a diagnosis and relief from Fibromyalgia symptoms can be frustrating, and sufferers can experience a drawn-out process of medical tests to rule out other conditions. Fibromyalgia can mimic; Lyme disease, Multiple Sclerosis(MS), Chronic Fatigue Syndrome (CFS/ME), Rheumatoid arthritis, Lupus, and vitamin deficiencies. It can take approximately 1-2 years to properly gain a diagnosis.
If health professionals have not connected the dots, attributed the symptoms to alternative conditions, or treated the symptoms in isolation, sufferers may experience medical gaslighting. Healthline clearly defines gaslighting as the "repeated denial of someone's reality in an attempt to invalidate or dismiss them" and states that gaslighting is a form of emotional abuse.
Many people with Fibromyalgia experience condescending attitudes from doctors and even loved ones, hinting at hypochondria, not having a “real” diagnosed condition, or even being accused of drug-seeking.
Rheumatologists are often the best doctor to diagnose Fibromyalgia. First, they will run blood tests to rule out rheumatic diseases (autoimmune and inflammatory diseases). Then they should assess your symptoms according to the American College of Rheumatology guidelines.
According to the guidelines set up by the American College of Rheumatology, you have Fibromyalgia if you meet the following criteria:
You experience near-constant pain in all four quadrants of your body for at least three months. This includes having pain on both sides of the body and pain localized above and below the waist level.
You have other symptoms such as fatigue, waking up unrefreshed, and cognitive problems (such as poor memory).
You have no other health problem that might be causing your symptoms.
Older diagnostic guidelines required you to experience tenderness in at least 11 of the 18 listed tender points throughout your body. The revised criteria for Fibromyalgia lessened the role of trigger point tenderness in the diagnosis, even though many doctors still use this as a factor in making the diagnosis.
The American College of Rheumatology proposed using the widespread pain index (WPI) instead of trigger point tenderness. The WPI used a checklist involving nineteen areas of the human body.
With the WPI, the patient gives a positive check-mark if they experienced pain within the previous seven days. Nineteen different body areas are included so that a given patient could have a score between 0 and 19.
In addition, the severity of the various symptoms in four different categories that are not related to pain, such as mental symptoms, urinary tract symptoms, and gastrointestinal symptoms, are taken into consideration.
The areas are scored from zero to three, so the total possible score in this section is 12. This part of the evaluation is called the symptom severity score or SS. Both the WPI and the SS are taken into account when diagnosing Fibromyalgia.
TRIGGER POINT EVALUATION
Some doctors still evaluate Fibromyalgia using the method of trigger point evaluation, also called the tender point evaluation. Even though the latest recommendations have minimized this examination, many doctors still feel that assessing these trigger points is an integral part of the evaluation.
The tender points are localized around (not within) joints in the body and usually just beneath the skin's surface. The doctor will press on each area with a single fingertip during a trigger point evaluation. The amount of pressure used is just enough to cause the nail bed to whiten. The doctor will then ask the patient if they feel pain from the touch.
When examining for tender points response, doctors will also test control points on the patient. These are points on the body that usually won’t cause the same pain reaction as the Fibromyalgia sufferer's tender points.
A person who suffers from Fibromyalgia may feel that the entire body is tender because of the extreme pain that radiates over the whole body.
NEXT: Fibromyalgia Tender Points; 9 specific pairs (18 points in all) assessed for pain when pressure is applied.
FIBROMYALGIA TENDER POINT:
The back of the neck contains significant pain points. Tender points can be at the base of the skull, where the shoulders meet the neck, and anywhere in between. There's also a strong likelihood of referred pain with the neck area, which means another area of pain is causing pressure on nerves, causing pain to radiate to the neck.
This pressure can result in a sensation of pain in a seemingly unrelated area. Therefore, your doctor will likely check for various related points in the neck.
The front of the neck is also strongly related to pain, so the whole neck can become very painful in this condition. In particular, muscular points of pain at the front of the neck are the big muscles at the sides of your head.
These muscles are called the sternocleidomastoid muscles and are involved with a wide range of neck movements. Therefore, one of the significant reasons Fibromyalgia causes such intense neck pain, possibly frequent headaches, and sleep problems.
Elbow pain also seems to be expected in Fibromyalgia. Keep in mind this is also a common site of injuries. Your elbows are aching doesn’t necessarily mean you have the condition in question.
If you do a lot of lifting or twisting motions with your arms regularly, you may develop a condition known as elbow tendonitis, or commonly called "tennis elbow". With Fibromyalgia, the elbow pain will be persistent and usually felt on the outside and the center of the arm.
The hips are another major pain point in Fibromyalgia. Hip pain is also often of significant concern for osteoarthritis and rheumatoid arthritis. Fibromyalgia pain in this area is not felt in the joints. Instead, it is centered in the gluteus maximus and gluteus minor muscles.
In plain English, this means your butt muscles hurt most of the time. Sitting can become excruciating, and standing may also hurt at times. In addition, this pain is a major contributor to sleep problems associated with Fibromyalgia.
The next major point is the lower back. There are multitudes of physical problems which can cause lower back pain. Sitting for lengthy periods can cause pain here. Standing too much can also do the same. A lack of exercise and being overweight can cause this pain. Injuries are a culprit too.
How is it experienced when people are dealing with Fibromyalgia? How is it different? There are usually two distinct trigger points right at the top of those butt muscles. Even gentle pressure on these little indentations above the hips will induce severe pain.
The knees hurt, which is another point that requires some clarification yet is usually involved with Fibromyalgia points. There are many potential knee problems. Your physician will most likely need to run some tests to determine if you might have an untreated injury or other serious issues that require different treatment.
The distinct nature of Fibromyalgia pain in the knees is that pain and sensitivity are mainly on the back of the knees, on the soft side. Mechanically, this is a bundle of nerves and tendons related to the buttocks and lower back support.
So far, all of these pain points are related to bodily support muscles or muscles, which hold you up and make you functional in general life activities. For example, the upper back is a point of Fibromyalgia pain related to shoulder and neck support.
Actual pressure points are between the spine and shoulder blades. In the same area, we often see people rubbing in states of fatigue.
With Fibromyalgia, these muscles called the trapezius muscles would hurt almost all of the time, contributing to neck pain, displacing the shoulders, and leading to balance issues and, ironically, neck pain.
Chest muscles are checked for pain by doctors to make a diagnosis. Sudden chest pain is not the same as what is being described here. If you have sudden chest pain and/or shortness of breath, dial 911 immediately. Any chest pain should be addressed by a physician.
Chest pain caused by Fibromyalgia will focus on one or both sides of the sternum. The sternum is the long bone down the center of your chest; the pain points are close to this bone and its connections to the ribs. In addition, the pain is localized, and not connected with side chest muscles or breathing muscles.
➤ Even though Fibromyalgia's tender points are predictable, medical professionals using trigger point evaluation don't usually conclusively diagnose Fibromyalgia by relying on that examination alone.
Other symptoms that will assist a doctor in confirming a diagnosis may include extreme fatigue, depression, irritable bowel syndrome, sleep disorders, and more.
In addition, reviewing medical history, the duration and severity of symptoms, and response to medications and treatments may also assist in obtaining an accurate diagnosis.