While there’s no definitive test to diagnose fibromyalgia, the American College of Rheumatology (ACR) has established criteria for identifying the disorder.
In the past, doctors would check the 18 tender points on the body to determine a person’s level of pain. Current guidelines don’t call for this kind of exam.
Instead, ACR guidelines suggest that doctors consider the following factors:
- How many areas of the body (out of 18) are painful
- Whether symptoms like fatigue, waking up unrefreshed, and difficulty thinking are present
- Whether these symptoms have lasted at least three months
- Whether any other condition might be the cause of these symptoms
Challenges in Diagnosing Fibromyalgia
Fibromyalgia is sometimes difficult to diagnose because many of its symptoms are similar to those of other disorders.
A diagnosis often requires excluding other conditions, rather than finding definitive proof that fibromyalgia is what you have.
“There’s very little to see on a physical exam” when someone has fibromyalgia, other than reported pain and tenderness, according to Don L. Goldenberg, MD, a rheumatologist and professor emeritus at Tufts University School of Medicine.
In addition, “laboratory tests are unremarkable,” and often give doctors little help, Dr. Goldenberg says.
You may end up seeing several doctors before getting an accurate diagnosis. This process may last longer than it should because of mistakes made by both doctors and patients, according to Goldenberg.
“Many patients with this condition will shop from doctor to doctor,” he says. “They’re sure that they’ve been injured or damaged, or there’s something in their environment. And they keep searching and searching.”
A diagnosis of fibromyalgia, says Goldenberg, requires accepting that your pain has no cause beyond the nervous system itself — and that it may, as a result, be more difficult to treat.
At the same time, doctors may prolong the diagnostic process by being either too deferential to — or too dismissive of — patients, Goldenberg says.
“A lot of doctors will order a lot of unnecessary tests,” he notes, due to patients’ desire to rule out improbable causes of their pain.
But more commonly, “Doctors will say, ‘It’s all in your head, toughen up,’” Goldenberg laments. “And of course that’s the last thing a person wants to hear.”
While Goldenberg doesn’t excuse this kind of behavior in doctors, he understands why some of them react so poorly to fibromyalgia.
“For a certain type of physician who likes things black and white, this is a real gray area,” he says. “There’s no cause and effect. The symptoms can be murky. The treatment is very murky.”
Ruling Out Other Conditions
Even if your doctor suspects that you have fibromyalgia, it may be desirable to rule out other, more serious conditions.
For example, “Widespread arthritis can cause pain in multiple areas,” Goldenberg notes. But most doctors can clearly distinguish pain due to arthritis from pain due to fibromyalgia.
If your doctor isn’t ready to diagnose fibromyalgia based on your symptoms and a physical exam alone, the following tests may be helpful:
- Complete Blood Count This test can help rule out a number of disorders, including anemia (inadequate red blood cells), infections, and leukemia.
- Erythrocyte Sedimentation Rate (ESR, or Sed Rate) This test can help reveal inflammatory processes throughout your body.
- Cyclic Citrullinated Peptide and Rheumatoid Factor These tests can help detect rheumatoid arthritis.
- Thyroid Function In some cases, it may be helpful to rule out a thyroid problem as the cause of your symptoms.
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