Making an initial diagnosis is often the most difficult step in treating fibromyalgia. Because the cause of fibromyalgia is not directly known and the symptoms show great overlap with those of several other diseases, your physician will look for symptoms specific to fibromyalgia while ruling out other conditions through a variety of tests.
Physicians that practice the specialty of rheumatology are leading experts in the diagnosis and treatment of fibromyalgia. Over the years, long-term care has evolved to embrace input from multiple physicians across diverse specialties, such as psychiatry, neurology, and immunology.
Fibromyalgia most often includes the following symptoms:
- chronic pain across large regions of the body
- painful responses to pressure in specific regions such as the shoulders, hips, back, chest and neck
- joint stiffness, especially upon waking
- extreme fatigue
- sleep disturbances
- one or more of the following: anxiety, depression, memory problems and inability to concentrate
Chronic widespread pain lasting for three months or more is the universal feature of fibromyalgia. This is usually what drives the patient to seek medical help from his or her physician and is the first symptom a physician will assess. If it is present, fibromyalgia might be the cause. If your initial visit is to a primary care doctor, you may be referred to a rheumatologist, who is an expert in conditions that involve musculoskeletal pain.
Ruling Out Other Conditions
Many symptoms seen in patients with fibromyalgia can be due to other illnesses. One of the important steps to a diagnosis is to ensure that symptoms like pain, extreme fatigue, and sleep disturbance are not caused by a disease that requires immediate treatment. Blood tests can check for lupus and rheumatoid arthritis, while thyroid function analysis provides the physician with proof that extreme fatigue, trouble sleeping and cognitive impairment are not caused by abnormal thyroid activity.
If the physician determines that a patient’s chronic widespread pain and other symptoms are not better explained by a different condition, the doctor will administer a clinical symptom checklist that tests for fibromyalgia.
In 2010, a dedicated group of rheumatologists with the American College of Rheumatology published a new and updated checklist for assessing patients believed to have fibromyalgia. Patients fill out this survey by selecting from the list symptoms they have and rating the severity of each symptom using a typical 1-10 scale, with 10 being most severe. The treating physician will tally the results and score the test.
The Final Diagnosis
The final decision regarding whether a patient has fibromyalgia will be made on the basis of the three primary factors discussed above. A positive diagnosis requires the patient meet three criteria:
- chronic symptoms lasting at least three months
- a fibromyalgia checklist score at or above the determined cutoff
- negative test results for other diseases that could explain the symptoms