How Do They Test For Fibromyalgia?

Fibromyalgia (FM) is a painful and debilitating condition that according to medical experts affects at least ten million people in the U.S. alone. Researchers have discovered persistent toxicity and chronic stress to be the main causes of fibromyalgia. The exact statistics on how many people are actually suffering from this condition is unknown. The last time the Centers for Disease Control and Prevention (CDC) reported on the number of people diagnosed with fibromyalgia was in 2005 – which at the time was 5 million cases.

In a 2011 research paper, the world renowned fibromyalgia researcher, Daniel Clauw, M.D. reported: “FM remains undiagnosed in an estimated 75% of people with the disorder….it is thought that FM remains undiagnosed in as many as 3 of 4 people with the disorder.” So the prevalence of fibromyalgia may be as high as forty million people, just in the U.S.

How To Diagnose Fibromyalgia?

When a patient presents complaining of chronic widespread pain and fatigue, the first step is to rule out the most common disease processes that could be the cause of these symptoms.

Routine laboratory testing of a blood sample can screen for the following common diseases that can cause widespread pain and fatigue: Lyme disease, Systemic Lupus Erythematosus (SLE), autoimmune disorders, connective tissue disease, hypothyroidism and other endocrine disorders , rheumatoid arthritis, polymyalgia, liver disease, and hypovitaminosis D (Vitamin D deficiency).

In addition, neurological testing should be used to rule out Multiple Sclerosis.

Once medical testing confirms the absence of the above conditions, then the American College of Rheumatology (ACR) diagnostic classification criteria can be followed for fibromyalgia diagnosis.

American College of Rheumatology

First the 1990 diagnostic criteria stated: Patients can be classified as having fibromyalgia if they have the following symptoms and findings:

  • Widespread musculoskeletal pain for at least 3 months,
  • Excess tenderness in at least 11 of 18 specific sites known as “tender points.”

american college of rheumatology fibromyalgia 2010
The 1990-2010 preliminary and modified 2010 American College of Rheumatology criteria

Then in 2010  the ACR developed a different set of criteria as the preliminary diagnostic criteria for fibromyalgia. These new criteria do not require a tender point examination, which was very difficult for many physicians to perform. These new criteria allow for the diagnosis to be made based upon combined numerical scores for the extent of widespread pain and for the severity and extent of symptoms. These criteria require the assessment of 3 key elements:

  • Presentation of chronic widespread pain in all 4 quadrants of the body for at least 3 months.
  • Widespread Pain Index (WPI)  that assesses the number of painful body areas –The WPI is essentially a list of 19 different body regions, which is used to record the number of painful regions.
  • Symptoms severity (SS) scale – The SS scale consists of categorical scales that assesses severity for fatigue, unrefreshed sleep, and cognitive symptoms, as well as the other somatic symptoms.

So fibromyalgia diagnosis is straight forward when you follow this simple two step process:

1. Have a physician rule out the most common disease processes that could be the cause for chronic widespread pain and fatigue (as discussed above), and

2. See a  rheumatologist who is fully familiar with the American College of Rheumatology (ACR) diagnostic criteria for fibromyalgia.

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