No specific laboratory or imaging test can diagnose fibromyalgia. Doctors usually rely on a comprehensive patient history, a thorough physical examination, and a few blood tests to rule out illnesses with similar symptoms.
Healthcare professionals may follow different diagnostic protocols, but all procedures focus on evaluating your pain, fatigue, and other related symptoms.
In 1990, the American College of Rheumatology (ACR) established classification criteria for fibromyalgia to assist clinicians in diagnosis. They diagnose a person with fibromyalgia if widespread musculoskeletal pain occurs along with excessive sensitivity in at least 11 of 18 designated “tender points” during a clinician’s examination.
In 2010, the ACR introduced updated diagnostic criteria. These criteria no longer require a tender point examination. Instead, clinicians assign a numerical score based on the extent and severity of a person’s pain. They also assess additional symptoms such as fatigue, cognitive difficulties (like trouble thinking clearly), and pain-related conditions such as headaches or gastrointestinal issues.
The Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTION)-American Pain Society (APS) Pain Taxonomy (AAAPT) suggests alternative criteria. These include multisite pain—pain in at least six of nine possible locations—and moderate to severe sleep problems or fatigue lasting at least three months.
If you have fibromyalgia symptoms, your doctor should take a medical history and perform a physical exam to rule out arthritis, other connective tissue issues, neurologic illnesses, and other disorders. Doctors may perform routine laboratory tests to rule out conditions such as inflammatory arthritis, thyroid disease, and muscle disorders. Most fibromyalgia patients show normal results on these tests.
Since fibromyalgia often causes symptoms beyond muscle pain—like chronic fatigue, headaches, unusual pain sensations, and sleep or mood disturbances—your doctor may recommend additional evaluations:
Sleep evaluation: Your doctor may take a detailed sleep history. If they identify a sleep disorder, such as restless legs syndrome or sleep apnea, you may be referred to a sleep specialist for further examination and treatment.
Mental health assessment: If you show signs of depression or anxiety, your doctor may refer you to a mental health professional for further evaluation or treatment.
Conditions that are related to fibromyalgia
In certain circumstances, evaluating whether a person’s signs and symptoms are due to fibromyalgia or another ailment can be a lengthy and difficult procedure. Many conditions can produce widespread muscular pains, exhaustion, and other fibromyalgia symptoms.
Fibromyalgia can develop in persons who have rheumatoid arthritis, systemic lupus erythematosus, osteoarthritis, and other disorders (see below). If this is the case, determining whether your symptoms of persistent pain and exhaustion are caused by fibromyalgia or another ailment may be challenging. This frequently necessitates consulting with a rheumatologist.
A sample of illnesses that your doctor may explore throughout the diagnosis procedure is as follows:
Rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) –
RA is a chronic condition that causes joint inflammation, resulting in pain, edema, and probable joint deformity. SLE is also a chronic, inflammatory connective tissue illness that can affect several organs.
Although RA and SLE have many symptoms with fibromyalgia, they also have traits that fibromyalgia patients do not experience, such as inflammation of the synovial membranes (the connective tissue that lines the spaces between bones and joints).
Osteoarthritis (OA) –
OA is a condition that causes stiffness, soreness, discomfort, and probable joint deformities in elderly people. Doctors can tell the difference between OA and fibromyalgia based on a patient’s medical history, physical examination, and x-ray data (in OA, x-rays can show degenerative joint changes that are not present in fibromyalgia).
Ankylosing spondylitis (AS) –
AS is a chronic, progressive inflammatory disease that affects the spine’s joints. This disorder causes spine stiffness, discomfort, and limited mobility. AS also generates distinctive x-ray results that are missing in persons with fibromyalgia. Spinal motion and x-rays, on the other hand, are frequently normal in persons with fibromyalgia.
Polymyalgia rheumatic (PMR) –
PMR is a chronic, inflammatory disorder that produces stiffness and discomfort in the shoulders, hips, and other joints. The condition, which typically affects persons over the age of 50, is commonly linked to inflammation of particular major arteries. A person’s medical history, physical examination, and blood tests are used to distinguish PMR from fibromyalgia.