How is Fibromyalgia diagnosed?

After years of research, a team of rheumatologists established definitive criteria for diagnosing fibromyalgia (FM).  In 1990, the American College of Rheumatology (ACR) defined and published these FM criteria (Wolfe et al, 1990). FM is diagnosed by:

1. A chronic history of widespread pain for a minimum of three months in all four quadrants of the body.
2. Pain upon digital palpation in 11 of 18 tender points that cluster around the neck, shoulder, chest hip, knee, and elbow regions of the body.

The key is to determine the location and sensitivity of "tender points." Approximately 4 kg (10 lbs) of pressure is applied by the forefinger or thumb to each of 9 pairs of tender points located bilaterally on both torsos and the trunk. A positive test consisted of pain felt in 11 of 18 tender points. The pain is rated on a scale of 1 to 5. This is useful when your client is retested after a period of time to determine the effectiveness of your intervention program.

There are no blood tests or X-rays that can accurately confirm or rule out FM Also musculoskeletal and neurological exams may be normal. Therefore, laboratory tests are valid only to rule out other diseases. Since other diseases mimic the symptoms, it is necessary to rule them out before making a diagnosis. Yet, it is not unusual for other diseases, such as arthritis, lupus, CFS, MPS, and Lymes to exist co-morbidity with FM.

Certain symptoms are essential for the diagnosis of FM. Therefore a complete medical history and physical examination including tender point analysis is necessary. The health history should include: activities of daily living, sleep habits, and how the patient copes with, or perceives these inherent life stressors. In most cases there is some disruption in the patients quality of life.

Presently the diagnostic criteria of tender point palpitation, pain, and fatigue are not without problems. Tender point pain can vary from day to day, may not be unilateral, number of tender points may be below the required 11, fibros may be more sensitive to pain, tender point locations may move, the prescribed 4 kg of pressure applied by the physician is difficult to standardize without a force transducer, and professional experience in diagnosing FM is highly variable and may yield erroneous results. New research shows promise of a definitive tool.

Dr. Stuart Donaldson claims there may be a signature spike in the EEG's (brain scans) of fibros, which may provide a marker. In addition, recent data presented by Dr. Wilson has shown the presence of an anti-polymer antibody (APA) present in greater amounts in severe cases of FM (61%) vs. mild FM (39%) vs. control (19%). He found that the pain response was somewhat related to the level of APA, and suggested the possible use of an APA assay as a marker in the diagnosis of FM.

The average fibro can suffer for years with FM, go from physician to specialist, spend thousands of dollars and unnecessary surgeries before he finds a physician that accurately diagnosis their condition. The unending list of symptoms with varying degrees of intensity and the fact that not all fibros have the same symptoms or what appears to be unexplainable and unlinked symptoms make it a difficult illness to diagnose. Perhaps, the most telling criticism is the presence of similar symptoms among individuals who do not have FM. For example, there is a 75% overlap in FM symptoms between CFS and diagnosed FM patients. In addition, people who suffer from arthritis or lupus experience many of the same symptoms. Even "normal" individuals display some of the classic symptoms of FM, including pain, fatigue, tender points, reduced levels of growth hormone and thyroid hormone, and even alpha wave intrusion in their slow wave (i.e., delta wave) sleep patterns resulting in lower levels of IFG-1 and lack of muscle restoration the following day. This makes the diagnosis of FM very problematic.

Here is a scenario to further illustrate the difficulty in diagnosing FM. One of the authors was diagnosed 6 years ago with sero-negative rheumatoid arthritis. One year later, after a visit to Mayo Clinic, the diagnosis was changed to sero-negative lupus. Then four years ago, FM was determined to be the true cause of her discomfort and pain. As seen from Figure 3, the illness is characterized primarily by pain. It is not the type of pain that necessarily gets worse with time, nor does it result in death, but there are many characteristics associated with FM that are truly debilitating (Figure 4)

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