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FIBROMYALGIA (FM) DIAGNOSIS View the Tender Points of the body

Fibromyalgia syndrome (FM) is a diagnosis of exclusion. That means before doctors can give you an FM diagnosis, they need to rule out a host of other conditions with similar symptoms. Typically, they'll order blood tests for hypothyroidism, infections, polymyalgia rheumatica, rheumatoid arthritis or lupus.

Doctors may also order other lab and imaging tests. Until recently, no test could definitively diagnose fibromyalgia, but a new blood test is now showing promise in some preliminary studies. It involves antipolymer antibodies, which may be found in about half of the people with Fibromyalgia.

Learn more by viewing the links below:


American College of Rheumatology

The American College of Rheumatology in 1992 established two criteria for a diagnosis of Fibromyalgia:

  • Pain in all four quadrants of the body and in the axial skeleton (bones of the head, throat, chest and spine) that's been present on a more-or-less continuous basis for at least three months.

  • A physical examination which includes a tender point exam. The criteria used for diagnosis is widespread pain for a duration of more than 3 months. Also, pain in 11 of the 18 tender point locations when a pressure of 4 kgs is used at the tender point location. The photo above indicates the 18 tender points on the body.  Click here for more information about Tender Points

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Exams and Tests

Remember, these tests aren't to diagnose fibromyalgia; they're to eliminate any other possible conditions. The doctor may order:

  • Anti-nuclear Antibody (ANA) Test:
    • Anti-nuclear antibodies are abnormal proteins that can be in your blood if you have lupus, a condition with symptoms similar to fibromyalgia). The doctor will want to see if your blood has these proteins in order to rule out lupus.

  • Blood Count:
    • By looking at your blood count, your doctor may be able to see another cause for your extreme fatigue, such as anemia.

  • Erythrocyte Sedimentation Rate (ESR):
    • An ESR test measures how quickly red blood cells fall to the bottom of a test tube. In people with rheumatic disease (such as rheumatoid arthritis), the ESR or "sed rate" is sometimes higher. The red blood cells fall quickly to the bottom of the tube, which suggests that there is inflammation in the body.

  • Rheumatoid factor (RF) Test:
    • In many patients with an inflammatory condition (such as rheumatoid arthritis, which has symptoms similar to fibromyalgia), a higher level of the rheumatoid factor can be identified in the blood. A higher level of RF doesn't guarantee that your pain is caused by rheumatoid arthritis (RA), but doing an RF test will help your doctor explore the possibility of an RA diagnosis.

  • Thyroid Tests:
    • These tests will help the doctor rule out thyroid problems.

  • Post Exertion P4 and A3 Receptor Test:
    • In this blood test, the vast majority of FM and CFS/ME sufferers will show a dramatic increase in A3 and P4 levels following 25 minutes of moderate activity. People without FM or CFS/ME will show no change in A3 and P4 levels.

  • Comprehensive History of Present Condition:
    • Most necessary information in discerning between types of FM can be gathered through a comprehensive history.

  • Infection Testing:
    • If your condition is suspected to have an infectious component, blood testing for common antigens is necessary. Common culprits include Lyme's Disease, Epstein‐Barr Virus, and Candida. In cases in which a specific antigen is not suspected, comprehensive panels to assess for viral, bacteria, and fungal infections are most beneficial.

  • Adrenal Stress Index (ASI):
    • The ASI monitors cortisol levels throughout a 12 hour period. Cortisol should be highest in the morning and lowest at night. Many FM and CFS/ME sufferers show a different pattern. This strongly suggests adrenal fatigue.

  • Hormone Testing:
    • Since FM and CFS/ME are strongly related to the HPA Axis, and thus the hormone system, it is important to test hormone levels. Important hormones to test include cortisol, estrogen, progesterone, testosterone, and the thyroid hormones.

  • Vital Signs:
    • Thyroid and adrenal dysfunction can often be suspected through heart rate, respiration rate, blood pressure, and other observed signs.

  • Cervical Xrays/MRI:
    • The results suggest or rebut the potential for CNS miscommunication via the cervical spine.

  • Nutrient and Toxic Elements Panel:
    • This blood test assesses toxin exposure and nutrient levels in the body. These are factors in many FM and CFS/ME cases.

  • Natural Killer Cells (NKC):
    • Every FM and CFS/ME sufferer should know their NKC levels due to an increased risk of cancer in people with chronic muscle pain, which is linked to low NKC levels.

  • Other Tests:
    • There are many condition‐specific tests that may be beneficial in diagnosing and determining the most appropriate treatments for your specific case.

Remember

Diagnosing fibromyalgia can take awhile. Your job as a patient is to be proactive in the diagnostic process; be your own advocate.

For example, when your doctor orders a test, ask why. Be sure you understand what the results will tell you and how that test will help figure out your pain. If you don't understand the results or reasoning, keeping asking questions until you do.

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Types of Doctors Treating Fibromyalgia

Here is a list of some of the doctors who specialize in treating FM and pain:

  • Rheumatologists diagnose and treat arthritis and other diseases of the joints, muscles, and bones. This includes FM, rheumatoid arthritis, osteoarthritis, gout, lupus, back pain, osteoporosis, bursitis, and tendinitis.

  • Pain Specialists are usually board certified anesthesiologists, neurologists, physiatrists, psychiatrists, or oncologists with additional training in pain management. They receive credentials from the American Board of Anesthesiology (ABA) in collaboration with the American Board of Physical Medicine and Rehabilitation (ABPMR) and the American Board of Psychiatry and Neurology (ABP&N). Or they may receive credentials from the American Board of Pain Medicine.

  • Neurologists diagnose and treat disorders of the nervous system. This includes treating common pain problems such as headaches, back pain, muscle disorders, FM, neuropathy (carpal tunnel syndrome), and reflex sympathetic dystrophy (RSD).

  • Physiatrists are doctors who specializes in physical medicine and rehabilitation (PM&R). Physiatrists are specially trained to diagnose, manage, and treat symptoms of acute and chronic pain. They also treat injuries and diseases of the musculoskeletal and neuromuscular systems.

  • Psychologists diagnose and provide therapy for problems associated with pain, perception, and emotional issues.

Finding a doctor who's willing to effectively diagnose and treat fibromyalgia is still difficult. To help in your search we have put together a database of doctors who treat Fibromyalgia and/or CFS/ME.

Doctors who have been verified by us as treating Fibromyalgia are listed as Treats FM. Doctors verified by us as treating CFS/ME are listed as: Treats CFS/ME.

Doctors referred to us by one or more of their patients are listed as: Patient Recommended.

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FM & CFS/ME

While Fibromyalgia (FM) and Chronic Fatigue Syndrome/ Myalgic Encephalomyelitis (CFS/ME) are two different conditions, 50-70% of FM patients also meet the criteria for CFS/ME.

People with CFS/ME are often tired, while those diagnosed with FM complain of pain. They often have swollen glands, sore throat, and fever which many FM patients don't have. However, it's not unusual for FM patients to also have CFS/ME. Researchers are still unsure if FM is the result of a virus, while most agree that CFS/ME is viral in origin.


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Sources:

  • Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia: report of the multicenter criteria committee. Arthritis Rheum. 1990;33:160-72.

  • Criteria for Diagnosis, Fibromyalgia Syndrome (FMS), Sullivan PF, et al. Psychological Medicine 32:881-888, 2002.

  • National Fibromyalgia Association: "Fibromyalgia: How is it diagnosed?"881-888, 2002.

  • National Fibromyalgia Association: "Fibromyalgia: What is the prognosis?"881-888, 2002.

  • National Institute of Arthritis and Musculoskeletal and Skin Disorders (NIAMS): "Fibromyalgia."881-888, 2002.

  • McIlwain, H, MD, and Bruce, D, PhD. The Fibromyalgia Handbook, Holt, 2007.881-888, 2002.

  • Fibromyalgia Research Review 2010, What's Wrong With Me? A Comprehensive Look at Fibromyalgia Syndrome and Chronic Fatigue Syndrome, Colorado Fibromyalgia Center, http://www.coloradofibromyalgia.com, Accessed Nov. 20, 2009.
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