Fibromyalgia Diagnosis

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Published: September 5, 2017
Last reviewed: October 23, 2017

A primary doctor or a specialist, usually a rheumatologist, can make a diagnosis of fibromyalgia from your symptoms and physical examination and after tests for similar conditions.

Tender Points

The old 1990 diagnostic criteria for fibromyalgia required the presence of at least 11 out of 18 possible tender points located on both sides of the body and above and below the waist (Picture 1).

Fibromyalgia Tender Points

Picture 1. Tender points map in fibromyalgia

The new diagnostic criteria for fibromyalgia introduced in 2010 by American College of Rheumatology and reviewed in 2016 include [1,3,11]:

  1. Body pain in at least 4 of 5 body regions is present.
  2. Pain and other symptoms, such as fatigue and mood changes, have been present at a similar level for at least 3 months.
  3. Symptoms are of a certain severity (explained in detail here).
  4. A diagnosis of fibromyalgia does not exclude the possibility of other health conditions.

If you have fibromyalgia, you can have tender points but also trigger points [4]. Trigger points, which are typically associated with muscle knots, are not a sign of fibromyalgia but a co-existing myofascial pain syndrome (Chart 1[14].

Chart 1. Tender vs Trigger Points

TENDER Points TRIGGER Points
In fibromyalgia In myofascial pain syndrome
No palpable lumps Muscle knots
In the muscle tendons In the muscle bellies
In most body regions In one or few body regions
Symmetrical (bilateral) Non-symmetrical
Applying pressure triggers pain only in the tender point Applying pressure triggers pain in the trigger point and a distant area
Massage, dry needling and injections do not relieve pain Deep massage, stretching, dry needling and injections can relieve pain

Char 1 references: 4,5,6

Tests and Investigations

Fibromyalgia currently cannot be detected by any known test [7,8]. According to the U.S. Food and Drug Administration (FDA), the FM/a test based on the cytokine levels in the blood is not reliable.

Before making a diagnosis of fibromyalgia, a doctor will likely suggest some blood tests (red and white blood cell count, sedimentation rate, mineral, vitamin and glucose levels, rheumatoid factor, antinuclear antibodies) or imaging investigations (X-ray, CT, MRI) to check for similar conditions (Chart 2).

Chart 2. Conditions Similar to Fibromyalgia

CONDITION SYMPTOMS
Adrenal dysfunction (Addison’s disease) [18] Severe exhaustion, muscle weakness, loss of appetite, craving for salt
Anemia [16] Shortness of breath after light exercise, paleness
Arthritis [27]:

  • Ankylosing spondylitis
  • Osteoarthritis
  • Rheumatoid arthritis
  • Sjögren’s syndrome
  • Systemic lupus erythematosus
Swollen and painful joints, rash, dry mouth and eyes
Chronic fatigue syndrome and myalgic encephalomyelitis (CFS/ME) [15] Fatigue, insomnia, memory problems, sore throatswollen lymph nodes
Diabetic neuropathy [10] Burning in the hands and feet
Ehlers-Danlos syndrome [17] Joint hypermobility and pain, loose skin, easy bruising
Hepatitis C [27,28] Abdominal, muscle or joint pain, jaundice, dark urine
Hyperparathyroidism [26] Excessive urination, nausea, bone and joint pains
Hypochondria Many complaints but no observable abnormalities
Hypothyroidism [19] Muscle weakness, sensitivity to cold, constipation, goiter, puffy face
Malingering Tenderness in the areas not typical for fibromyalgia (fingers, forearm)
Muscle disorders
  • Myasthenia gravis: muscle weakness, drooping eyelid, difficulty swallowing [21]
  • Polymyalgia rheumatica: pain, stiffness and weakness around the shoulders and hips; in elderly [22]
  • Polymyositis and dermatomyositis: muscle weakness and rash [23]
Neurological disorders
  • A pinched nerve due to a herniated disc: pain or tingling in the neck and arm or lower back and leg
  • Multiple sclerosis (MS): vision problems, muscle weakness and numbness [20]
  • Chronic inflammatory demyelinating polyneuropathy (CIDP): tingling, numbness and weakness in the hands and feet [12,24]
  • Small fiber neuropathy: burning feet and hands [13,25]
Systemic inflammation or infection (infectious mononucleosis, influenza, Lyme disease, sarcoidosis) Fever or rash, sore throat, cough, fatigue, muscle pain, swollen lymph nodes
Vitamin B1, B6, B12, D or mineral (potassium, calcium) deficiency [29] Muscle weakness, hair loss, brittle nails, scaly skin, cracked lips

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