Arriving At The Diagnosis Fibromyalgia

Arriving At The Diagnosis Fibromyalgia

It is not an easy process to arrive at the diagnosis of fibromyalgia. A patient arrives in the office complaining of constant pain and fatigue. There are numerous illnesses and conditions that have pain and fatigue as symptoms. A process of elimination of possible diagnoses begins with a medical history, list of symptoms and the onset of each symptom and also a complete physical examination. After all those things are done there are routine tests that can be run that together with the symptom list, medical history and physical examination will start to narrow down the possibilities regarding a diagnosis.

The Symptoms:

The symptoms that are typically experienced when a person has fibromyalgia are widespread pain, fatigue, irritable bowel syndrome, sleep disorders, chronic headaches, jaw pain, cognitive or memory dysfunction, morning stiffness or morning muscle pain, numbness or tingling in the feet and hands, dizziness or a light headedness, skin and or chemical sensitivities, and if female the patient may have painful menstruation.

What complicates the scenario is the fact that although you may have one particular disease or condition there may also be associated diseases or conditions that you also have going on inside your body. An example would be that you very well may have fibromyalgia but you also suffer from sleep apnea, which is a sleep disturbance, and you may also suffer from migraines and irritable bowel syndrome.

Typically laboratory testing will reveal normal results and because many of the symptoms are also characteristic of many other conditions, disorders and illnesses arriving at a diagnosis is going to be a journey in which the doctor will use the medical history, and physical examination along with the results from the blood work, and x-rays to rule out a whole list of other possible diagnoses including anemia, bone disease, cancer, hormonal imbalances, infection, joint disease, nerve disease, muscle disease, osteoarthritis, polymyalgia rheumatica, and rheumatoid arthritis.

Your doctor may order an electromyography (EMG) or a nerve conduction velocity (NCV) test in order to check the muscle and nerves.

When your doctor is conducting the physical examination, he/she may check what is called the, fibromyalgia tender points. The individual with the condition, fibromyalgia will be sensitive to pressure over certain areas of the body that are called “tender points”. There are specific guidelines set for that are “diagnostic criteria” set for that patients must meet regarding these tender points. One symptom of fibromyalgia is that the patient with the condition will have widespread pain over four quadrants of the body for a minimum history of 3 months. The pain that is experienced in the presenting case in order to be considered to be “widespread”, must be present in all areas of the body that correspond to the left side of the body, the right side of the body, above the waist, below the waist, in the neck, in the front chest area, in the mid-back area, and in the lower back area.

There are 18 specific tender points illustrated in a diagram that the doctor will have and the patient must be sensitive to the touch in 11 out of 18 tender points on the diagram.

Since the symptoms of fibromyalgia change from day to day on the particular day the patient is at the doctor’s for diagnosis there may be less than 11 points of tenderness, this does not mean that they do not have fibromyalgia. Other days when the same patient is checked there may be more than 11 points of tenderness. Some patients with fibromyalgia will only have pain on one side of the body and not the other on a consistent basis so the criteria for diagnosing fibromyalgia is just a guideline for doctors to go by. When arriving at the diagnosis the doctor will take into consideration all the history, symptoms, examination findings including the tender points examination, and all testing. Your doctor may also ask for assistance in arriving at the diagnosis by referring you to a neurologist or rheumatologist for further evaluation before determining your diagnosis.