Fibromyalgia - Diagnosis

Highlights	Conditions with Similar Symptoms	Medications
Introduction	Prognosis	Resources
Causes	Treatment	References
Risk Factors	Lifestyle Changes
Diagnosis	Behavioral Therapy

Diagnosis

There is no unequivocal objective method for diagnosing fibromyalgia. The criteria used for studying fibromyalgia are very helpful, particularly if the patient does not have any accompanying disorder, such as depression or arthritis, which could complicate the diagnosis. Failure to meet the criteria, however, does not rule out fibromyalgia.Fibromyalgia should be suspected in any patient with muscle and joint pain when no identifiable cause has been found.

Criteria for Classifying Fibromyalgia

In 1990, the American College of Rheumatology (ACR) established the following criteria for the classification of fibromyalgia.

A. Widespread pain must persist for at least three months. This pain must appear in all of the following locations:

Pain on both sides of the body
Pain above and below the waist
Pain along the length of the spine

B.Pain inat least 11 of 18 specific areas called tender points on the body. The pain experienced when pressing on a tender point is very localized and intensely painful (not just tender). Tender points arelocated in the following areas:

The left or right side of the back of the neck, directly below the hairline
The left or right side of the front of the neck, above the collar bone (clavicle)
The left or right side of the chest, right below the collar bone
The left or right side of the upper back, near where the neck and shoulder join
The left or right side of the spine in the upper back between the shoulder blades (scapula)
The inside of either arm, where it bends at the elbow
The left or right side of the lower back, right below the waist
Either side of the buttocksbelow the hip bones
Either knee cap

Other Factors. The ACR classification provides a guideline, but doctors will also use a patient?s medical history and other symptoms in making a diagnosis. Fibromyalgia is often diagnosed when other diseases have been excluded. Long-term symptoms that may indicate fibromyalgia include:

Morning stiffness
Fatigue
Sleep disturbance
Numbness or tingling in the hands and feet
Headache

The 18 fibromyalgia tender points are located throughout the body. According to the American College of Rheumatology, a diagnosis of fibromyalgia requires widespread body pain pluslocalized painin 11 of these 18 specific points.

Medical and Personal History

A doctor should always take a careful personal and family medical history, which would include a psychological profile and a history of any factors that might be indicative of disorders other than fibromyalgia. Such factors might include recent weight change, physical injuries, infectious diseases, muscle weakness, rashes, and any instances of sexual, physical, or substance or alcohol abuse. The patient should report any drugs being taken, including vitamins and over-the-counter or herbal medications.