Criteria for Diagnosis and Diagnostic Tests

Fibromyalgia is characterized by chronic widespread pain (CWP) and may be the most common CWP syndromes (Perrot, Dickenson & Bennett, 2008). Diagnosis includes a full medical history plus physical examination. The medical history should indicate CWP for at least 3 or more consecutive months (Huynh, Yanni & Morgan, 2008).  In addition, complete blood work should be done testing specifically for thyroid, liver function, erythrocyte sedimentation, and muscle enzymes (Perrot et al., 2008).  Differential diagnosis includes rheumatological disorders (lupus, rheumatoid arthritis, ankylosing spoindylitis, etc.), neurological disorders (MS., peripheral neuropathies, etc.), muscle disorders (inflammatory myositis, metabolic myopathy, etc.); infectious disorders (HIV, viral hepatitis, Lyme disease); and endocrine disorders ( hyper thyroidism) (Huynh et al., 2008).  Repeated diagnostic tests need to be done over a period of time to ensure an accurate diagnosis(Perrot et al., 2008).  There is no specific test that will conclusively identify fibromyalgia; it is not a diagnosis of exclusion, however. (Huynh et al., 2008). The American College of Rheumatology (ACR) diagnostic criteria include CWP both above and below the waist  and a great deal of tenderness at a minimum of 11 of 18 specific sites (Perrot et al., 2008). If both these criteria are satisfied, fibromyalgia is differentiated from other chronic pain syndromes about 85% of the time (Huynh, 2008).

Risk factors for Fibromyalgia

Fibromyalgia occurs in both women and men, but is more prevalent in women than men (Perrot et al., 2008).  Other risk factors include having a close relative with fibromyalgia and having a rheumatic disease (lupus, or rheumatoid arthritis) (Mayo Clinic, 2011).

Explaining the Diagnosis to Patients

One of the issues with fibromyalgia is that patients may feel as if no one believes they have a “real” disease.  In one recent study of fibromyalgia patients it took nearly a year (11.1 months) for them to go to a physician with their pain (Choy, Perrot, Leon, Kaplan, Petersel, Ginovker, & Kramer, 2010).   More than one third (38%) believed the doctor would not take their symptoms seriously (Choy et al., 2010).  Even worse, the average time after visiting the physician until  diagnosis was well over 2 years (2.3 years), and required visiting 3 or 4 different physicians (Choy et al., 2010). Patients with fibromyalgia also often report that their symptoms interfere with work and ordinary life activities, and that the disease has caused them to incur significant medical costs to deal with it (Choy et al., 2010).

It is important in explaining the diagnosis to the patient to reassure them that they do have a real disease. While the exact cause of the disease is not known, the simple assurance that their condition has a name can generate relief in the patient (Undeland & Malterud, 2007).  It is also important to explain the availability of support groups and medications that can help with their symptoms (Undeland & Malterud, 2007).  Explaining the disease is also important; Huynh et al. (2008) report that patients receiving a diagnosis that explains their CWP can experience fewer and milder symptoms.

The critical aspects of fibromyalgia to explain to the patient are thus (1) that it is a real disease suffered by millions of people in the U.S. (statistics vary but between 7 million and 12.5 million—2% to 4% may have the disease); and (2) that fibromyalgia is a chronic disease where the symptoms will vary in severity from time to time, but that it does not shorten the patient’s life expectancy (Undeland & Malterud, 2007).

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