Because fibromyalgia has no blood test or x-ray used to make the diagnosis, the American College of Rheumatology has set forth guidelines for the diagnosis of the condition. Fibromyalgia can mimic other diseases, including Lyme disease, HIV disease, degenerative spine diseases, low thyroid conditions, and certain types of cancer.
While there are blood tests and other testing modalities for these types of diseases, these can take time and a simple diagnostic examination can set the record straight as to whether or not you have fibromyalgia.
The latest criteria set for the diagnosis of fibromyalgia were developed in 2010. According to the guidelines set up by the American College of Rheumatology, you are suffering from fibromyalgia if you meet the following criteria:
- You have the experience of nearly constant pain on all four quadrants of your body. This includes having pain on both sides of the body as well as pain localized above and below the level of the waist.
- You have the experience of tenderness in at least 11 of the 18 listed tender points exhibited by people who have fibromyalgia.
This diagnostic protocol has its critics. Because the symptoms of fibromyalgia tend to wax and wane, an individual who does not meet the criteria for fibromyalgia on one evaluation may meet the criteria for the disease at a later time, even though it may be only a few hours later. The criteria are also mainly pain-related and ignore the many other symptoms associated with fibromyalgia, including the fatigue symptoms, depressive symptoms, gastrointestinal symptoms, and urinary tract complaints.
The 2010 diagnostic criteria for fibromyalgia lessened the role of trigger point tenderness in the diagnosis of fibromyalgia even though many doctors still use this as a factor in making the diagnosis.
Instead of trigger point tenderness, the American College of Rheumatology proposed the use of the widespread pain index, also known as the WPI. The WPI used a checklist involving nineteen areas of the human body.
With the WPI, the patient gives a positive checkmark if they experienced pain in a particular area within the previous seven days. Nineteen different areas of the body are included so that a given patient could have a score of between 0 and 19.
In addition, the severity of the various symptoms in four different categories that are not related to pain, such as mental symptoms, urinary tract symptoms, and gastrointestinal symptoms are taken into consideration. These areas are scored on a scale from zero to three so that the total possible score in this section is 12. This part of the evaluation is called the symptom severity score or SS. Both the WPI and the SS are taken into account when making the diagnosis of fibromyalgia.
The Trigger Point Evaluation
Your doctor may evaluate your fibromyalgia using the trigger point evaluation, also called the tender point evaluation. Even though the use of this examination has been minimized by the latest recommendations, many doctors still feel that the evaluation of these trigger points are an important part of the evaluation.
When you have a trigger point evaluation, the doctor will press on each area with a single fingertip. The amount of pressure used is just enough to cause the nail bed to whiten. The doctor will then ask you if you feel pain to the touch.
Pain Points Seen In Fibromyalgia:
- The area between your shoulder blades
- The very top part of your shoulders
- The back part of the head
- The front part of the neck
- The upper chest area
- The inside soft area of the elbows
- The upper hip area
- The inner knees
- The sides of the hip joints
Because other conditions yield symptoms that can mimic fibromyalgia, the doctor will often rule these out in order to make sure that the diagnosis is fibromyalgia and not some other disease. This can involve blood tests used to identify conditions such as hypothyroidism, HIV disease, Lyme disease, and rheumatoid arthritis.
Tests you might undergo besides blood tests include x-ray evaluations, CT scans of the body, and MRI scans to look for spinal degenerative disease or possibly cancer. Some doctors do tissue biopsies for cancer along with sleep study evaluations and psychological evaluations.
It can help the doctor if you keep a diary of the symptoms you are experiencing. Such a diary might include:
- Where your pain is located
- What your pain is like
- The severity of your pain
- How long the pain lasts
- Other non-pain related symptoms
Keeping this diary can help the doctor get a personalized picture of your daily symptoms and may help make the diagnosis of fibromyalgia.