So you have pain all over, trouble sleeping, brain fog or just feel out of it. Maybe you already have a condition that causes chronic pain, like rheumatoid arthritis, lupus, or had a physical trauma. Now, you have this pain that won’t go away and seems to get worse when you are stressed, over-do it, or even when it rains! It could be time to see your primary care physician for an examination.
A Little History…
The 1990 Criteria: In the recent past, the main provider to diagnose fibromyalgia was the rheumatologist. They would conduct an examination of tender points all over the patient’s body. If the patient scored greater than 11 out of 18, a diagnosis of fibromyalgia syndrome could be given. This was the standard of diagnosis until 2010, when a new study determined a better method for diagnosis. There are still some providers who us the Tender Points Test to diagnose patients, but this test is no longer the most current.
There were problems found with this way of diagnosing FMS. Many practitioners did not know how to correctly conduct the Tender Points Test (TPT), and patients had to be referred to specialists for diagnosis and treatment. Also, there is now more information about FMS and the 1990 Criteria does not include key features of FMS like, fatigue, unrestful sleep, disrupted sleep, and cognitive symptoms. This assessment simply fails to address the varied symptoms of Fibromyalgia patients.
Fast-forward to 2010, when a new study resulted in a better way of diagnosing patients with FMS. The new method doesn’t replace the older TPT, but helps address areas that were lacking in the TPT. These include such as fatigue, cognitive symptoms, unrefreshing sleep, physical symptoms like headaches, numbness & tingling, nausea, etc. as well as fluctuations in pain levels. These additions help doctors make more accurate diagnoses of FMS. It also allows more types of doctors to diagnose FMS and is no longer limited to rheumatologists. Now, neurologists and even primary care providers are successfully diagnosing and treating FMS, meaning greater access to care and treatment for those who suffer from its symptoms.
So, How Will My Doctor Diagnose Me?
While there are no specific tests to confirm or negate a diagnosis of fibromyalgia syndrome, your doctor may begin by running many different labs and diagnostics in order to rule out other conditions which could cause very similar symptoms. Ruling out other conditions is a very important part of thi assessment as there are many other conditions with similar symptoms to FMS. These include, Multiple Sclerosis (MS), Lupus, Lyme Disease, and Inflammatory arthritis conditions. The testing is extensive, but that is a good thing. The doc definitely wants to be certain of your diagnosis.
You may have any number of the following screenings performed:
• Blood tests
o Your doctor could be screening for genetic markers, infection, inflammation, or specific sets of indicators of other conditions.
• Radiology (x-rays)
o These are done to rule out any musculoskeletal problems that may be contributing to your pain, such as osteoarthritis, spondylitis, inflammatory arthritis, etc.
• MRI (Magnetic Resonance Imaging)
o This gives a better picture of the structures (bones), soft tissues(muscles) and connective tissues (tendons)
• EMG (Electromyogram)
o These measure the electrical activity of muscles, and are used to diagnose a number of disorders affecting the nerves and muscles.
• There may be other studies that are not mentioned here that your provider believes will help with making an accurate diagnosis.
Your provider will also perform a physical examination along with a thorough history. You may be asked questions about your family medical history, any autoimmune diseases, injuries, recent illnesses, trauma, or surgeries. The provider will also ask questions about your pain, fatigue, rest, cognitive symptoms and more. Be patient with all of these questions. Your doctor really will use this information in making a diagnosis. Try to be as accurate as you possibly can. (Check out our "There's an App for That" section for handy tools to help you track these symptoms. The link will be coming soon!)
For the physical examination, your provider will check a number of things, including reflexes, your joints for redness, warmth, swelling and pain, and perform the TPT mentioned earlier in this article. When all of the necessary data is finally collected, your provider will be able to arrive at a diagnosis. It is at that time when you will be able to discuss different treatment plans for FMS with your doctor. Though there is no cure, with the right treatment plan and a good care team, many FMS patients are able to live full and rich lives.