Fibromyalgia

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Diagnosis

Diagnosis is based on the exclusion of other conditions, especially chronic fatigue syndrome and myofascial pain syndrome; the patient's history of symptoms; and evidence of tender points located at specific areas of the body.

Tender points are 18 specific points located from the neck to the knees. To diagnose fibromyalgia, at least 11 of these points must be painful when touched. Some physicians believe a patient can have fibromyalgia even if the required number of tender points is not met.

In 1990, the American College of Rheumatology defined two diagnostic criteria for fibromyalgia:

• At least 11 of 18 designated tender points are painful when pressure is applied to them.
• The patient has experienced widespread pain for at least 3 months in all four quadrants of the body (i.e., right and left sides of the body and above and below the waist) or axial skeletal pain (cervical, thoracic, lumbar spine, anterior chest).

Differential Diagnosis

Imaging tests and electrophysiological studies of the nerves and muscles may be performed to rule out illnesses with similar symptoms, including rheumatoid arthritis, lupus, chronic fatigue syndrome (CFS), Lyme disease, muscle diseases (e.g., myofascial pain syndrome), hypothyroidism, and bacterial and viral infections.

Research shows that 50-70% of patients with fibromyalgia also fit the criteria for CFS. However, patients with CFS usually do not meet the criteria for diagnosing fibromyalgia that has been established by the American College of Rheumatology. There is additional physical evidence that the two disorders are distinct.

Pain is a hallmark of fibromyalgia and fatigue is a hallmark of CFS. Patients with fibromyalgia may have high levels of substance P in their spinal fluid and CFS patients may not. CFS is thought to be viral in origin, and while a virus is suspected in fibromyalgia, there is no evidence to support it. Symptoms such as fever, sore throat, and swollen glands are more common in patients with CFS. Aerobic exercise often improves muscle function and reduces pain in fibromyalgia, but CFS patients often find that exercise is impossible and worsens symptoms.

Fibromyalgia, Diagnosis, Differential Diagnosis reprinted with permission from neurologychannel.com
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