Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. Researchers believe that fibromyalgia amplifies painful sensations by affecting the way your brain and spinal cord process painful and nonpainful signals.
Fibromyalgia is often considered as an invisible illness since people who have it often looks healthy and normal from the outside, yet are battling constant pain, fatigue, and other debilitating symptoms on the inside. This can make fibromyalgia difficult to diagnose. Diagnosis typically involves a complete physical and medical examination along with ruling out other conditions that may have similar signs and symptoms.
What are the symptoms of fibromyalgia?
People with fibromyalgia usually have pain and stiffness in multiple parts of the body along with increased sensitivity to pressure and touch. Other common fibromyalgia symptoms include:
- Fatigue
- Sleep problems
- Headaches
- Depression
- Anxiety
- Memory and concentration issues known as “fibro fog”
- Numbness or tingling in hands and feet
- Pain or cramps in abdomen
- Dry eyes and mouth
- Dizziness
- Urinary problems such as urgency or frequency
The intensity of symptoms can vary from day to day. Symptoms may flare up at times without apparent reason.
Who is at risk for fibromyalgia?
Fibromyalgia can affect anyone, but women are much more likely to develop it than men. Other risk factors include:
- Family history – Fibromyalgia tends to run in families.
- Rheumatic disease – If you have rheumatoid arthritis, lupus or ankylosing spondylitis you may be at higher risk.
- Age – Onset is most common between 30-50 years old.
How do neurologists diagnose fibromyalgia?
Neurologists take a systematic approach to diagnosing fibromyalgia which includes:
Medical history
The first step is a complete medical history to understand the onset, duration, location and severity of symptoms. The neurologist will ask questions like:
- When did you first start experiencing symptoms?
- Have the symptoms been continuous or intermittent?
- Where are your pain and tender points located?
- Does anything make your symptoms better or worse?
Details about other medical conditions, family history, medications, and lifestyle factors are also gathered.
Physical examination
A thorough hands-on physical exam helps identify areas that are painful or tender to touch. As part of the exam, the doctor will check:
- Muscle strength
- Reflexes
- General appearance
- Posture
- Range of motion
- Skin sensitivity
Tenderness is assessed by palpation at 18 specific trigger points located throughout the body. Tenderness at 11 or more of these points indicates fibromyalgia.
Review of symptoms
In addition to pain and fatigue, the neurologist will ask about other common symptoms of fibromyalgia including:
- Sleep disturbances
- Mood issues like anxiety or depression
- Concentration and memory problems
- Headaches
- Numbness/tingling
- Digestive issues
Lab tests
While there are no lab tests to confirm a fibromyalgia diagnosis, certain tests may be ordered to help rule out other potential causes such as:
- Complete blood count
- Erythrocyte sedimentation rate
- Thyroid function tests
- Vitamin D levels
Diagnostic criteria
Doctors may use established diagnostic criteria to confirm a fibromyalgia diagnosis. This includes meeting the following requirements:
- Widespread pain present for at least 3 months.
- Pain in at least 4 of 5 regions of the body.
- Moderate to severe fatigue, sleep disturbances, or memory/thinking issues.
Are there other tests for fibromyalgia?
In some cases, certain imaging and other tests may be used to help rule out other conditions or investigate the source of particular symptoms:
X-rays
X-rays can help identify or rule out arthritis and joint abnormalities.
MRI
Magnetic resonance imaging (MRI) can reveal problems with soft tissues, ligaments and tendons.
Ultrasound
Ultrasound uses sound waves to produce images inside the body. It may be used to examine muscles, ligaments and joints.
Psychiatric evaluation
A mental health assessment can identify conditions like anxiety, depression or bipolar disorder which commonly occur with fibromyalgia.
Sleep study
A polysomnogram monitors brain waves, oxygen levels, heart rate and breathing during sleep. It can diagnose conditions like sleep apnea.
What conditions should be ruled out?
Due to overlapping symptoms, doctors need to rule out several other disorders before confirming a fibromyalgia diagnosis:
Rheumatoid arthritis
This autoimmune disease causes joint inflammation and damage. It is distinguished from fibromyalgia by the joint involvement pattern and blood markers.
Polymyalgia rheumatica
Polymyalgia rheumatica causes muscle tenderness and morning stiffness, primarily around the shoulders and hips. It mainly affects older adults.
Myofascial pain syndrome
Myofascial pain also causes muscle pain and tenderness but is associated with myofascial trigger points in isolated areas of muscle. Pain is limited to certain muscles, unlike the widespread pain of fibromyalgia.
Hypothyroidism
An underactive thyroid gland can lead to muscle pain, fatigue and memory problems. Thyroid blood tests are used to rule it out.
| Condition | Key Differentiating Features |
|---|---|
| Rheumatoid arthritis | Joint-related inflammation, swelling, deformities. Abnormal inflammatory markers on lab tests. |
| Polymyalgia rheumatica | Stiffness and pain concentrated in shoulders and hips. Mostly affects adults over 50. |
| Myofascial pain syndrome | Isolated muscle pain related to myofascial trigger points. Not widespread. |
| Hypothyroidism | Abnormal thyroid function tests. Goiter may be present. |
How is fibromyalgia treated?
While there is no cure for fibromyalgia, a variety of medications and alternative therapies can help manage symptoms. Common treatment approaches include:
Medications
Prescription medications for fibromyalgia may include:
- Pain relievers
- Antidepressants
- Anti-seizure drugs
- Sleep aids
These can help reduce pain, improve sleep, and boost energy levels.
Exercise
Staying physically active with low-impact aerobic activity, stretching and strength training has been shown to reduce pain, fatigue and stiffness.
Stress reduction
Relaxation techniques like meditation, deep breathing, massage and yoga help manage stress and anxiety. Getting enough restorative sleep is also important.
Counseling
Seeing a therapist can help develop coping strategies for dealing with chronic pain and emotional struggles. Joining a support group provides encouragement.
What’s the long-term outlook with fibromyalgia?
Fibromyalgia is considered a long-term condition without a definite cure. Many people do see improvement in their symptoms and quality of life with proper treatment and self-care. Flare ups of symptoms may come and go. With time, people learn to pace their activities, set priorities, and find a sustainable balance.
Conclusion
Diagnosing fibromyalgia involves a thorough medical history, physical examination, review of symptoms, and ruling out other potential causes. There is no single definitive test for fibromyalgia. Doctors rely on a constellation of symptoms including widespread pain and tenderness, fatigue, sleep and mood disturbances to make the diagnosis based on established criteria. While challenging to manage, various treatments can provide substantial symptom relief and improvement in functioning.