If you think you have fibromyalgia, visit your GP. Diagnosing fibromyalgia can be difficult, as there's no specific test to diagnose the condition. Fibromyalgia symptoms? Work with your doctor to ensure a timely fibromyalgia diagnosis. Instead, a fibromyalgia diagnosis can be made if a person has had widespread pain for more than three months — with no underlying medical.
Fibromyalgia How Diagnosed is
Fibromyalgia patients may also feel tenderness on their forearms, near the crease of each elbow. The pain tends to be below the crease and toward the outer side of the arm. Other causes of elbow pain can include tendonitis or repetitive strain injuries. In addition to the back of the neck, doctors will check potential fibromyalgia patients for pain at the front of the neck. This pair of trigger points is located well above the collarbone, on either side of the larynx.
Hip pain is common in those with osteoarthritis, but people with arthritis tend to feel it in the joint. In contrast, people with fibromyalgia may have a tender point near where the buttock muscles curve to join the thighs. The lower back is one of the most common body parts to be the source of pain.
Overall, more than 1 in 4 U. However, people with fibromyalgia may have pain trigger points at the very top of the buttocks, right at the bottom of the lower back. While knee trouble is common in people with fibromyalgia, the inside of each knee pad may feel tender to the touch. Everyday Ways to Prevent Knee Pain. Tender points are often sites on the body where tendons and muscles meet.
Serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, antiepileptics, and muscle relaxants have the strongest evidence of benefit for improving pain, fatigue, sleep symptoms, and quality of life. Multiple complementary and alternative medicine therapies have been used but have limited evidence of effectiveness. Opioids should be used to relieve pain in carefully selected patients only if alternative therapies are ineffective.
Patients who present with chronic pain, mood symptoms, and fatigue can represent a diagnostic challenge for the primary care physician. Many of these patients meet the criteria for fibromyalgia, a condition that can generate uncertainty and potential frustration in primary care management. Recent studies have improved our understanding of the pathophysiology, clinical diagnosis, and effective management of this condition, making it a disorder that can be appropriately managed by the primary care physician.
A combination of the diagnostic criteria from the American College of Rheumatology, symptom scores, and presence of chronic widespread pain with fatigue and sleep symptoms should be used to diagnose fibromyalgia. Aerobic exercise 20 to 30 minutes two or three days per week improves pain symptoms and fatigue in patients with fibromyalgia. Tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors, and cyclobenzaprine Flexeril have the strongest evidence of benefit for improvements in pain, sleep, and quality of life in patients with fibromyalgia.
Tricyclic antidepressants and serotonin-norepinephrine reuptake inhibitors improve symptoms of fatigue. Antiepileptics may provide benefits for pain, sleep, and quality of life in patients with fibromyalgia. For information about the SORT evidence rating system, go to https: Do not test for Lyme disease as a cause of musculoskeletal symptoms without an exposure history and appropriate physical examination findings. For more information on the Choosing Wisely Campaign, see http: For supporting citations and to search Choosing Wisely recommendations relevant to primary care, see https: Fibromyalgia should be suspected in patients with a combination of widespread chronic pain, fatigue, and sleep disturbance.
There is no preferred method to diagnose fibromyalgia, and different methods identify slightly different overlapping populations of patients. Laboratory testing may be helpful to rule out other disorders that commonly present with fatigue, such as anemia and thyroid disease.
However, extensive testing is usually not necessary. Patients with fibromyalgia represent a heterogeneous population, with variable presence and severity of symptoms, and variable functional impairment and impact on quality of life.
The core symptoms include widespread pain right and left sides of the body, above and below the waist, and in the axial skeleton of at least three months' duration, fatigue, and sleep disturbance. Tenderness of muscles and tendon insertion sites, joint stiffness, mood disturbance, and cognitive symptoms e.
The American College of Rheumatology diagnostic criteria for fibromyalgia emphasized pain on digital palpation of at least 11 of 18 designated tender point sites Figure 1 2 , as well as widespread chronic pain.
The American College of Rheumatology Criteria recommended anatomic tender point locations for diagnosis of fibromyalgia. Reprinted with permission from Chakrabarty S, Zoorob R. A comparison of diagnosis based on the tender point criteria, a symptom survey, and an overall assessment by an experienced clinician found that all three methods identify patients who are thought to have fibromyalgia.
The American College of Rheumatology updated its criteria in to focus on symptoms rather than tender points Figure 2. Diagnostic criteria for fibromyalgia from the American College of Rheumatology. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res Hoboken.
Laboratory testing is not necessary to diagnose fibromyalgia. However, testing patients with chronic fatigue for anemia, electrolyte disturbances, and thyroid disease is recommended. In the absence of suggestive symptoms, diagnoses such as systemic lupus erythematosus, rheumatoid arthritis, or other connective tissue disorders are unlikely. Erythrocyte sedimentation rate, C-reactive protein level, and rheumatoid factor testing have poor specificity and should be ordered only if connective tissue disorders are suspected.
Fibromyalgia should be strongly suspected based on clinical findings. Formal symptom surveys or tender point examination can be performed to support the diagnosis, but not to exclude it. Regardless of the method used, establishing the diagnosis will help validate the patient's experience of symptoms and lead to more efficient implementation of a treatment plan. Fibromyalgia is caused by central amplification of peripheral sensory signals, so that normal sensations are perceived as painful.
Because this pathophysiology is shared with other chronic functional pain syndromes, it is appropriate to evaluate patients for these conditions. Patients with fibromyalgia should be evaluated and treated for mood disorders and sleep disturbance. Posttraumatic stress disorder PTSD , traumatic experiences, and chronic widespread pain coexist in many patients with fibromyalgia, although there is no clear causal or temporal relationship.
The underlying pathophysiology of fibromyalgia—heightened central sensitivity to peripheral sensations 6 —is shared by other functional pain syndromes, 1 and these conditions are more common in patients with fibromyalgia. Mood disturbance is a feature of many rheumatologic conditions. The association between pain and mood is complex and bidirectional. The relationship between fibromyalgia and PTSD is complex. PTSD is a risk factor for fibromyalgia, and vice versa; these conditions likely share antecedent traumatic experiences.
A history of sexual abuse is associated with chronic nonspecific pain, and a history of rape is associated with fibromyalgia.
Establishing and explaining the diagnosis of fibromyalgia appear to improve patients' well-being and functionality, as well as reduce symptoms and costs of care. Patients with fibromyalgia have often had disabling pain and fatigue for months or years, sought treatment from many physicians, had multiple diagnostic tests or ineffective treatments, and been told that there is nothing wrong. Establishing the diagnosis and educating patients about their illness are essential parts of fibromyalgia management.
Patient education and counseling independently improve fibromyalgia symptoms and patient well-being, and they should be part of an active fibromyalgia management approach. A framework for fibromyalgia management for primary care providers. Pain and functionality are improved with regular exercise of moderate intensity in patients with fibromyalgia. Patients should be counseled about the effectiveness of exercise and given specific instructions for exercise type, frequency at least two or three days per week , and duration 20 to 30 minutes at a time.
Although aerobic exercise has the strongest evidence of effectiveness, stretching or flexibility exercises, strengthening exercises, yoga, and tai chi seem to improve symptoms as well. Patient interest and ability to continue the activity should guide the type of exercise. Frequent supportive reinforcement may be necessary to maximize adherence to exercise regimens. Regular physical activity is an important part of fibromyalgia management.
An exercise prescription specifying the type, frequency, and duration of activity may help ensure patient understanding and adherence. Aerobic exercise moderate intensity, for 20 to 30 minutes two or three days per week has the most consistent evidence for improvement in pain and mood symptoms, and in overall functional status. Duloxetine Cymbalta , milnacipran, and pregabalin Lyrica are approved by the U. Food and Drug Administration for treatment of fibromyalgia.
These drugs are effective for treating multiple symptoms. Serotonin-norepinephrine reuptake inhibitors are generally the most effective antidepressants, although tricyclic antidepressants are more effective for treating fatigue. Cyclobenzaprine Flexeril improves pain and sleep quality. Opioids, nonsteroidal anti-inflammatory drugs, and other analgesics are often used in patients with fibromyalgia, but they have limited effectiveness and are associated with serious adverse effects.
All studies and systematic reviews of drug treatments for fibromyalgia are hampered by small sample sizes and short study durations typically not longer than a few months , which makes it difficult to compare long-term benefits. Antidepressants or antiepileptics are reasonable options for initial treatment, with subsequent assessment of patient response.
A dosage adjustment, medication change, or addition of an adjunct medication may be effective in patients with partial or no response to antidepressants or antiepileptics. Tricyclic antidepressants reduce pain, fatigue, and sleep disturbances; selective serotonin reuptake inhibitors have slight benefit for reducing pain; and serotonin-norepinephrine reuptake inhibitors have some benefit for reducing pain, sleep disturbances, and depressed mood.
Pregabalin and gabapentin Neurontin may be useful adjunct treatments to reduce pain in some patients with fibromyalgia. However, their use is often limited by cognitive or other adverse effects. Muscle relaxants can be useful when combined with antidepressants or antiepileptics. Cyclobenzaprine improves fibromyalgia-associated pain and sleep quality, but not fatigue. The use of opioids in patients with fibromyalgia is challenging and controversial.
However, opioids can be used safely in some patients. A reduction in peripheral sensory signals may reduce central amplification of pain, suggesting a possible mechanism of benefit.
Table 1 outlines patient selection principles for opioid use in fibromyalgia. Reevaluate to confirm fibromyalgia as the diagnosis, potentially with rheumatology consultation. Ensure that adequate trials of multiple serotonin-norepinephrine reuptake inhibitors, antidepressants, antiepileptics, muscle relaxants, exercise interventions, and other treatments have been ineffective. Obtain and document personal or family history of medication or substance abuse.
Discuss treatment goals for pain relief and functional improvement; emphasize that complete pain relief is unlikely. At subsequent visits, ask about symptom relief, functional status, and adverse effects. Information from reference Many complementary and alternative medicine CAM therapies are used by patients with fibromyalgia. Although individual patients may benefit from these therapies, none has strong evidence for effectiveness in the general population.
Most patients with fibromyalgia try CAM therapies at some point. Other CAM therapies e. Physicians should work with patients who are interested in CAM therapies and use symptom diaries or other measures including smartphone apps to assess their impact. This approach allows patients to potentially benefit from treatments, while limiting adverse effects, drug-herb interactions, and needless costs.
We searched Medline using the keyword fibromyalgia and the medical subject heading fibromyalgia. The search was limited to English, human, core clinical journals AIM , and publication years to Additional searches were conducted combining the baseline search with searches for the terms opioids, irritable bowel syndrome, exercise, PTSD, and other relevant terms.
Reference lists of retrieved reviews were also used to identify additional relevant original studies.
It can be hard to diagnose fibromyalgia because it doesn't show up on a test or X- ray. Find out how doctors figure out if you have it. Since there are no lab or imaging tests available for fibromyalgia, it can be a difficult condition to diagnose. Learn about steps your doctor will. Because there is no test to confirm fibromyalgia, your doctor must solely rely on your panel of symptoms to make a diagnosis, while excluding all other causes.