Fibromyalgia Symptoms and Diagnosis

Fibromyalgia is a chronic disorder characterized by pain and tenderness throughout the body, as well as fatigue.

Although the condition is often grouped in the same category of disorders such as arthritis, it doesn’t cause damage to joints or other tissue.

Instead of being caused by inflammation, fibromyalgia is widely understood to be a disorder of the central nervous system — meaning that the brain is oversensitive to pain signals.

Symptoms of Fibromyalgia

Fibromyalgia symptoms may fluctuate in intensity, and may improve or worsen over time.

Factors such as stress, changes in weather, too much or too little exercise, and too much or too little rest can affect the severity of your symptoms.

Symptoms of fibromyalgia may include:

• Widespread pain, occurring on both sides of the body, above and below your waist
• Tenderness to touch
• Fatigue, despite getting enough rest
• Difficulty falling or staying sleep
• Morning stiffness, or pain that’s more pronounced in the morning
• Difficulty with memory or concentration (known as “fibro fog”)
• Dizziness
• Problems with balance or coordination
• Numbness or tingling in your hands or feet
• Sensitivity to temperature (hot or cold)
• Sensitivity to bright lights or loud noises
• Painful menstrual periods in women
• Pain in your face or jaw
• Headaches, including migraines
• Digestive issues, including abdominal pain, bloating, or constipation
• Bladder difficulties
• Skin sensitivity

Fibromyalgia Tender Points

Fibromyalgia tender points — also known as trigger points — are areas of the body where pain frequently occurs.

People with fibromyalgia often say that these areas hurt when you press on them with a finger.

There are 18 identified tender points (nine pairs) that tend to be painful when pressed.

These spots are commonly found on both sides of the body around the elbows, shoulders, knees, neck, hips, sides of the breastbone, and back of the head.

Fibromyalgia Diagnosis Challenges

Fibromyalgia is sometimes difficult to diagnose because many of its symptoms are similar to those of other disorders.

A diagnosis often requires excluding other conditions, rather than finding definitive proof that fibromyalgia is what you have.

In someone with fibromyalgia, “There’s very little to see on a physical exam,” other than reported pain and tenderness, according to Don L. Goldenberg, MD, a rheumatologist and professor emeritus at Tufts University School of Medicine who is based in Portland.

In addition, “Laboratory tests are unremarkable,” and often give doctors little help, Dr. Goldenberg says.

You may end up seeing several doctors before getting an accurate diagnosis. This process may last longer than it should because of mistakes made by both doctors and patients, according to Goldenberg.

“Many patients with this condition will shop from doctor to doctor,” he says. “They’re sure that they’ve been injured or damaged, or there’s something in their environment. And they keep searching and searching.”

A diagnosis of fibromyalgia, says Goldenberg, requires accepting that your pain has no cause beyond the nervous system itself — and may, as a result, be more difficult to treat.

At the same time, doctors may prolong the diagnostic process by being either too deferential to — or too dismissive of — patients, Goldenberg says.

“A lot of doctors will order a lot of unnecessary tests,” he notes, due to patients’ desire to rule out improbable causes of their pain.

But more commonly, “Doctors will say, ‘It’s all in your head, toughen up,’” Goldenberg laments. “And of course that’s the last thing a person wants to hear.”

While Goldenberg doesn’t excuse this kind of behavior in doctors, he understands why some of them react so badly to fibromyalgia.

“For a certain type of physician who likes things black and white, this is a real gray area,” he says. “There’s no cause and effect. The symptoms can be murky. The treatment is very murky.”

How Fibromyalgia Is Diagnosed

While there’s no definitive test to diagnose fibromyalgia, the American College of Rheumatology (ACR) has established criteria for identifying the disorder.

In the past, doctors would check the 18 tender points on the body to determine a person’s level of pain. Current guidelines don’t call for this kind of exam.

Instead, the ACR instructs doctors to consider the following factors:

• How many areas of the body (out of 18) are painful
• Whether symptoms like fatigue, waking up unrefreshed, or difficulty thinking are present
• Whether these symptoms have lasted at least three months
• Whether any other condition might be the cause of these symptoms

It’s important to find a doctor who is familiar with fibromyalgia. Many rheumatologists, internists, and family doctors can properly diagnose and treat the disorder.

Before seeing your doctor, you may want to write a list that includes:

• All past and present medical conditions
• A detailed description of your symptoms
• Medical conditions that run in your family
• All medicines and supplements you take
• Any questions you’d like to ask your doctor
  

Ruling Out Other Conditions

Even if your doctor suspects you have fibromyalgia, it may be desirable to rule out other, more serious conditions.

For example, “Widespread arthritis can cause pain in multiple areas,” Goldenberg notes. But most doctors can clearly distinguish pain due to arthritis from pain due to fibromyalgia.

If your doctor isn’t ready to diagnose fibromyalgia based on your symptoms and a physical exam alone, the following tests may be helpful:

Complete Blood Count This test can help rule out a number of disorders, including anemia (inadequate red blood cells), infection, and leukemia.

Erythrocyte Sedimentation Rate (ESR, or Sed Rate) This test can help reveal inflammatory processes throughout your body.

Cyclic Citrullinated Peptide and Rheumatoid Factor These tests can help detect rheumatoid arthritis.

Thyroid Function In some cases, it may be helpful to rule out a thyroid problem as the cause of your symptoms.

Additional reporting by Quinn Phillips.