The sharp sting of a bee, a broken bone, the burn from a hot stove—these injuries, typically accidental, heal. But what about the pain that never goes away? In some instances, aching, burning, and sharp pangs are relentless. If that is you, perhaps you could have a chronic pain condition known as fibromyalgia. Continue reading to learn how to test for fibromyalgia.
Fibromyalgia is a non-life threatening condition causing chronic, widespread musculoskeletal pain. Someone with fibromyalgia experiences pain and tenderness that migrates to various parts of the body. Fibromyalgia is not inflammatory, meaning it does not damage the bones, joints, or muscles over time. However, experts do link the condition to the nervous system. Painful sensations to stimuli (i.e. touch) occur due to the way the brain processes pain signals.
Aside from widespread pain, other various symptoms are indicative of fibromyalgia. These include:
Any physician is capable of performing the tests to diagnose fibromyalgia. After performing a physical examination to evaluate for other conditions sharing similar symptoms, a patient with suspected fibromyalgia may be referred to a rheumatologist—a specialist knowledgeable about the musculoskeletal disease and systemic autoimmune conditions.
There is no single test to diagnose fibromyalgia. With fibromyalgia being so elusive, physicians rely on a combination of tests and procedures. Genetic testing or key blood markers do not currently exist at this time. The diagnosis is based on clinical signs. Various pain diagnostic scales along with a physical exam are part of the clinical evaluation.
The Widespread Pain Index (WPI) is a scale that assesses the locations of a patient’s pain. It consists of two front and back body illustrations with common pain areas (i.e. the jaw, chest, abdomen, neck, shoulder girdle, upper arm, lower arm, upper leg, lower leg, upper back, lower back, and hip). The patient then checks boxes of the areas they have experienced pain or tenderness during the last 7 days. They receive 1 point per checked box with an overall score that can range from 1 to 19. The diagnostic criteria for a fibromyalgia diagnosis require the patient to fulfill a Widespread pain index score greater than or equal to 7.
The symptom severity scale (SS) is a multi-part scale that evaluates the severity of a patient’s symptoms that may be related to fibromyalgia. Part A requires that the patient rate their levels (0 to 3) of fatigue, the extent to which they “wake up unrefreshed,” and cognitive symptoms. They are given the rating options of: 0 = No problem, 1 = Slight or mild problems; generally mild or intermittent, 2 = Moderate; considerable problems; often present, and 3 = Severe; pervasive, continuous, life-disrupting.
The second portion of the symptoms severity scale (SS) has patients check other symptoms they have experienced over the past week. This may include symptoms like muscle pain, irritable bowel syndrome, weakness, headaches, cramps in abdomen, diarrhea, constipation, vomiting, loss of appetite, dry mouth, itching, rash, seizures, fever, blurred vision, nervousness, chest pain, dizziness, depression, painful urination, and more. The score is calculated as follows: 0 symptoms = score of 0, 1 to 10 symptoms = score of 1, 11 to 24 symptoms = score of 2, and 25+ symptoms = score of 3.
The physician calculates the patient’s score by adding the sums of parts A and B with a final score ranging from 0 to 12. The fibromyalgia diagnostic criteria require a symptom severity scale score greater than or equal to 5.
In addition to the pain scales, diagnosing fibromyalgia relies on specific tender points around the body. Tender points are trigger points that when pressed with a normal amount of pressure, provoke pain or tenderness. Those with fibromyalgia experience pain or tenderness in at least 11 out of the 18 tender points. The tender points are in symmetrical pairs:
While tender point testing was once the holy grail of the fibromyalgia diagnosis, it is no longer universally agreed upon. Physicians argue it was leading to the overdiagnosis of fibromyalgia. The tender point exam is not as accurate as the widespread pain index (WPI) and the symptom severity pain assessment scales, as the chronic pain associated with fibromyalgia can be intermittent and migratory. It also fails to address the sleep and cognitive symptoms characteristic of the diagnosis. Many rheumatological and autoimmune syndromes share fibromyalgia tender points, which contributes to the confusion.
Because there is no single test for fibromyalgia, the diagnostic process is more about finding what the chronic pain condition is not rather than performing one test to confirm the diagnosis. Below are conditions that have similar symptoms to fibromyalgia.
Neurological disorders impact the nervous system. The main symptoms that can be confused with fibromyalgia are numbness and tingling in the extremities. Examples of neurological disorders with similar symptoms are multiple sclerosis and myasthenia gravis, a chronic autoimmune neuromuscular disease causing profound weakness in the skeletal muscles.
Hypothyroidism is an underactive thyroid gland. The thyroid is a gland is located in the front of the neck and secretes hormones into the bloodstream to regulate bodily functions. In hypothyroidism, the thyroid does not produce enough hormones for metabolism. The symptoms of widespread body pain, constipation, and fatigue mimic fibromyalgia.
Rheumatologic diseases result in inflammation in supporting structures of the body, decreasing its function. Those with rheumatological diseases have pain in the joints, tendons, ligaments, bones, and muscles. The widespread pain is easy to mistake for fibromyalgia without a thorough medical assessment, especially if the condition shares its trigger points.
Mental disorders such as anxiety and depression can be comorbid conditions occurring with fibromyalgia. Whether the mental disorder exists alone or with fibromyalgia, they contribute to chronic pain, sleep disturbance, and generalized symptoms. Studies from Harvard suggest combining mental health services with fibromyalgia treatment because of frequent mental disorders as comorbidities.
Chronic fatigue syndrome is similar to fibromyalgia in that there is no single test to diagnose the condition. Additionally, the two diagnoses have considerable symptom overlap—specifically fatigue and cognitive difficulties like memory and concentration impairments.
We receive vitamins and minerals from the foods we eat. However, if someone has a poor diet or inadequate absorption, nutritional deficiencies in vitamins, minerals, and electrolytes can mirror the symptoms of fibromyalgia. Low levels of vitamin D, coq10, carnitine, magnesium, and B vitamins can result in widespread body pain, depression or anxiety, and fatigue. Vitamin D is especially imperative as a regulator of the immune system. Researchers have found conflicting evidence of whether vitamin D levels are lower amongst fibromyalgia patients. Studies reveal patient groups with lower levels, as well as an equal number of patients with higher levels of plasma vitamin D (Makrani, 2017). Still, the consensus is that vitamin D deficiency contributes to widespread musculoskeletal pain and fatigue.
Medical imaging allows doctors to visualize the inside of the body. The most prevalent types of imaging are regular x-rays, computerized tomography (CT) scans, and magnetic resonance imaging. The former uses electromagnetic radiation, while the latter uses magnetic fields and radio waves to produce images. Medical imaging detects cancer or damage to the internal structures caused by degenerative conditions. Fibromyalgia will not show on scans.
People with chronic pain are often referred to a physical therapist. Physical therapists are experts in tailoring custom exercises regimens to combat a patient’s pain using tools to stretch to enhance flexibility, relax tense muscles, and move joints. Since fibromyalgia is a diagnosis of exclusion, physical therapists can discern how successful their treatment is, and if unsuccessful, ask whether the patient’s symptoms are from causes other than fibromyalgia.
Medical capabilities have rapidly progressed with technology. The FM/a test is a test soon-to-be at the forefront of fibromyalgia diagnostics. This blood test measures immune system patterns of chemokine and cytokines within white blood cells. Abnormally low levels are linked to fibromyalgia. Studies show the test has a 93% accuracy. Although still in the research and development process, researchers hope the FM/a test is a definitive option to diagnose fibromyalgia (Epigenetics, 2013).
Doctors expect patients to convey how they feel. Without a clear picture of what is going on, they cannot make a diagnosis. Keeping a journal to track pain and other symptoms is beneficial. When suffering from chronic pain, it is difficult to determine up from down most days. A symptom journal offers organization to the chaos of daily ailments. Through the journal, patients log the severity of their pain and the activities they engaged in. Over time, they may notice patterns of certain activities exacerbating pain. The journal is also helpful for simply remembering what to tell the doctor during moments of cognitive difficulties. It is unrealistic for a doctor to read the entire journal, but using the information logged, patients can identify symptom patterns to verbally tell their doctor.
Arnold LM. (2008). Management of Fibromyalgia and Comorbid Psychiatric Disorders. Journal of Clinical Psychiatry, 69 (2).
Epigenetics. (2013). What is the FM/a® Test?. Retrieved from https://fmtest.com/healthcare-professionals/
Makrani, A. H., Afshari, M., Ghajar, M., Forooghi, Z., & Moosazadeh, M. (2017). Vitamin D and fibromyalgia: a meta-analysis. The Korean journal of pain, 30(4), 250–257. doi:10.3344/kjp.2017.30.4.250