How Do I Know if I Have Fibromyalgia?
How Do I Know if I Have Fibromyalgia?
Table of Contents
Is There a Test for Fibromyalgia?
The diagnostic criteria for fibromyalgia, published in 2016 by the American College of Rheumatology, requires that the following three conditions are met:
- WPI ≥ 7 and SSS score ≥ 5 OR WPI of 4–6 and SSS score ≥ 9.
- Presence of generalized pain, defined as pain in at least four of five regions. Jaw, chest, and abdominal pain are not included in generalized pain definition.
- Symptoms have been generally present for at least three months.
- A diagnosis of FM is valid irrespective of other diagnoses. A diagnosis of FM does not exclude the presence of other clinically important illnesses.2
The Widespread Pain Index
The Widespread Pain Index (WPI; 0–19) is a summary count of the number of nineteen painful regions from the regional pain scale, a self-reported list of painful regions. Regions include:
- Left upper region (region one): left jaw, left shoulder girdle, left upper arm, left lower arm.
- Right upper region (region two): right jaw, right shoulder girdle, right upper arm, right lower arm.
- Left lower region (region three): right hip (buttock, trochanter), right upper leg, right lower leg.
- Right lower region (region four): hip (buttock, trochanter), right upper leg, right lower leg.
- Axial region (region five): neck, upper back, lower back, chest, abdomen.2
The Symptom Severity Scale and Polysymptomatic Scale
The Symptom Severity Scale (SSS; 0–12) is the sum of the severity scores of three symptoms (fatigue, waking unrefreshed, and cognitive symptoms; 0–9) plus the sum (0–3) of the number of the following symptoms the patient has been bothered by that occurred during the previous six months:2
- Headaches (0–1)
- Pain or cramps in the lower abdomen (0–1)
- Depression (0–1)
Lastly, the Polysymptomatic Severity Scale (PSD; 0–31), also known as the FM severity score, is the sum of the WPI and SSS. The PSD scale measures the magnitude and severity of FM symptoms in those satisfying and not satisfying criteria. A positive FM diagnosis has a score of at least 12.2
The ACR criteria use the term “symptom.” Colloquially, the words “sign” and “symptom” are often used interchangeably. However, in a medical context, the two are distinct terms.3
A symptom is subjective evidence of disease as perceived by the patient. A sign is objective evidence of disease perceptible to an outside observer.
Because widespread pain is the essential feature of fibromyalgia, only patients with fibromyalgia can perceive the severity and locale of the pain. Physicians cannot perceive this pain.
Diagnosing fibromyalgia can be a challenge since several other conditions can cause symptoms like those of fibromyalgia and can even co-occur with fibromyalgia. Rheumatoid diseases (osteoarthritis, rheumatoid arthritis, lupus, and ankylosing spondylitis) have symptoms that overlap with those of fibromyalgia.4
As such, to exclude other possible causes, laboratory tests may still be ordered while diagnosing fibromyalgia, including:
- A complete blood count (CBC) (can check for anemia, which can cause weakness and fatigue)
- An erythrocyte sedimentation rate (ESR) or a C-reactive protein (CRP) test (can detect diseases that cause inflammation, such as polymyalgia rheumatica)
- A blood calcium level test (a low level can cause muscle cramps)
The Revised Fibromyalgia Impact Questionnaire (FIQR) is a standardized survey used to evaluate an individual’s fibromyalgia symptoms and the extent they interfere with daily living (all questions are framed in the context of the past seven days). The questionnaire is divided into three domains: function, overall impact, and symptoms.5
In the ‘function’ domain the user rates the difficulty, from 0-1, of activities (particularly large-muscle activities) using the upper and lower limbs.
In the ‘overall impact’ domain the user rates the overall impact of FM, from 0-10, on functional ability and the perception of reduced function.
In the ‘symptoms’ domain, the user rates the severity, from 0-10, of symptoms including pain, stiffness, lack of restorative sleep, poor energy, anxiety, depression, tenderness, memory, balance, and environmental sensitivity.
Symptoms of Fibromyalgia
The essential, primary symptom of fibromyalgia is widespread pain, which has been described as stabbing and shooting pain and deep muscular aching, throbbing, and twitching. Numbness, tingling, and burning are also often present.6
Other symptoms of fibromyalgia usually include:
- Fatigue that can interfere with occupational, personal, social, or educational activities
- Nonrestorative sleep caused by abnormalities in the deep sleep stage
- Irritable bowel and bladder
- Headaches and migraines
- Restless legs syndrome
- Cognitive problems (e.g., forgetfulness, concentration difficulties, mental slowness, memory and attention problems, etc.)
Maintenance Treatment for Fibromyalgia
It is not known what causes fibromyalgia, so there is no cure. Most people with fibromyalgia are still able to work and complete their regular activities.
Long-term treatment of fibromyalgia generally includes medication. The FDA has approved three drugs for fibromyalgia:7
- Duloxetine (Cymbalta) – an antidepressant
- Milnacipran (Savella) – an antidepressant
- Pregabalin (Lyrica) – an anticonvulsant
Duloxetine and milnacipran affect serotonin and norepinephrine, brain chemicals that help control pain levels. Pregabalin blocks overactive nerve cells involved in pain transmission.8
Opioid narcotic medications, benzodiazepine medications, and nonsteroidal anti-inflammatory drugs (NSAIDs) are not recommended for the treatment of fibromyalgia.
Neuroimaging is the process of producing images of the structure or activity of the brain or other parts of the nervous system by techniques such as magnetic resonance imaging or computerized tomography. Neuroimaging is used across a range of disciplines to spot problems, to understand what happens during tasks, thoughts, and emotions, and to assess the effectiveness of various treatments.9
Many neuroimaging studies comparing fibromyalgia patients with healthy individuals have been performed; however, there is relatively little evidence of a neurobiological signature associated with fibromyalgia specifically.10
Alternative Pain Management
In addition to medication, typical treatment plans for fibromyalgia include alternative forms of pain management, mainly exercise, diet, a good sleep routine, and cognitive behavioral therapy (CBT).
CBT is the most common psychologic intervention for individuals with chronic pain.11
Key elements of CBT for fibromyalgia include:12
- Education about the nature of fibromyalgia
- Realistic goal setting for work or work-like activities, social activities, and involvement with family and friends
- Relaxation training (e.g. progressive muscle relaxation training, controlled diaphragmatic breathing)
- Appropriate behavioral pacing of activities to not overdo or underdo activity levels
- Identification of dysfunctional thought patterns and techniques to counter negative automatic thoughts, and the underlying maladaptive attitudes or beliefs fueling these thoughts
- Communication skills training, to enhance appropriate assertiveness and to enhance interactions with healthcare providers and others
- Strategies for acquisition, maintenance, and generalization of skills
- Strategies for relapse prevention and for managing painful flare-ups
Regular, mild to moderate exercise is one of the most helpful treatments for fibromyalgia. Low-impact aerobic exercise, such as walking, swimming, biking, or water aerobics, is particularly beneficial because it builds general strength and endurance. Stretching and strengthening exercises are also appropriate.13
Complementary treatment (treatment and medicine used in addition to standard medical care) including acupuncture, chiropractic therapy, dietary supplements, herbal products, and vitamins, yoga, massage therapy, and meditation have been used to treat fibromyalgia.14 However, there is little supporting evidence that chiropractic therapy and acupuncture are effective treatments for fibromyalgia.15 16
Mindfulness-based stress reduction (MSBR) has been shown to significantly improve symptoms of fibromyalgia.17
MSBR is a structured group program that uses mindfulness meditation to alleviate suffering associated with physical, psychosomatic, and psychiatric disorders. A systematic procedure is employed to develop an enhanced awareness of the moment-to-moment experience of perceptible mental processes.
The idea is that greater awareness provides a more realistic perception, reduces negative affect, and improves vitality and coping. MSBR can increase the individual’s disposition to experience life as meaningful and manageable, which helps those with fibromyalgia cope with living with chronic pain.18
Find the Right Doctor for Fibromyalgia Treatment
Diagnosing Can Be Difficult
Diagnosing fibromyalgia can be difficult because fibromyalgia and fibromyalgia diagnostic criteria are inherently subjective, culture- and context-driven, and subject to measurement error. There are substantial and continuing problems relating to definition, validity, and reliability.
Fibromyalgia is not considered to be a type of arthritis because it does not cause inflammation or damage to joints, muscles, or other tissues. However, because fibromyalgia can cause chronic pain and fatigue like arthritis, rheumatologists are often used to detect fibromyalgia and rule out rheumatic diseases. Rheumatologists are your best bet for diagnosis, given that there is no fibromyalgia test.
Why Is Misdiagnosis Common?