According to the National Fibromyalgia Association, fibromyalgia is one of the most common chronic pain conditions. Fibromyalgia affects an estimated 10 million people of all ethnic groups in the United States. Most sufferers---75 to 90 percent -- are women, but men and children may also be affected. Diagnosis is usually made between the ages of 20 to 50 years but the incidence increases with age. The American College of Rheumatology established the diagnosis criteria for fibromyalgia in 1990. Diagnosis of fibromyalgia is based on the patient's medical history, self-reported symptoms, a physical examination and a manual tender point examination.
Diagnostic Tests
There are no laboratory or X-ray tests available for diagnosing fibromyalgia as of early 2010. Health care providers may order diagnostic tests to rule out other conditions, but the presence of other diseases does not rule out a diagnosis of fibromyalgia.
Medical History
An accurate medical history is required in the diagnosis of fibromyalgia. The National Fibromyalgia Association reports that diagnosing fibromyalgia may take as long as five years because many fibromyalgia symptoms---fatigue, muscle pain, stiffness, sleep disorders---overlap with those of other conditions. Conditions with similar symptoms include chronic fatigue syndrome, myofascial pain syndrome, major depression, multiple chemical sensitivity, stress-related disorders, autoimmune disorders and Lyme disease.
Certain medical conditions are commonly associated with fibromyalgia, including tension headaches, migraine, irritable bowel syndrome, irritable bladder syndrome, premenstrual tension syndrome, cold intolerance and restless legs syndrome. Patients with established rheumatoid arthritis, lupus and Sjogren's syndrome often develop fibromyalgia during the course of their disease.
ACR Requirement: Widespread Pain
According to the fibromyalgia diagnosis criteria established by the American College of Rheumatology, the patient must have a history of widespread pain for a minimum of three months. Pain is considered to be widespread if it is present along the spine and in all four quadrants---above and below the waist and on both sides--of the body. Patients often report, according to the National Fibromyalgia Association, that the pain seems to arise in the muscles and is less noticeable when they are at rest. The pain may be severe enough to limit their ability to work, exercise and perform normal daily activities.
ACR Requirement: Tender Points
The health care provider must perform an accurate manual examination of 18 specific tender points, according to the American College of Rheumatology diagnostic criteria. Tender points are palpated on both sides of the body, including the sides of the back of the neck, front of the neck, chest above the collarbone, upper back, inner elbow, lower back, lower hip and knees. The patient must experience localized and intense pain at least 11 of the 18 tender points to support a diagnosis of fibromyalgia. Tenderness on palpation is not sufficient. The pain may vary from day to day, so a negative tender points examination may be repeated on another date.
