Diagnosis
Fibromyalgia (FM) was recognized by the American College of Rheumatology in 1990. FM is thought to exist in 2% to 3% of the population. It occurs in both men and women, but it is more common in women. In women, Fibromyalgia occurs most commonly between the ages of 30 to 60. FM can also affect teenagers, children, and the elderly. FM has no known cause. Current research into how the nervous system deals with pain has shown that various abnormalities are present in people who have FM.
Other studies have indicated that genetic (inherited) factors may predispose some individuals to develop FM. These genetic factors can affect how the body responds to pain, physical or emotional trauma, and illnesses (such as viral infections).
This work is at the research stage and not yet available for doctors to help diagnose patients with FM in their offices. But this knowledge can be helpful in the management of FM.
The main symptom of FM is body pain that is felt in many parts of the body and has been present for at least 3 months. The pain may be burning, searing, tingling, shooting, stabbing, deep aching, sharp, and/or feeling bruised all over. Patients may be hypersensitive to painful stimuli (hyperalgesia), or experience pain from a stimulus e.g. light touch, that is not usually painful (allodynia). Over time, the pain becomes more constant and affects more areas of the body. The pain can vary in its location and how severe it is, and can be made worse in cold or humid weather. Stress can also cause the pain to become worse.
- Fatigue
- Poor (non-restorative) sleep
- Cognitive dysfunction (this includes problems with memory, thinking clearly, and ability to put thoughts into words)
- Mood disorder (this includes depression and/or anxiety)
- Irritable bowel syndrome
- Migraine headaches
- Severe menstrual pain
- Lower urinary tract symptoms such as painful urination
- Pain in the tissues, joints and muscles of the face (myofascial facial pain or temporomandibular joint TMJ or jaw pain)
As with many other health problems, early diagnosis of FM will help patients avoid the fear and anxiety of not knowing what is wrong with them. Early diagnosis also allows for better management of symptoms. For example, early and effective treatment for pain will decrease the risk of other pain and non-pain related symptoms (such as depression).
A diagnosis of FM is based on symptoms including body pain on both sides of the body, above and below the waist that has been present for at least 3 months. The other main symptoms are deep, profound fatigue and sleep disturbances. All patients with symptoms that suggest a diagnosis of FM should undergo a physical examination.
As there is no specific laboratory test to confirm FM, blood tests should be limited to those that can rule out other conditions that may have symptoms similar to FM. These include endocrine (gland) diseases such as hypothyroidism, rheumatic conditions such as early inflammatory arthritis, or neurological disease such as myopathy or multiple sclerosis.
Any further testing should be based on the individual patient’s symptoms. For example, a patient with significant sleep disturbance should be referred to a sleep specialist for evaluation.
