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Fibromyalgia Diagnosis: Putting the Symptom Puzzle Together

Fibromyalgia is a complex and often misunderstood condition characterized by widespread musculoskeletal pain and fatigue, along with a number of other symptoms. Affecting millions of people worldwide, its diagnosis can be challenging due to the variability of symptoms and the lack of specific tests. This article aims to explore the process of diagnosing fibromyalgia, with an emphasis on the evolution of diagnostic criteria and their implications for patients and healthcare providers.


Medical history and physical examination

The medical history and physical examination are fundamental to the diagnosis of fibromyalgia . This process involves a detailed interview with the patient and a comprehensive physical examination.

Medical history: During this phase, the healthcare provider gathers information about the patient’s symptoms, medical history and any family history of similar conditions. Key areas of focus include the duration and intensity of pain, fatigue levels, sleep patterns and any cognitive difficulties such as memory or concentration problems.

Fibromyalgia Diagnosis: Putting the Symptom Puzzle Together

Physical examination: This involves a thorough physical examination where the doctor looks for specific tender points on the body. Although the emphasis on tender points has decreased over time, the examination of these points can still provide valuable information. The doctor will also assess your overall physical condition and look for signs that may indicate other conditions.

Together, these steps provide a comprehensive view of the patient’s health and symptoms, which is crucial to accurately diagnosing fibromyalgia and ruling out other conditions.


Understanding the symptoms of fibromyalgia is crucial for early detection and effective treatment. Fibromyalgia is known for its hallmark symptom: chronic, widespread pain throughout the body. This pain is often described as a constant dull ache, typically in the muscles and soft tissues. Patients may also experience increased sensitivity to pain, even to stimuli that are not normally painful.

In addition to pain, fibromyalgia is associated with fatigue, which can be severe and debilitating. This fatigue is not just a feeling of tiredness, but an overwhelming sense of exhaustion that can interfere with daily activities. Sleep disturbances are also common, with people struggling to get a good night’s sleep, making the fatigue worse.

In addition, many people with fibromyalgia report cognitive difficulties, commonly known as ‘fibro fog’, which include problems with memory, concentration and organising thoughts. These cognitive problems can significantly affect a person’s ability to carry out everyday tasks.

Understanding these symptoms is the first step in getting a proper diagnosis and treatment plan. It’s important for people experiencing these symptoms to consult with healthcare professionals for accurate diagnosis and treatment.


Diagnostic criteria for fibromyalgia

Fibromyalgia is a condition whose understanding and diagnostic criteria have evolved over the years. There have been significant changes in the primary criteria used for its diagnosis, particularly between the 1990 and 2010 guidelines and the 2011 and 2016 proposals.

1990 criteria

The criteria for diagnosing fibromyalgia, initially established by the American College of Rheumatology (ACR) in 1990, focused on physical examination. It required:

– Chronic pain for at least three months.

– Pain in at least 11 of 18 specific tender points on digital palpation.

18 trigger points of fibromyalgia - fibromyalgia trigger points

These criteria were the first to provide a standardized way of diagnosing fibromyalgia, but they were limited because they relied heavily on tender point examination.

2010 Criteria

In 2010, the ACR updated these criteria to address the limitations of the 1990 version. The new criteria eliminated tender point counting and introduced:

– The Widespread Pain Index (WPI): assessing pain in 19 areas of the body.

– The Symptom Severity (SS) scale: assessing the severity of symptoms such as fatigue, unrefreshed awakening and cognitive symptoms, as well as the extent of somatic symptoms in general.

This change recognized the variability and subjective nature of pain and included a broader range of symptoms, making the diagnosis more comprehensive.


Modifications in 2011

In 2011, further modifications were proposed to simplify the diagnostic process. These changes allowed for a self-report questionnaire, making it easier for both patients and clinicians to identify fibromyalgia.

2016 criteria

The 2016 revisions refined the 2010/2011 criteria. These updates:

– Emphasized the importance of severity and duration of symptoms.

– Removed the requirement to rule out other conditions, recognising that fibromyalgia can co-exist with other conditions.

Traditionally, fibromyalgia is considered female predominant. However, depending on the criteria used, the gender ratio varies significantly. A greater number of men are diagnosed with fibromyalgia using the 2010 ACR criteria. In fact, when using the 1990 ACR criteria, the female-to-male ratio was 13.7:1, compared to 4.8:1 with the 2010 ACR criteria and even lower with the 2011 proposal (2.3:1).

The evolution of these criteria from 1990 to 2016 reflects an ongoing effort to better understand and diagnose fibromyalgia. Each revision brings a more nuanced approach, taking into account the wide range of symptoms and their impact on patients’ lives. Understanding these criteria is important for healthcare providers and patients alike to ensure accurate diagnosis and appropriate management of fibromyalgia.


Exclusion of other conditions

Excluding other conditions is a critical step in the diagnosis of fibromyalgia because its symptoms are common to several other conditions, making diagnosis difficult. Fibromyalgia can mimic several conditions due to its variety of non-specific symptoms, requiring a thorough differential diagnosis.

Some of the key conditions to consider are:

Rheumatic diseases: These include systemic lupus erythematosus and rheumatoid arthritis, which share symptoms such as joint pain and fatigue with fibromyalgia.

Hypothyroidism: This can cause symptoms similar to fibromyalgia, such as muscle pain and fatigue.

Myofascial pain syndrome: This condition is characterised by chronic pain in muscle tissue, similar to the musculoskeletal pain in fibromyalgia.

Chronic fatigue syndrome: It shares the symptom of persistent fatigue with fibromyalgia, but with a greater emphasis on extreme exhaustion.

Healthcare professionals usually carry out various tests, such as blood tests and X-rays, to rule out these and other conditions. The process involves a careful assessment of the patient’s medical history, symptoms and physical examination findings. This comprehensive approach ensures that the symptoms are not attributed to other organic conditions and allows an accurate diagnosis of fibromyalgia.


Laboratory and medical imaging findings

Clinical laboratory and imaging findings play a supportive role in the diagnosis of fibromyalgia, mainly by ruling out other conditions. Unlike many diseases, fibromyalgia does not have specific laboratory tests or imaging findings for direct diagnosis.

Laboratory tests: Doctors often use blood tests to exclude conditions with similar symptoms, such as rheumatoid arthritis, lupus or thyroid problems. These tests help to ensure that symptoms are not caused by other conditions.

Medical imaging: Although imaging tests such as X-rays, CTs or MRIs are not used to diagnose fibromyalgia directly, they are valuable in ruling out other causes of musculoskeletal pain, such as fractures or arthritis.

Finally, the diagnosis of fibromyalgia relies more on the patient’s history, symptoms and physical examination than on laboratory tests or imaging. However, these tests are crucial in ensuring a thorough and accurate diagnosis by ruling out other potential causes of the symptoms.

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