How Do Doctors Know if You Have Fibromyalgia

Diagnosing Fibromyalgia

If you lot feel tired all the time and have musculus aches and pains, y'all might remember you're coming down with the influenza or another disease. But if your symptoms have been persisting for weeks or months and y'all likewise have indisposition, GI distress, or cognitive issues like "brain fog," consider making an engagement with your general practitioner to discuss the possibility of having fibromyalgia.

Here are other common fibromyalgia symptoms to be aware of.

What Is Fibromyalgia?

Fibromyalgia is a disorder that causes widespread chronic pain and tenderness. According to the American Higher of Rheumatology, fibro (as many patients call information technology) is more common in women than in men and also mutual among people with arthritis or chronic hurting, such as rheumatoid arthritis, ankylosing spondylitis, or lupus. Fibromyalgia tin occur at any age merely about oftentimes start strikes in middle historic period.

Doctors don't know exactly what causes fibromyalgia, but they know that the condition is not due to an autoimmune illness, systemic inflammation, or concrete articulation or muscle disorder.

"People who have fibromyalgia take a reduced pain threshold," says Frederick Wolfe, Medico, a rheumatologist and fibromyalgia expert in Wichita, Kansas, who helped create the original and updated fibromyalgia diagnostic criteria from the American College of Rheumatology. "If you lot stick your finger in someone's chest who has fibromyalgia, when you press downwardly, they volition say that it hurts. The pressure is more than painful than in someone who doesn't have fibromyalgia."

Diagnosing Fibromyalgia Can Be Hard

At that place's no single test (such as a blood test or an imaging examination like an X-ray) that can confirm a diagnosis of fibromyalgia. Rather, fibromyalgia is considered a "diagnosis of exclusion," which means that doctors first accept to dominion out other wellness issues.

Make an date with your family doctor or rheumatologist (if y'all already have i) to discuss your symptoms. It could be helpful to download a fibromyalgia pain log to track your symptoms, the severity of pain, and how your lifestyle is impacted and bring that to the physician's office.

Yous tin also employ our ArthritisPower app to track your symptoms and share your results with your doctor.

Diagnosing fibromyalgia is often challenging, says John Dombrowski, Doctor, anesthesiologist and pain direction specialist at The Washington Pain Center, Washington, D.C. "It can be a challenge for the physician just too for patients," he says. "When you have a headache or a broken os, you tin can point to the problem. With fibromyalgia, the symptoms can be somewhat vague."

Here'south why fibromyalgia tends to be tricky to diagnose:

1. You lot might not be visiting the right doctor

While your first form of action will probably be to talk to your primary intendance doctor, you lot may want to enquire for a referral to a rheumatologist. "The people who mainly work with fibromyalgia are rheumatologists because fibromyalgia is a rheumatologic problem," says Dr. Dombrowski. A visit to a rheumatologist may involve tests to rule out wellness problems that can take similar symptoms as fibromyalgia, including Lyme illness, rheumatoid arthritis (RA), axial spondyloarthritis, and osteoarthritis.

Information technology's wise to get a specialist involved who's used to dealing with fibromyalgia patients for diagnosis and initial treatment. Once you take a fibro diagnosis, a pain direction specialist similar Dr. Dombrowski can offer customized treatments to fibromyalgia patients for whom chronic pain is an outcome.

If yous can't get to a pain specialist or rheumatologist because there isn't 1 available in your area correct away, talk to your master care doctor about your symptoms and mention that yous remember it could be fibromyalgia. They could try to diagnose it themselves and care for the symptoms to see if that helps.

ii. Your doctor might non be screening you properly

One of the reasons that fibromyalgia can be difficult to diagnose is that doctors spend time and resources searching for diseases that could be causing all of the various symptoms of fibromyalgia, says Dr. Wolfe. If your doctor doesn't doubtable fibromyalgia — and depending on the exact nature of your symptoms and related diseases, they might not — they might country on a different condition, such every bit depression or irritable bowel syndrome. Seeing a rheumatologist or dr. who is experienced in treating fibromyalgia patients may accelerate your time to getting diagnosed.

three. Fibro pain is oft invisible

It'southward of import to verbalize exactly where on your body you experience pain, and to describe how the pain feels, what brings it on, how long it lasts, and what, if anything, makes it feel better. While someone with, say, RA can oftentimes point to a specific body part (like the hand) that has swelling, redness, and stiffness in addition to pain, someone with fibromyalgia tends to experience widespread hurting and tenderness in larger areas, like specific quadrants of the body. Some people with fibromyalgia experience tingling or burning sensations, along with pain, in areas of the body, likewise as pregnant fatigue.

4. Fibro can occur with other diseases

People tin have fibro at the same time as other diseases, such as inflammatory arthritis or osteoarthritis. They're all chronic pain conditions, but a rheumatologist should be able to ask questions and do lab or imaging tests that help distinguish them. A scenario is that a patient might have a diagnosis of RA and is taking medication that reduces inflammation but still experiences hurting. In this case, the pain may be due to fibro (or something else) rather than from the RA. One study published in the journal Annals of Rheumatic Diseases establish that 14 per centum of the RA patients who participated in the inquiry as well fulfilled fibromyalgia criteria. If you accept RA or OA and recall y'all might too accept fibromyalgia, bring it up to your rheumatologist to see if they can treat those symptoms of fatigue and overall pain as well.

Physical Exam and Medical History for Diagnosing Fibromyalgia

In gild to diagnose fibromyalgia, your doctor should ask yous nigh the following symptoms and their severity: pain you've felt throughout the by week, fatigue, cerebral problems, and whether y'all wake up feeling tired. They volition likely want to know about specific pain, sensitivity, and tenderness that yous experience in sure areas of the torso.

In add-on, your doctor should too ask about other symptoms, since fibromyalgia usually coexists with other seemingly unrelated wellness bug, including irritable bowel syndrome (IBS), jaw pain from clenching, headaches, frequent urination, and anxiety or depression.

"An over-stimulated nervous organisation could lead to undiagnosed stomach issues, as well as jaw pain and headaches from clenching your jaw in response to the overall pain," says Dr. Dombrowski. This is why it'due south so important to have a physician who listens to your symptoms and tin make the connection among them. "Eighty pct of the diagnosis is the physician listening."

Older vs. Newer Criteria for Diagnosing Fibromyalgia

The criteria (or "rules") for diagnosing fibromyalgia have inverse over the last decade. Criteria from the American College of Rheumatology (ACR) outset published in 1990 required:

Presence of hurting on both sides of the body
Presence of pain above and beneath the waist
Presence of at least 11 out of a possible eighteen tender points
Pain present for at least iii months
Pain not due to another disorder

Even so, more than contempo criteria have downplayed the function of the tender points in clinching a fibromyalgia diagnosis. The ACR's updated fibromyalgia diagnostic criteria from 2010 — created with the help of Dr. Wolfe — suggests using questionnaires that assess pain and related symptoms, chosen the widespread pain index (WPI) and symptom severity calibration (SSS).

The WPI asks where yous felt hurting in specific areas of the trunk, noting a "1" for each area. The SSS assesses how the pain feels in terms of fatigue, cerebral symptoms, and how you feel when you wake upward, on a scale of 0 (no issues) to 3 (severe and continuous).

Today, doctors diagnose fibromyalgia based on the post-obit general guidelines:

Using the Widespread Pain Index and Symptom Severity Calibration when (WPI) ≥7 and the Symptom Severity Scale (SSS) score ≥5, OR WPI 4–vi and SSS score ≥ix.
Generalized pain, divers equally hurting in at to the lowest degree 4 of 5 regions (left upper, right upper, left lower, right lower, low back) is present.
Symptoms have been present and consistent for at least three months
Counting tender points (not required)

The Role of Counting Tender Points

When doctors would diagnose fibromyalgia years ago, they would count tender points and track those tallies over time to determine if the patient's status was getting better or worse. They would apply force per unit area to 18 (sometimes 19) specific points on the body where fibromyalgia patients tend to feel more pain and sensitivity. The tender points, which occur on both sides of the body, include:

Lower neck in front
Edge of upper chest
Arm near the elbow
Knee
Base of the skull in the back of the head
Hip bone
Upper outer buttock
Back of the neck
Dorsum of the shoulders

Now the tender point counting method is non recognized as a standardized measure for diagnosing fibromyalgia and determining whether the condition is getting improve or worse. That'south because enquiry institute that tender points were only nowadays in about 50 percent of fibromyalgia patients. Many people didn't fulfill the pain criteria for these specific areas, but in full general had "pain all over" or in specific areas. Counting and assessing tender points was seen as arbitrary and excluded people who had fibro just didn't fulfill these criteria.

Counting and evaluating tender points is withal being used today past some doctors but shouldn't be used exclusively for a fibromyalgia diagnosis. Yous can have fibromyalgia without having pain in these specific tender points.

Tests for Diagnosing Fibromyalgia

In that location is no specific claret examination to diagnose fibromyalgia. Your physician may take blood to screen for other diseases and rule other diseases, such as hypothyroidism (underactive thyroid gland), polymyalgia rheumatica, rheumatoid arthritis, or lupus.

Tests such as C-reactive poly peptide (CRP) and erythrocyte sedimentation charge per unit (ESR) discover inflammation in the body. They should be elevated in diseases like rheumatoid arthritis but not in fibromyalgia. (1 study found that CRP levels were reported college in those people who had been diagnosed with fibromyalgia, merely high BMIs and other chronic diseases might explain that association.)

If your CRP tests come back with depression or medium levels and ESR tests show low inflammation, that might eliminate other diseases and point your dr. in the direction of diagnosing fibromyalgia. Emerging research using vibrational spectroscopy (an advanced blood test) may assist place specific protein biomarkers in the claret that differentiates fibro from other disorders. But this test isn't expected to be ready for mainstream utilise for some other five years at least.

Imaging Tests for Diagnosing Fibromyalgia

While arthritis that has caused joint damage can be seen on an X-ray, fibromyalgia does not show up on X-rays. So if you have fibro symptoms like widespread body pain (or in those specific areas mentioned above) simply X-rays don't testify joint damage, that could exist another indicator that your symptoms are due to fibromyalgia.

In research studies, functional brain imaging tests in people with fibromyalgia have noted aberrant pain processing in specific areas of the brain. Magnetic resonance spectroscopy (a noninvasive test that measures biochemical changes in the encephalon) found higher concentrations of the neurotransmitter glutamate in specific hurting-related areas in fibromyalgia patients. Researchers have used this technology during studies but information technology's not even so being done in doctor's offices to assist diagnose patients. Your medico should be able to diagnose fibromyalgia using the methods outlined to a higher place.

How Doctors Know It's Fibromyalgia and What Happens Next

Once your doctor has assessed whether you encounter the criteria for fibromyalgia diagnosis and has ruled out other weather, they may suggest prescription medication and lifestyle modifications to treat and manage fibromyalgia.

Your md may recommend certain antidepressant medication, which tin can not only treat low, but likewise address pain and fatigue linked with fibromyalgia. Another category of commonly prescribed medication for fibro is anti-seizure drugs that tin can also help with the nerve-related hurting from fibromyalgia. These include gabapentin (Neurontin) and pregabalin (Lyrica).

Lifestyle changes are a core role of fibro treatment. "I advise patients swallow a salubrious diet and do relaxation techniques, like meditation, stretching, yoga, and physical therapy," says Dr. Dombrowski.

Therapies like cerebral behavioral therapy (CBT) and talk therapy may be recommended, too as acupuncture, massage therapy, and chiropractic help to reduce pain and symptoms. Getting regular exercise — fifty-fifty in very minor increments at starting time — is of import. Information technology'due south primal to get enough slumber and practice stress management and self-care to assist with fatigue from fibro.

Once your rheumatologist or pain specialist has come up up with a treatment plan, y'all tin can keep to see them or piece of work with your master care dr. to manage symptoms and adjust prescriptions and lifestyle habits as needed.

Back up for Managing Fibromyalgia

Chances are, if y'all're seeing a rheumatologist or other doctor considering you have concerns almost having fibromyalgia, you've already seen quite a few health intendance providers by at present. We know this procedure can be exhausting and exasperating. Nosotros are here for yous to help make things easier. Get part of the CreakyJoints customs (you can sign upwardly in the upper right corner of our site) and follow u.s. on Facebook and Twitter for ongoing back up and didactics.

Go a more than specific list of fibromyalgia symptoms and check out these tips for living better with fibromyalgia from swain patients. Stay upwards to date hither on all of our fibromyalgia news and resources.

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Source: https://creakyjoints.org/about-arthritis/fibromyalgia/fibromyalgia-overview/fibromyalgia-diagnosis/