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Diagnosing Fibromyalgia

Shoulder and Neck Pain image

Diagnosing fibromyalgia can be very tricky.  Currently there is no definitive test for Fibromyalgia although despite considerable resources being invested into the discovery, study and science of fibromyalgia.

However, new diagnosing methods have been discovered in the past few years.  In 1990 and until 2010 the "tender point" analysis was the preferred method of diagnosis, which included a physical exam and discussion with the patient.  In the past years a new method has emerged measuring symptom severity and occurrence, as well as genetic testing and blood testing.

The current recommended test is the 2010 American College of Rheumatology fibromyalgia survey diagnostic criteria and symptom severity scale; outlined below as Widespread Pain Index (WPI) and Symptom Severity Survey (SS).

Though, at this point, there is still no definitive and clear cut medical signal to identify fibromyalgia.  Instead, the most recent method of diagnosis uses a pain index of symptoms, called "widespread pain indexing" to qualify patients on a fibromyalgia scale.  

Widespread pain indexing is considered superior to "tender point analysis" or "tender point diagnosis".

Widespread Pain Index (WPI) and Symptom Severity Survey (SS)

The current recommended method of diagnosis for Fibromyalgia is widespread pain indexing whereby the patient completes a questionnaire rating the location and severity of pain on a scale from 0-3.  A sample of the pain index survey can be found here (courtesy of the Fibromyalgia Network).

A free online fibromyalgia test is available by clicking the button below.

Take the Online Fibromyalgia Test

A complete clinical outline of the measurement criteria and benefits of this survey versus tender point analysis can be found here: Self-Report Fibromyalgia Screener

Fibromyalgia researchers have developed a new diagnostic criteria on 829 people with fibromyalgia along with a matched group of individuals that do not have fibromyalgia, but had other pain disorders such as neck or back pain syndromes and osteoarthritis[1]. Through this control group they were able to develop a widespread pain index.  This index is able to identify fibromyalgia patients to a success rate of 88% without the need for a tender point or physical exam.

FM/a Blood Testing

There is a blood test called FM/a that can help identify key genetic markers found in people with fibromyalgia.  The test can help determine whether fibromyalgia is present while also helping eliminate other often misdiagnosed or similar conditions such as Lupus and chronic myofascial pain, or smyalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). There are similarities between chronic fatigue syndrom and fibromyalgia, and between fibromyalgia and arthritis. However, despite the similarities fibromyalgia is a distinct condition that benefits from diagnosis and unique treatment.  

FM/a blood testing can be inquired about with your physician.

Tender Point Diagnosis

The tender point method of diagnosis, designed in 1990, is now considered to be an outdated method of classifying fibromyalgia and is no longer the recommended course of action to take for diagnosis.  There are numerous issues with this classification for fibromyalgia including bias between patient and doctor[2].

 “They were intended to be classification criteria to be used to standardize research into fibromyalgia, and they served that purpose very well, and will continue to be used by most researchers for this purpose," says Daniel J. Clauw, MD, a rheumatologist at the University of Michigan in Ann Arbor.

“The trick to fibromyalgia is diagnosing it,” says Robert Katz, MD.  “A lot of people experience widespread pain, but when do you give it the label of fibromyalgia?".  Fibromyalgia cannot be specifically measured, X-Ray'd or cat scanned.  The most common method of diagnosis is diagnosing the widespread pain disorder primarily on “tender point” exams or tenderness to the touch.  These areas of "tenderness" need to occur at 11 or more of 18 specified tender points and widespread pain in all four quadrants of the body for three months.

Genetic Testing and Diagnosis

Most recently, the Proove Fibromyalgia Profile genetic test identifies 11 genes that modulate the transmission and processing of pain in fibromyalgia[1].

Chronic and persistent pain is estimated to affect up to 30% of the world's population[3], as such, much research has been made into the genetic linkages over the past 20 years in order to better identify those with chronic pain and work towards better treatments[4].

Thus far markers in 11 genes that modulate the transmission and processing of pain in fibromyalgia have been identified and are being studied.  The identification of these genes and the resulting symptoms of fibromyalgia can help with diagnosis and hope to lead to better treatments[5].

Genetic testing can help as follows:

  • Patients requiring diagnoses can receive a mouth swab which is sent for lab testing
  • Doctors would then receive a report highlighting the patient’s genetic predisposition for developing fibromyalgia
  • The report can then be used for clinical recommendations for how a patient is likely to respond to commonly prescribed fibro medications
  • Medical professionals can use the genetic insights to help diagnose fibromyalgia
  • Medical professionals can individualize treatment based on recorded past experiences of similar patients[6]

The Importance of an Accurate Fibromyalgia Diagnosis

There are many misconceptions with fibromyalgia, as well as skeptical doctors.  Fibromyalgia is difficult to diagnose and finding a diagnosis can be a frustrating ordeal for anyone suffering from widespread pain.  However, an accurate diagnosis is important in order to move forward with the knowledge of fibromyalgia and to find appropriate treatment.

Recent genetic testing the identification of specific genetic markers leaves no doubt of the reality of suffering and pain of fibromyalgia for those affected.  As far back as 2009 key biomarkers were identified:

Fibromyalgia is a common pain syndrome characterized by widespread pain, tenderness, and a number of other somatic symptoms and syndromes. Although there was original skepticism that any objective abnormalities would be identified in these individuals, at present there are many that have been reproducibly identified, and most point to dysregulation of central nervous system function as a key underlying pathogenic mechanism in this and related illnesses. [7]

Armed with the knowledge that fibromyalgia does indeed exist and staying determined to find a doctor that supports your fibromyalgia diagnosis will benefit your treatment and overall well being tremendously.  

Now that you're familiar with the methods of diagnosis for fibromyalgia why not: Find a Fibromyalgia Doctor

Footnotes:
  1. a, b A New Way of Diagnosing Fibromyalgia, 2015
  2. ^ Diagnosis and Diagnostic Tests, W. Häuser, F. Wolfe
  3. ^ A New Decision Tool for Treating Patients with Fibromyalgia., 2017
  4. ^ Elzahaf et al., 2012
  5. ^ Genetic predictors of human chronic pain conditions., 2016
  6. ^ New Genetics Testing Could Improve Fibromyalgia Diagnosis, Treatment, 2016
  7. ^ Biomarkers in Fibromyalgia

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