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Fibromyalgia Diagnosis: How is Fibromyalgia Diagnosed?

Many people with Fibromyalgia report that they’ve seen numerous doctors, and obtaining a diagnosis of their illness has taken a year or more, Why?  The honest truth lies in the fact that fibromyalgia is often difficult to diagnose. The difficulty with diagnosing fibromyalgia is that, in most cases, laboratory testing appears normal and that many of the symptoms mimic those of other rheumatic conditions such as arthritis or osteoporosis.  So then, how do doctors diagnose people with fibromyalgia? 

In general, most doctors diagnose patients with a process called differential diagnosis, which means that doctors consider all of the possible things that might be wrong with you based on your symptoms, gender, age geographic location, medical history and other factors.  They then narrow down the diagnosis down to the most likely one.  A doctor familiar with fibromyalgia, however, can make a diagnosis based on two criteria established by the American College of Rheumatology. In 1990, the American College of Rheumatology, a professional organization of thousands of rheumatologists, developed criteria to help doctors determine whether patients have fibromyalgia.  Very basically, these following criteria were established:

1. Widespread pain in all four quadrants of their body for a minimum of three months. Pain is considered widespread when all of the following are present:

   • Pain in the left side of the body

   • Pain in the right side of the body

   • Pain above the waist

   • Pain below the waist

   • Pain in the neck, front of your chest, mid-back, or low back

2. Pain experienced when at least 11 of the 18 specified tender points (These are areas of pain on touch but without signs of redness, swelling or heat in the surrounding joints or muscles) are touched with a force of about 4 kg (9 pounds) or less The location of the 18 tender points are:

(1 & 2) Occiput: on both sides (bilateral), at the sub-occipital muscle insertions.
(3 & 4) Low Cervical: bilateral, at the anterior aspects of the inter-transverse spaces.
(5 & 6) Lateral Epicondyle: bilateral, 2 cm distal to the epicondyles
(7 & 8) Knee: bilateral, at the medial fat pad proximal to the joint line.
(9 & 10) Second Rib: bilateral, at the second costochondral junction, just lateral to the junctions on upper surfaces.
(11 & 12) Trapezius: bilateral, at the midpoint of the upper border of the muscle.
(13 & 14) Supraspinatus: bilateral, at origins, above the spine of the scapula (shoulder blade) near the medial border
(15 & 16) Gluteal: bilateral, in upper outer quadrants of buttocks in anterior fold of muscle.
(17 & 18) Greater Trochanter: bilateral, posterior to the trochanteric prominence.

Why Eleven Points?  Some experts believe that a person does not need to have the required 11 tender points to be diagnosed and treated for fibromyalgia. This criterion was originally intended for research purposes. A diagnosis of fibromyalgia may still be made if a person has less than the 11 of the required tender points so long as they have widespread pain and many of the common symptoms and associated syndromes connected to fibromyalgia.  In some cases, doctors diagnosing fibromyalgia may decide that you need a special scan or test on the part of your body that’ causing you pain.  The scans and tests include:

• Computerized tomography (CT) Scan

• Magnetic resonance imaging (MRI)

• X-ray