Fibromyalgia

The FAQs and More

Fibromyalgia: The Tests

How exactly is one diagnosed with fibromyalgia? There are no specific blood tests or other proof positive examines which will say you have it. Fibromyalgia is often diagnosed after many other things have been eliminated AND a specific core of symptoms have been present for 3 or more months. Fibromyalgia is a great mimicker of several other diseases, yet will result in negative test results.

When one usually presents to the doctor not feeling well (with a broad category of complaints that may or may not seem related), they will usually start with a general physical examination and blood test. You may get your temperature and blood pressure checked, given a brief reflex test, eye/nose/throat exam, and they will draw some blood. If nothing pops out at them, they may dismiss it as a cold or flu. If the doctor is good, he/she may give a more thorough physical, update you on your shots, and request a bit more of an extensive blood panel test before dismissing you. The results of the blood test can come back within a few days and will usually all be normal.

Contrary to what most people may think, a so-called standard blood test is very limited in scope. There really is no such thing as a "standard" blood test, but there are minimal tests that are normally initially run which include: A complete blood count (CBC), blood chemistry tests, blood enzyme tests, and blood tests to assess heart disease risk. Usually all these tests will reveal is your white/red blood cell status (checks for anemia, inflammation, oxygen or limited indications that there is some problem), checks for cholesterol levels and signs of heart disease, sees if your kidneys and liver are functioning on a normal level and determine your glucose levels.

There is a protocol involved in ordering more complex blood tests. If any of the initial set of blood tests come back positive or inconclusive, the doctor may ask you to come back for further tests. Usually, if the blood tests are normal and nothing pops out to the doctor, they will chalk it up to a cold or flu and think nothing more about it. In most cases, it really is nothing serious and the patient does feel better in a few days or a few weeks.

If you still do not feel well or have more intense or new symptoms after a few weeks, you might follow up with the doctor to update him/her about what is going on. Depending on the doctor and you symptoms, he/she may run a further series of blood tests or refer you to a specialist or tell you to come back in a few weeks if nothing improves or gets worse while doing nothing except taking a "wait and see" approach. If you are sent to a specialist, they will only check out the area of their specialty and may not put it all together. They will usually send the results to your main doctor who might put it together.

If you complain of pain, your primary care doctor may give one of two of the common tests given are Erythrocyte Sedimentation Rate (ESR) test and C-Reactive Protein (CRP) test both of which give an idea of how much inflammation. They will usually test one or the other, not both. If it comes back positive, then they will give you the Antinuclear Antibodies (ANA) serum test is usually used to follow up on a positive ESR or CRP test to determine a specific auto-immune disease. If it comes back negative, they will either refer you to a specialist or tell you to come back later if it hasn't improved.

If you complain of diarrhea, you may be tested for electrolyte balance and specific virus/bacteria. They may give you a prescription to help control the symptom and if nothing comes out positive they may refer you to a specialist such as a gastrointestinologist. The gastrointestinologist may give you a series of specific blood tests and conduct an upper GI endoscopy and a colonoscopy. If you also have pain, they may also conduct an MRI and/or CT scan. A pain in the upper right quadrant might suggest a gallbladder problem. In the lower right quadrant it might suggest appendicitis. In the upper center, it might suggest gastritis or an ulcer. For the most part, if these tests come back normal, they eliminate all the really serious diseases, but it leaves it with a multitude of other things it could possibly be.

If you complain about fatigue they may test for mononucleosis or lyme disease or any other known malady that can cause fatigue. If they cannot find anything wrong, they may even directly prescribe anti-depressants assuming you might be depressed and tell you to come back later if things are not better. If the primary care doctor has worked with several anti-depressants and you still don't feel better, they will usually refer you to a psychiatrist and/or a sleep specialist. If you go to a sleep specialist, they may conduct a sleep study test to see how well you sleep (do you snore, kick, talk, walk in your sleep) and if they find problems will recommend specific treatment (for instance, if you have sleep apnea, they will recommend a CPAP machine). A psychiatrist will prescribe stronger medication and send you to a therapist to talk out your problems, but if your problem is not psychiatric in nature this can be a waste of years when you could get actual help. If you feel you are getting nowhere with psychological help and your primary care physician will not look further into your ailment, find another doctor.

There are many types of specialists you can be sent to for an evaluation and they will eliminate most problems. Often after several visits with several specialists, you may eventually be sent to a rheumatologist, a neurologist, or your primary care physician who will then evaluate if you have fibromyalgia.

The evaluation will take place when just about everything else has been ruled out by your doctor and/or specialists, you have a complaint of widespread pain that has lasted longer than 3 months, and you have one or more other condition(s) such as Raynaud's syndrome (secondary), irritable bowel syndrome, overactive bladder, headaches, migraines, restless legs syndrome, impaired memory, trouble concentrating, skin sensitivity, rashes, dry eyes and mouth, anxiety, ringing in the ears, dizziness, vision problems, neurological symptoms (seizures, twitching, numbness/weakness in limbs), arthritic-type stiffness (in the morning, before bed, and when still too long), and impaired coordination.

The pain factor is the main determination of diagnosis. There are currently thought of as 18 fibromyalgia specific pressure points where the pain is most intense when pressure of about 8 pounds is applied (enough to turn the bed of your nail white). If you have pain in 11-14 out of the 18 points (depends on the doctor) along with other complaints often seen with the syndrome and this has been shown to be the case over 3 months, then the conclusion is fibromyalgia. The pressure points are outlined below:

Lower right vertebra of the neck
Lower left vertebra of the neck
Between the first and second rib towards the center right
Between the first and second rib towards the center left
Inner side of right elbow
Inner side of left elbow
Inner towards middle of right knee
Inner towards middle of left knee
Upper left muscle at base of the skull
Upper right muscle at base of the skull
Upper left portion of shoulder blade
Upper right portion of shoulder blade
Lower left portion of shoulder blade
Upper right portion of shoulder blade
Muscle directly above left buttocks on back
Muscle directly above right buttocks on back
Muscle directly below left buttocks on thigh
Muscle directly below right buttocks on thigh

This test can be misleading and is not always consistent. Fibromyalgia pain can literally be anywhere in the body, not just at those points at any given time. A person may have an active flare-up when nowhere near a doctor or have pain active in any other place than those specific points and may or may not be diagnosed as FMS. In my case, I have had a constant point of pain in the same area of my body where my liver is located which led doctors to thinking it was a gallbladder or liver problem initially, but after a year all the classic symptoms developed and I was diagnosed.

This is a very frustrating syndrome for the patient and doctors alike. It can also be very expensive to diagnose as it will take so many tests to come to this conclusion and even with the diagnosis there is no cure, just treatment for each of the different symptoms.