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More on Diagnosis

Because of the way that Fibromyalgia is diagnosed, and the fact that the symptoms could be attributed to so many different illnesses, diagnosing Fibromyalgia is difficult, and can sometimes take many years. This is made worse by the past lack of an objective test and the lack of recognition of Fibromyalgia as a 'real' diagnosis.

Fibromyalgia is often diagnosed through the exclusion of all other illnesses that can cause the symptoms being experienced by the patient. If the patient is still experiencing those symptoms after approximately six months they are then considered chronic.

In 2013 EpicGenetics, an American company, announced a new blood test, "FM/a", that tested blood patterns of chemokines and cytokines and was 94% successful at identifying Fibromyalgia. There has been some controversy about this as there has not been much published work on this test. Additionally, for Fibromyalgia patients living outside the United States, EpicGenetics are the sole testing facility and the cost is over USD$700. Another issue not canvassed by EpicGenetics is the impact of a negative result on someone who has been living with Fibromyalgia for a long time.


New American College of Rheumatology Criteria for Fibromyalgia

The New Criteria for the diagnosis of Fibromyalgia was formulated by the American College of Rheumatology in 2010 and incorporates the idea of tender points, as well as recognising the importance of a quantitative measure of widespread pain, the widespread pain index (WPI). The criteria also incorporate key Fibromyalgia symptoms and provides severity scales to measure the extent of widespread pain and symptom severity; the symptom severity scale (SS).

 

Fibromyalgia Diagnostic Criteria

Criteria

A patient satisfies diagnostic criteria for fibromyalgia if the following 3 conditions are met:

 1. Widespread pain index (WPI) > 7 and symptom severity (SS) scale score > 5 or WPI 3–6 and SS scale score > 9.
 2. Symptoms have been present at a similar level for at least 3 months.
 3. The patient does not have a disorder that would otherwise explain the pain.

 

Ascertainment

1. WPI (widespread pain index): note the number areas in which the patient has had pain over the last week. In how many areas from the following list has the patient had pain? The score will be between 0 and 19.

Shoulder girdle, left  Hip (buttock, trochanter), left Jaw, Left  Upper Back
Shoulder girdle, right Hip (buttock, trochanter), right Jaw, right Lower Back
Arm, left upper Leg, left upper Neck Chest
Arm, right upper Leg, right upper
Abdomen  
Arm, left lower Leg, left lower    
Arm, right lower Leg, right lower    

 2. The Symptom Severity score (SS) is based on the patient's experienced severity of:

      • Fatigue
      • Waking unrefreshed
      • Cognitive symptoms

The patient indicates whether, during the past week,  they have experienced these symptoms and the score ( 0 to 3) is recorded:

 0. No problem
 1. Slight or mild problems, generally mild or intermittent
 2. Moderate, considerable problems, often present and/or at moderate level
 3. Severe: pervasive, continuous, life-disturbing problems

Somatic symptoms (symptoms that are experienced as a physical feeling or sensation.) in general, that might be considered: muscle pain, irritable bowel syndrome, fatigue/tiredness, thinking or remembering problem, muscle weakness, headache, pain/cramps in the abdomen, numbness/tingling, dizziness, insomnia, depression, constipation, pain in the upper abdomen, nausea, nervousness, chest pain, blurred vision, fever, diarrhoea, dry mouth, itching, wheezing, Raynaud's phenomenon, hives/welts, ringing in ears, vomiting, heartburn, oral ulcers, loss of/change in taste, seizures, dry eyes, shortness of breath, loss of appetite, rash, sun sensitivity, hearing difficulties, easy bruising, hair loss, frequent urination, painful urination, and bladder spasms. The patient indicates whether they have experience:

 0. No symptoms
 1. Few symptoms
 2. A moderate number of symptoms
 3. A great deal of symptoms

The SS scale score is the sum of the severity of the three symptoms (fatigue, waking unrefreshed and cognitive symptoms) plus the extent (severity) of the somatic symptoms in general. The final score is between 0 and 12.

Reference: Arthritis Care & Research; Vol.62, No.5, May 2010,pp 600-610


The "Rediculously Long List of Fibromyalgia Symptoms"

You can download a copy of this list here

Symptom Overlap

There are many illnesses that have overlapping symptoms with Fibromyalgia. This can cause people with fibro to be misdiagnosed with other illnesses, and people to be diagnosed with Fibromyalgia that have another illness.

More information here