The path to a diagnosis of fibromyalgia can be a long and uncertain one. It takes an estimated five years on average to receive a fibromyalgia diagnosis. Waiting to see whether symptoms continue or worsen is an unfortunate aspect of the process for many people. Other conditions may be suspected or even misdiagnosed before a person is finally diagnosed with fibromyalgia. Some people have multiple chronic conditions, making it difficult for doctors to identify which is causing pain and other symptoms.
Many doctors previously denied the validity of fibromyalgia as a diagnosis since it cannot be detected by tests, and researchers still do not know how it develops. Physicians often insisted that symptoms were purely psychological. Fibromyalgia is more widely recognized now, and guidelines exist for its diagnosis and treatment.
How is fibromyalgia diagnosed?
There is no one conclusive test that proves fibromyalgia. Instead, there are three main criteria, all of which must be present to diagnose fibromyalgia:
Although fibromyalgia symptoms can differ between people, certain core symptoms must be established for fibromyalgia to be considered as a diagnosis. Severity and duration of symptoms are also important.
Tests and what they show
Some tests can provide support for a fibromyalgia diagnosis, while others are performed to rule out other conditions.
The doctor will take a thorough history, asking for specific details about pain and other symptoms over time. They will likely ask about family medical history and possible exposures to toxins or infections. A clear picture may emerge from the medical history that will help a doctor assess risk factors that may strengthen the suspicion of fibromyalgia or rule out other conditions.
The doctor will carefully examine you, checking for tender points and any other source of pain. The results of the physical exam may suggest fibromyalgia or another condition.
Ruling out other conditions
Dozens of other conditions can produce fibromyalgia-like symptoms such as fatigue and chronic pain, and these must be ruled out in order to confirm fibromyalgia. The process of ruling out similar conditions is referred to as differential diagnosis. To list just a few, conditions that may resemble fibromyalgia may include hypothyroidism (low thyroid hormones), polymyalgia rheumatica, depression, and autoimmune disorders such as lupus, spondylitis, Sjögren's syndrome, multiple sclerosis, myasthenia gravis, and rheumatoid arthritis.
Your doctor may be able to rule out many of these conditions quickly based on your medical and family history or simple blood tests. Other disorders may require time and repeated tests before they can be confirmed or ruled out. The presence of other diseases in addition to fibromyalgia may complicate the differential diagnosis and eventually result in multiple diagnoses.
Blood tests cannot prove fibromyalgia, but they can rule out many other conditions. For example, hypothyroid tests will show abnormally low levels of thyroid hormones. Most autoimmune conditions will show high levels of inflammatory proteins and autoantibodies, or proteins made by the immune system that attack the body’s tissues. If all blood tests are normal, a diagnosis of fibromyalgia looks more likely.
If the doctor suspects a degenerative condition such as rheumatoid arthritis, they may order X-ray, computed tomography (CT), or magnetic resonance imaging (MRI) scans to check for damage to joints. Fibromyalgia does not cause damage.
What is the prognosis for fibromyalgia?
Fibromyalgia is a chronic condition, but symptoms may come and go with significant periods of remission. Fibromyalgia is not life-threatening, and it does not shorten the lifespan. There is no cure for fibromyalgia, but it can be treated. Read more about fibromyalgia treatments.