# 4 – How fibromyalgia is diagnosed.

The diagnosis of fibromyalgia evolved over time. Like many other disorders, the progress of medical science keeps revising how fibromyalgia is diagnosed. Although fibro has been a health problem dating back thousands of years, the formal recognition of the disorder by the World Health organization did not happen until 1990. The same year, the American College of Rheumatology published its first guidelines.

Since 1990, there have been several editions of the diagnostic guidelines, with the latest version published in 2016.  Interestingly, I found several prominent websites and organizations still list 2010 guidelines.

You can view the abstract of the guidelines here - https://acrabstracts.org/abstract/2016-revisions-to-the-20102011-fibromyalgia-diagnostic-criteria/

To be diagnosed with fibromyalgia a patient must have widespread pain for at least 3 months and appropriate score combination of the severity scale and widespread pain index.  See my post about pain in fibromyalgia here. The 2016 guidelines removed the tender point count required for the diagnosis, as they may be absent in some patients.

Other symptoms are also included in the symptom severity score – fatigue, unrefreshed sleep, cognitive symptoms (brain fog), headaches, pain/cramps in lower abdomen and depression.

One important change in this version of guidelines is that now the patient who meet these criteria can be diagnosed with fibromyalgia regardless of other diagnoses and it does not exclude the presence of other illnesses. This is new: Fibromyalgia diagnosis used to require that there be no other diagnosis to explain the findings. Many patients have other pain disorders concurrently with fibromyalgia.

Although the published guidelines may sound straightforward, I caution patients to avoid self-diagnosis. I recommend evaluation by an experienced physician - rheumatologist, neurologist, pain specialist or primary care physician.  Many of the patients I evaluated were appropriately diagnosed with fibromyalgia by the primary care doctors who are well equipped to treat it as well.  During the evaluation, a careful medical history is taken, including inquiring of the present and past health problems, what medication you take, family history.   A physical exam should always be performed.  Blood tests are taken to rule out other conditions but may not be necessary.

Next post will examine the principles fibromyalgia treatment.

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