DIAGNOSING FIBROMYALGIA Someone goes to the doctor reporting pain ‘all over’ and exhaustion that does not go away even after a night’s sleep.  Such pain and fatigue are the two main symptoms of fibromyalgia.  However, these symptoms can also occur for other reasons - perhaps another illness or an injury.  How does the doctor know whether the person has fibromyalgia? Fibromyalgia is diagnosed in two steps.  First, other illnesses and conditions are ruled out by a thorough examination, including: (a)   A review of the person’s medical history, to ensure that no previous condition is         in some way responsible for the symptoms; (b)   Laboratory tests, including analysis of the person’s blood and urine, to find out         whether some hidden infection or disease could be causing the problem.         Sometimes x-rays or neurological tests are done, depending on when and how         the symptoms began. The second step is to apply the criteria, or standards, that distinguish fibromyalgia from other pain syndromes.  (A syndrome is a particular set of symptoms rather than a defined disease). It was only recently that diagnostic standards for fibromyalgia were agreed on and published.  In 1986, a committee of 24 doctors from medical centers across North America began a study to determine criteria for the classification of fibromyalgia.  They found that the criteria below, used in combination, were the best available for classifying and diagnosing fibromyalgia. Diagnostic Criteria for Fibromyalgia, 1990 1.  History of widespread pain (present for at least 3 months) Pain is considered widespread when it is felt in all of the following regions: A.   left side of the body; B.   right side of the body; C.   above the waist; D.   below the waist; E.   axial skeleton (cervical spine or anterior chest or thoracic spine or low back) -     shoulder and butttock pain is considered pain on the side or sides reported -     ‘low back’ pain is considered pain ‘below the waist’ 2.  Pain on digital palpation in 11 of the following 18 tender point sites. (The 9 locations listed appear on both sides of the body for a total of 18). A.   Occiput;  at the suboccipital muscle insertion B.   Low cervical; at the anterior aspect of the intertransverse spaces at C5-C7 C.   Trapezius;  at the midpoint of the upper border D.   Supraspinatus: at origin, above the scapular spine near the medial border E.   2nd rib:  at the second costochondral junction F.   Lateral epicondyle:  2 cm. distal to the epicondyle G.   Gluteal:  in the upper outer quadrant of buttock in anterior fold of muscle H.   Greater trochanter:  posterior to the trochanteric prominence I.     Knees:  at the medial fat pad proximal to the joint line For the tender point to be considered positive, the person must state that the palpation was ‘painful.’  A reply of ‘tender’ is not to be considered painful.  Digital palpation should be performed with an approximate force of 4 kg. Reprinted, with changes, from “The American College of Rheumatology 1990 criteria for the classification of fibromyalgia;  report of the multicenter criteria committee.”  by F. Wolfe, H.A. Smythe, M.B. Yunus et al.,  Arthritis and Rheumatism Journal. Vol. 33, No. 2 (February 1990), pp. 160-72, copyright 1990.  Used by permission of the American College of Rheumatology.