Fibromyalgia causes widespread pain and tenderness.Chris Rout/Alamy
Fibromyalgia is a chronic disorder characterized by pain and tenderness throughout the body, as well as fatigue.
Although the condition is often grouped in the same category of disorders such as arthritis, it doesn’t cause damage to joints or other tissue.
Instead of being caused by inflammation, fibromyalgia is widely understood to be a disorder of the central nervous system — meaning that the brain is oversensitive to pain signals.
Symptoms of Fibromyalgia
Fibromyalgia symptoms may fluctuate in intensity, and may improve or worsen over time.
Factors such as stress, changes in weather, too much or too little exercise, and too much or too little rest can affect the severity of your symptoms.
Symptoms of fibromyalgia may include:
Widespread pain, occurring on both sides of the body, above and below your waist
Tenderness to touch
Fatigue, despite getting enough rest
Difficulty falling or staying sleep
Morning stiffness, or worsened pain in the morning
Difficulty with memory or concentration (known as “fibro fog”)
Problems with balance or coordination
Numbness or tingling in your hands or feet
Sensitivity to temperature (hot or cold)
Sensitivity to bright lights or loud noises
Painful menstrual periods in women
Pain in your face or jaw
Headaches, including migraines
Digestive issues, including abdominal pain, bloating, or constipation
Dry eyes or mouth
Skin sensitivity or rash
Fibromyalgia Tender Points
Fibromyalgia tender points — also known as trigger points — are areas of the body where pain frequently occurs.
People with fibromyalgia often say that these areas hurt when you press on them with a finger.
There are 18 identified tender points (nine pairs) that tend to be painful when pressed.
These spots are commonly found on both sides of the body around the elbows, shoulders, knees, neck, hips, sides of the breastbone, and back of the head.
Fibromyalgia Diagnosis Challenges
Fibromyalgia is sometimes difficult to diagnose because many of its symptoms are similar to those of other disorders.
A diagnosis often requires excluding other conditions, rather than finding definitive proof that fibromyalgia is what you have.
In someone with fibromyalgia, “There’s very little to see on a physical exam,” other than reported pain and tenderness, according to Don L. Goldenberg, MD, a rheumatologist and professor emeritus of medicine and nursing at Oregon Health and Science University in Portland.
In addition, “Laboratory tests are unremarkable,” and often give doctors little help, Dr. Goldenberg says.
You may end up seeing several doctors before getting an accurate diagnosis. This process may last longer than it should because of mistakes made by both doctors and patients, according to Goldenberg.
“Many patients with this condition will shop from doctor to doctor,” he says. “They’re sure that they’ve been injured or damaged, or there’s something in their environment. And they keep searching and searching.”
A diagnosis of fibromyalgia, says Goldenberg, requires accepting that your pain has no cause beyond the nervous system itself — and may, as a result, be more difficult to treat.
At the same time, doctors may prolong the diagnostic process by being either too deferential to — or too dismissive of — patients, Goldenberg says.
“A lot of doctors will order a lot of unnecessary tests,” he notes, due to patients’ desire to rule out improbable causes of their pain.
But more commonly, “Doctors will say, ‘It’s all in your head, toughen up,’” Goldenberg laments. “And of course that’s the last thing a person wants to hear.”
While Goldenberg doesn’t excuse this kind of behavior in doctors, he understands why some of them react so badly to fibromyalgia.
“For a certain type of physician who likes things black and white, this is a real gray area,” he says. “There’s no cause and effect. The symptoms can be murky. The treatment is very murky.”
How Fibromyalgia Is Diagnosed
While there’s no definitive test to diagnose fibromyalgia, the American College of Rheumatology (ACR) has established criteria for identifying the disorder.
In the past, doctors would check the 18 tender points on the body to determine a person’s level of pain. Current guidelines don’t call for this kind of exam.
Instead, the ACR instructs doctors to consider the following factors:
How many areas of the body (out of 18) are painful
Whether symptoms like fatigue, waking up unrefreshed, or difficulty thinking are present
Whether these symptoms have lasted at least three months
Whether any other condition might be the cause of these symptoms
It’s important to find a doctor who is familiar with fibromyalgia. Many rheumatologists, internists, and family doctors can properly diagnose and treat the disorder.
Before seeing your doctor, you may want to write a list that includes:
All past and present medical conditions
A detailed description of your symptoms
Medical conditions that run in your family
All medicines and supplements you take
Any questions you’d like to ask your doctor
Ruling Out Other Conditions
Even if your doctor suspects you have fibromyalgia, it may be desirable to rule out other, more serious conditions.
For example, “Widespread arthritis can cause pain in multiple areas,” Goldenberg notes. But, he adds, “Most doctors, although not all, should clearly be able to see that.”
If your doctor isn’t ready to diagnose fibromyalgia based on your symptoms and a physical exam alone, the following tests may be helpful:
Complete Blood Count This test can help rule out a number of disorders, including anemia (inadequate red blood cells), infection, and leukemia.
Erythrocyte Sedimentation Rate (ESR, or Sed Rate) This test can help reveal inflammatory processes throughout your body.
Cyclic Citrullinated Peptide and Rheumatoid Factor These tests can help detect rheumatoid arthritis.