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Page: Diagnosis
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Strictly speaking, there are no "diagnostic criteria" for the disorder. Rather, there exist a widely accepted set of classification criteria for research purposes which were elaborated in 1990 by the Multicenter Criteria Committee of the the American College of Rheumatology. These criteria, which are known informally as "the ACR 1990" define fibromyalgia according to the presence of the following criteria:
* A history of widespread pain lasting more than three months — affecting all four quadrants of the body, i.e., both sides, and above and below the waist.
* Tender points — there are 18 designated possible tender points (although a person with the syndrome may feel pain in other areas as well). During diagnosis, four kilograms-force (40 newtons) of force is exerted at each of the 18 points; the patient must feel pain at 11 or more of these points for fibromyalgia to be considered. Four kilograms of force is about the amount of pressure required to turn fingernails white or to feel pain sensations on the forehead. This technique was developed by the American College of Rheumatology as a means of classifying an individual as having fibromyalgia for both clinical and research purposes. While these criteria for classification of patients were originally established as inclusion criteria for research purposes and were not intended for clinical diagnosis, they have become the de facto diagnostic criteria in the clinical setting. It should be noted that the number of tender points that may be active at any one time may vary with time and circumstance.
Objective Tests
Many people with fibromyalgia have abnormal autonomic function, which may be demonstrated by tilt table testing, which is an evaluation of autonomic function. In addition, several studies have demonstrated a reduction in heart rate variability (HRV) in patients with fibromyalgia, which may be interpreted as reflecting an increase in sympathetic tone or, alternatively, a decrease in parasympathetic tone. One interpretation of this phenomenon is that it may represent a less adaptive autonomic nervous system in response to physiological stressors.
Differentials
A number of other disorders can produce essentially the same symptoms as fibromyalgia. Other disorders known to produce similar symptoms are:
* Chronic fatigue syndrome
* Depression
* Ehlers-Danlos Syndrome
* Gulf War syndrome
* Influenza
* Lead poisoning
* Lupus erythematosus (SLE)
* Lyme disease
* Mercury toxicity
* Myofascial pain syndrome
* Tendonitis
* Tension myositis syndrome
* Thyroid disease
* Vitamin B12 deficiency
* Vitamin D deficiency
* Whiplash-associated disorder
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Important notice:
The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other
qualified health provider with any questions you may have regarding a medical condition.
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