You might be in constant or frequent pain, have really bad headaches and an irritable bowel. But is it fibromyalgia? Diagnosis of fibromyalgia is difficult because usually labs tests are normal and a lot of the typical symptoms are the same as the symptoms of other disorders.

It is important to make sure that no other disease is present before a definite diagnosis of fibromyalgia syndrome can be given. All doctors agree that fibromyalgia is a diagnosis of exclusion.

A complete medical history, a thorough physical examination, blood tests and x-rays can either confirm or rule out :

• Hormonal imbalance
• Anemia
• Infection
• Muscle disease
• Bone disease
• Nerve disease
• Joint disease
• Cancer
• Rheumatoid arthritis
• Hypothyroidism
• Polymyalgia rheumatica

Diagnostic Tender Points of Fibromyalgia

If you suffer from fibromyalgia you will have clearly defined tender points. The diagnostic criteria for the syndrome are:

Widespread pain for a minimum of three months in all of the following general areas of your body:

• Pain in the left side of the body
• Pain in the right side of the body
• Pain above the waist
• Pain below the waist
• Pain in the neck, front of your chest, mid-back, or low back

Also you must have pain in a minimum of 11 of 18 specified tender points. These tender points are recognized as symptoms of fibromyalgia if you feel pain when someone pushes with their finger with an approximate force of 4kg (enough pressure to change the colour of your skin).

The 18 Diagnostic Pain Points

(1 & 2) Occiput: on both sides (bilateral), at the sub-occipital muscle insertions.
(3 & 4) Low Cervical: bilateral, at the anterior aspects of the inter-transverse spaces.
(5 & 6) Lateral Epicondyle: bilateral, 2 cm distal to the epicondyles
(7 & 8) Knee: bilateral, at the medial fat pad proximal to the joint line.
(9 & 10) Second Rib: bilateral, at the second costochondral junction, just lateral to the junctions on upper surfaces.
(11 & 12) Trapezius: bilateral, at the midpoint of the upper border of the muscle.
(13 & 14) Supraspinatus: bilateral, at origins, above the spine of the scapula (shoulder blade) near the medial border
(15 & 16) Gluteal: bilateral, in upper outer quadrants of buttocks in anterior fold of muscle.
(17 & 18) Greater Trochanter: bilateral, posterior to the trochanteric prominence.

Why are Eleven Points Significant?

The criterion of 11 consistently and recurring painful points was intended for research purposes only.

A diagnosis of fibromyalgia will be made if less than 11 painful points are recorded if you also have general widespread pain as described above and a few of the other common symptoms:

• Fatigue
• Irritable Bowel Syndrome
• Sleep Disorders
• Chronic Headaches
• Jaw Pain
• Cognitive or Memory Impairment
• Muscle Pain or Morning Stiffness
• Painful Menstruation
• Numbness and Tingling in the Extremities
• Dizziness or Light Headedness
• Skin and Chemical Sensitivities

Because people with fibromyalgia present with normal blood and x-ray results the criteria outlined above are crucial. But there are weaknesses to this system of diagnosis. The notion that sufferers experience pain in 18 specific parts of the body does not account for the sensitivity to painful stimuli throughout the body that many sufferers report.

Also, the stipulation that for a diagnosis of fibromyalgia to be confirmed a person must experience continual pain in at least 11 of the 18 points is flawed. On ‘good’ days a sufferer may experience pain in less than 11 pain points. Logically this means that on some days they have fibromyalgia and on others they don’t. This is nonsense.

Similarly, some patients will not always have pain in the larger general areas of the body as required in the diagnostic criteria. Some sufferers experience pain only on one side or on the upper or lower half of the body. For now, and in the absence of a foolproof laboratory marker for fibromyalgia, the criteria explained above remains the best diagnostic tool for this condition.

Do not self-diagnose, this is dangerous and you may be inadvertently masking another condition.

Make sure that your doctor is familiar with fibromyalgia - the range of symptoms and their association with other disorders can cause problems if a doctor is either not familiar with the condition. Most countries have support groups – so contact them. If you do need to see a different doctor they may be able to recommend one in your area. If you are happy with your usual doctor the support group will still be of use.