Diagnosis
Fibromyalgia is not simply a diagnosis of exclusion, it is a distinctive syndrome, which can be diagnosed with clinical precision.¹ The diagnostic criteria are based on the American College of Rheumatology definition produced in 1990_⁵ (see Table 2). These criteria are widely accepted in the UK and there is growing recognition of fibromyalgia as a distinct subgroup of chronic pain sufferers.⁶

On assessment it is important to take a careful history and to acknowledge the individual’s experience and description of pain. Patients with fibromyalgia do not look ill and do not appear clinically weak.⁷

Apart from restriction of movement due to pain and the presence of the multiple tender points, physical examination tends to be unremarkable. Blood tests, x-rays and scans will typically yield a negative result.

Before any intervention is considered, other pathological processes that can cause chronic pain and/or fatigue need to be excluded. Waddell et al, in 1992, first used the descriptive term "red flags", in the context of back pain, as indicators of potentially serious pathology.⁸

For fibromyalgia, "red flags" indicating other potential pathology could include:

• Involvement of the joints
• Systemic malaise, especially with weight loss
• Evidence of thyroid dysfunction

New presenting symptoms will need to be considered and possibly investigated as they arise. Appropriate referral onto other healthcare professionals will need to be determined at this stage (e.g. a Rheumatologist).

Main Symptoms

• Widespread muscular pain
• Generalised stiffness
• Persistent fatigue
• Non-refreshing sleep

Main Sign

• Specific tender points

Commonly Associated Symptoms

• Irritable bowel syndrome
• Cognitive dysfunction
• Exercise intolerance
• Anxiety and reactive depression

Other Associated Symptoms

• Numbness & tingling
• Cold sensitivity
• Headaches
• TMJ dysfunction
• Raynaud’s phenomenon
• Restless legs
• Dysmenorrhoea
• Irritable bladder

Differential Diagnosis

• This may include:
• Polymyalgia rheumatica
• Regional myofascial pain
• Hypothyroid
• ME
• Systemic lupus
• Lymes disease
• Osteoarthritis
• Connective tissue disease

Table 1 (citation to ref. 1)