How Fibromyalgia Is Diagnosed

By MaryAnn DePietro, CRT. Medically reviewed by Tom Iarocci, MD. May 7th 2016

Fibromyalgia syndrome (FMS), a chronic pain disorder that causes not only widespread pain throughout the body but also excessive fatigue and digestive problems, affects 5 million people in the United States.

Diagnosing fibromyalgia is often difficult due to ambiguity of the symptoms, but fortunately, once fibromyalgia is diagnosed and treated properly, patients have a significant reduction in uncomfortable symptoms and a much better quality of life.

While a specific cause is unknown, there are certain risk factors, including genetics and gender. According to the National Fibromyalgia Association, 90 percent of fibromyalgia patients are women.


Symptoms of fibromyalgia

One of the primary ways fibromyalgia is diagnosed is by reviewing a patient’s symptoms, which include chronic widespread pain over a long period, fatigue and sleep disturbances. The pain sometimes affects several areas of the body, such as the shoulders, back, hips and legs, and is generally located both above and below the waist. It may become more intense in cold weather or during times of inactivity or stress.

For many fibromyalgia sufferers, fatigue or insomnia is the predominant symptom and reason to seek medical attention. Many experience non-restorative sleep, which means you sleep enough hours but don’t wake up feeling refreshed. In some instances, fatigue is so severe that it can interfere with everyday activities, such as employment and family responsibilities.

As with other syndromes, not all people with fibromyalgia suffer the same symptoms. Other symptoms may include headaches, restless leg syndrome or sensitivity to bright light. Some patients may have (or may develop) anxiety and mild depression. Cognitive problems may also develop, including memory lapse and concentration difficulties.


Difficulties diagnosing fibromyalgia           

With many types of medical conditions, lab tests, X-rays or a biopsy can help confirm a disease diagnosis. Fibromyalgia, however, is different: There’s no one medical test that indicates whether a person has the condition. To make diagnosis more challenging, certain symptoms are also present with other conditions, and symptoms may flare up but dissipate over time. According to the National Fibromyalgia Association, it takes about five years for a patient to be accurately diagnosed.

Traditional standards for diagnosing fibromyalgia include the presence of pain for at least three months with positive findings in a “tender point” exam. Established by the American College of Rheumatology in 1990, the tender point test designates 18 spots throughout the body as possible painful areas, located near various joints including the hips, elbows, and shoulders. During the exam, the physician applies pressure with a finger to the points.

In the past, the criteria to make a diagnosis of fibromyalgia included pain in at least 11 of 18 pressure points.  Over the last 20 years, however, doctors have come to realize that many people with fibromyalgia or chronic widespread pain may not meet these exact criteria, which appears to be the case in men especially.


Although the tender point exam may still be helpful in making a diagnosis, its results aren’t considered a primary indication of fibromyalgia. The problem is that symptoms may come and go, and tender points may hurt one day and not another. Doctors are more likely to consider widespread pain for more than three months (along with the presence of other symptoms) to diagnose the condition.

Since many fibromyalgia symptoms are very similar to those of other conditions, many patients will undergo several other medical tests to rule out other conditions, a process that’s often long and costly. Some medical conditions that have similar symptoms include rheumatoid arthritis, multiple sclerosis and lupus. In some instances, mental health issues (such as anxiety and depression) can cause symptoms that are quite similar to fibromyalgia as well.


Medical tests performed to exclude other conditions will often include blood work, which can measure sedimentation rate; a high “sed rate” can indicate an inflammatory disease like rheumatoid arthritis. X-rays may be taken to determine if bone or tissue damage is present. Since some symptoms also occur with multiple sclerosis, an MRI may be ordered. In certain cases, a mental health evaluation may be recommended to rule out psychiatric causes.

Take the next steps

Although it may take some time, an accurate diagnosis is essential in developing an effective treatment plan. There’s no cure for fibromyalgia, but ongoing treatment and a more nutritious diet can relieve some symptoms and your quality of life.

Your doctor may prescribe certain medications to treat sleep problems and pain as well. According to Cedars-Sinai Medical Center, lifestyle changes such as moderate exercise, stress-reducing activities like meditation and certain nutrition tweaks will help reduce more painful symptoms.

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