Fibromyalgia Diagnostic Process

by

When it comes to fibromyalgia, the diagnostic process can be extremely cumbersome and complicated. Since no two people experience the same symptoms and disease course, there is no “one size fits all” approach to diagnosing the condition. Instead, the diagnosis of fibromyalgia relies heavily on the exclusion of other conditions that frequently co-occur with it or mimic it symptomatically. One of the best things a fibromyalgia patient can do to help make their journey to diagnosis as problem free as possible is to understand that the journey itself is not without obstacles and pitfalls, and to use this information to their advantage.

Common Diagnostic Process

A diagnosis of fibromyalgia is difficult for a number of reasons. First, there are no definitive tests for fibromyalgia. The lack of adequate testing methods in a medical system that relies heavily on such diagnostic tools is also an impediment to accurate and timely diagnosis of fibromyalgia. In addition, many physicians lack a full understanding of fibromyalgia and the most effective means of treating it, and some even continue to doubt its legitimacy as a true disease entity. For many years, the medical community considered fibromyalgia to be a “whiners disease,” discounting patients’ symptoms and suggesting their pain was all in the head.  Unfortunately this negative stereotyping continues among some providers to this day. This often results in mis-diagnosis and treatments that are at best, marginally effective. Adding to this confusion and lack of understanding is the fact that easily defined and effective treatment strategies are also not abundant for fibromyalgia. Although there is no “typical” process of diagnosis for fibromyalgia patients since each individual’s disease is somewhat unique, there are some common categories of diagnostic procedures, specialists, and processes of elimination that frequently occur.

As previously stated, a number of conditions are commonly associated with fibromyalgia, either as co-morbid conditions or because they present with symptoms that are strikingly similar to those of fibromyalgia itself. The most notable among these include chronic fatigue syndrome, irritable bowel syndrome, interstitial cystitis, depression/anxiety, systemic lupus erythematosus, and rheumatoid arthritis. A complicating factor along the diagnosis pathway is the fact that the diagnosis of most of these conditions is compartmentalized –  usually performed by specialists in particular disease fields. For instance, rheumatoid arthritis is most often best diagnosed by a rheumatologist; anxiety and depression are generally best identified by a psychiatrist or psychologist; neurological conditions are best addressed by a neurologist, and so on. Since fibromyalgia patients can exhibit a number of symptoms across a wide variety of bodily systems, they may need to visit several different specialists in order to rule out the existence of any of these diseases and move closer toward a diagnosis of fibromyalgia through the process of elimination.

Rheumatic diseases, such as rheumatoid arthritis and lupus can usually be ruled out by the presence of joint swelling, joint deformities, and specific abnormalities in particular blood tests, as well as rashes and generalized inflammation. Ruling out the presence of neurologic conditions can be more difficult, as many fibromyalgia patients experience neurologic signs and symptoms, such as numbness, tingling, and burning sensations. However, most fibromyalgia patients do not show abnormal findings when evaluated using standard neurologic testing methods. One of the greatest difficulties in the diagnosis of fibromyalgia occurs when trying to distinguish it from other functional pain disorders, such as temporomandibular joint disorder (TMJ), irritable bowel syndrome, and chronic fatigue syndrome (CFS). CFS and fibromyalgia co-occur in as many as 80% of patients, and 70% of fibromyalgia patients also have irritable bowel syndrome. Furthermore, roughly 40%-70% of fibromyalgia patients have TMJ as well. These high rates of comorbidities  complicate the diagnostic process and frequently lead to mis-diagnosis.

While the fibromyalgia patient may become accustomed to dealing with several different doctors as they search for their elusive diagnosis through process of elimination, such a process may appear haphazard to their friends and family, who may not fully understand their loved one’s plight. This lack of understanding often causes negative stigma around fibromyalgia and leads to negative attitudes toward those who suffer from it. It is human nature to fear or doubt things we do not understand, and this can manifest itself in fibromyalgia through feelings of doubt and mistrust, as well as harsh and condescending attitudes.  This negative feedback can foster distrust and decrease family and friend support for the fibromyalgia patient, which can feed stress and exacerbate their signs and symptoms, such as depression, sleep disturbances, and pain.

In summary, the diagnostic process in fibromyalgia follows no predetermined path for all individuals. There is no best-practices model that will definitively lead doctors to a conclusive diagnosis for all patients. Specialists will need to be involved in order to rule out similar conditions, and patience will be required on both the part of the patient and their families and support systems.

——————————————–

References

1.        Goldenberg DL. Diagnosis and differential diagnosis of fibromyalgia. Am J Med. 122(2):S14-S21).

2.        Nickel JC, Tripp DA, Pontari M, Moldwin R, Mayer R, Carr LK, Doggweiler R, Yang CC, Mishra N, Nordling J. Interstitial cystitis/painful bladder syndrome and associated medical conditions with an emphasis on irritable bowel syndrome, fibromyalgia and chronic fatigue syndrome. J Urol. 2010;184(4):1358-1363.

3.        Sperber AD, Atzmon Y, Neumann L, Weisberg I, Shalit Y, Abu-Shakrah M, Fich A, Buskila D. Fibromyalgia in the irritable bowel syndrome: studies of prevalence and clinical implications. Am J Gastroenterol. 1999;94(12)3541-3546.

4.        Light KC, White AT, Tadler S, Iacob E, Light AR. Genetics and gene expression involving stress and distress pathways in fibromyalgia with and without comorbid chronic fatigue syndrome. Pain Res Treat. 2012;2012:427869.

5.        Blasurbramaniam R, de Leeuw R, Zhu H, Nickerson RB, Okeson JP, Carlson CR. Prevalence of temporomandibular disorders in fibromyalgia and failed back syndrome patients: a blinded prospective comparison study. Oral Surg Oral med Oral Pathol Oral Radiol Endod. 2007;104(2):204-216.

 

Leave a Comment

{ 0 comments… add one now }

Google Analytics Alternative