A great deal of the pain and fatigue from fibromyalgia can be relieved by obtaining a complete diagnosis that emphasizes finding those conditions that can be treated and then reducing the total number of things that interfere with getting well.
Fibromyalgia can be referred to as a diagnosis of exclusion, because in order for it to be made, all other diagnoses must first be ruled out. Whenever medicine is required to give a diagnosis this way, it is less preferable than having an objective test to prove the presence of the problem.
We do not really know what causes fibromyalgia, but we know it is not a progressive disease. Numerous factors seem to aggravate it, and there are a wide variety of associated symptoms. Chronic muscle, ligament and joint pain can prevent sufferers from enjoying daily activities and, in many cases, from getting a good night’s sleep. In severe cases, it can be debilitating. People do not simply wake up one day with fibromyalgia; rather its onset is often insidious. While the presence of either a major or minor inciting event is common, it is not required.
A diagnosis of fibromyalgia is sometimes given in error, and this can be frustrating to the patient. For example, take the case of someone who was pain free, suffers from a injury, and then complaints persist beyond the expected recovery time. This does not mean that the person now has, or did have previously, "asymptomatic" fibromyalgia.
Alternatively, sometimes doctors tell the afflicted that they have fibromyalgia simply because an x-ray shows little or no evidence of arthritis (see Arthritis) or disk disease (see Oh, My Aching Back and Low Back Pain) and symptoms have been present for over three to six months. As noted previously, fibromyalgia is a diagnosis of exclusion, because in order for it to be made, all other diagnoses must first be ruled out.
Unlike primary fibromyalgia, where the source for the problem cannot be found, secondary fibromyalgia occurs when there are associated treatable conditions. These are frequently missed and include:
· ligamentous strain (see Prolotherapy),
· muscular spasm (see Myofascial Syndrome),
· reflex sympathetic dystrophy (see RSD),
· thoracic outlet syndrome (see Thoracic Outlet Syndrome)
Other commonly occurring diagnoses that can contribute to secondary fibromyalgia include:
· Peripheral neuropathy (see Peripheral Neuropathy),
· cardiovascular or peripheral arterial disease (see PAD),
· hormonal imbalance (see Hormonal Therapy),
· nutritional deficiencies, and
· toxic environmental exposure (see Disease
If one of the problems listed above is present, then fibromyalgia is either worsened by or secondary to the underlying cause.
There are many other confounding factors in the diagnosis of fibromyalgia. These include symptoms of:
· numbness and tingling,
· muscle twitching,
· impaired coordination,
· morning stiffness,
· skin sensitivity,
· pain without boundaries,
· sleep disorders,
· headache or jaw pain,
· mental or physical fatigue,
· cognitive impairment, and
· memory problems.
Associated conditions include autonomic dysfunction, swollen extremities, irritable bowel syndrome, irritable bladder and PMS.
Perpetrating factors include depression, stress or anxiety, nutritional or metabolic insufficiency, weather sensitivity, and hormonal imbalance. All of these may contribute to associated chronic fatigue; however, other esoteric factors such as hidden infection, coagulopathies (bleeding disorders), and poor oral pharyngeal muscle tone may also be the culprit.
No single test can detect fibromyalgia; however, there is at least one telltale sign on physical exam: a pattern of specific "tender spots" — muscles and tendons that are painful when touched. They cannot be located in any single anatomical distribution, must be present for at least three months, and must include 11of 18 defined locations (Figure 1).
Proper diagnosis requires a doctor with expertise in neuro-musculoskeletal medicine. There is a device called an Alogometer that can be used to measure just how tender the sites involved are (Figure 2); however, the majority of doctors rely upon their physical exam skills to determine this.
Fortunately there are numerous non-surgical specialty care techniques that are effective in the treatment of both primary and secondary fibromyalgia (see Pain Cure and We Help What Hurts). If you experience unexplained achiness, persistent fatigue, headache and difficulty sleeping for three months or more then you should visit with your doctor.