Table of ContentsView AllTable of ContentsWhy Delay Testing?Diagnosis of ExclusionWhat to Rule OutSymptom CriteriaTalking to Your DoctorFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
Why Delay Testing?
Diagnosis of Exclusion
What to Rule Out
Symptom Criteria
Talking to Your Doctor
Frequently Asked Questions
Diagnosingfibromyalgia(FM) can be challenging. It’s not uncommon for someone to ask their healthcare provider if they could have the condition only to have the suggestion waved off. What’s going on?
Fibromyalgia is a common chronic pain condition that involves fatigue, cognitive dysfunction, sleep disruptions, and many other possible symptoms. When you bring up a possible FM diagnosis with your healthcare provider, you may expect immediate testing to confirm or deny that you have it. But with fibromyalgia, it’s not that simple.
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Reasons to Delay Testing
Your healthcare provider may have valid reasons to delay testing you for FM. The first is that your symptoms may not have lasted long enough yet. Under the fibromyalgia diagnostic criteria, symptoms need to have been present and consistent for at least three months.
Who Diagnoses Fibromyalgia?
Diagnosing Fibromyalgia
In 2010 and again in 2016, the American College of Rheumatology (ACR) updated its diagnostic criteria to create a more accurate, faster, and simplified process. The latest 2016 criteria says that a person has fibromyalgia if all of the following three conditions are met:
As a result of these criteria, the diagnosis of fibromyalgia is no longer a “diagnosis of exclusion” where you would have to be tested for a long list of other diseases to rule out FM.However, the diagnosis does not “exclude the presence of other clinically important illnesses.“So you can have overlapping conditions with FM such assleep apneaand micronutrient deficiencies.
Unfortunately, despite these new criteria, patients are still being tested for other diseases before being diagnosed and medical providers are still using the outdated and no longer recommended pressure point exam. This leads to continued misdiagnoses and delays in treatment.
Tests to Rule Out Other Conditions
Since your healthcare provider may want to rule out a dozen or more conditions, testing can be extensive and often includes blood tests and imaging. Fortunately, some blood tests can help rule out numerous diseases.
You may also have blood tests for:
Imaging studies that may be performed include:
Other kinds of tests may include:
You will likely only need a fraction of these, and testing will probably be done in several rounds. It’s common for healthcare providers to start with tests that have a broad significance and base further testing on those results.
For example, if your first round of tests shows you don’t have elevated inflammatory markers, there’s probably no need to test for antibodies indicating autoimmune diseases with high levels of inflammation.
When to Call a Healthcare ProviderAny time you’re having unexplained pain, severe fatigue, or cognitive changes, you should see a medical professional. Tell your healthcare provider all of the symptoms you’ve been having, even if they don’t seem related.
When to Call a Healthcare Provider
Any time you’re having unexplained pain, severe fatigue, or cognitive changes, you should see a medical professional. Tell your healthcare provider all of the symptoms you’ve been having, even if they don’t seem related.
After symptoms have persisted for at least three months, it’s time to start looking at FM diagnostic criteria.
First, you need to have generalized pain in four of five regions. Those regions are the four quadrants of your body plus the “axial” region, which is along the spine. This criterion specifically excludes the jaw, chest, and abdomen.
Next, it’s time for the two FM diagnostic questionnaires—the Widespread Pain Index (WPI) and the Symptom Severity Scale (SSS).
Widespread Pain Index
By definition, fibromyalgia pain is widespread. The WPI includes 19 places on the body and asks you whether you’ve had pain there in the past week. You get a point for every “yes,” with the left and right sides of most areas counted separately. The areas are:
Your healthcare provider may also ask you to characterize your pain. For example, is it dull, sharp, electrical, stabbing, etc.?
Symptom Severity Scale
The SSS has part A and part B. Part A measures three key FM symptoms and Part B looks at other somatic (physical) symptoms you may have. The Part A symptoms are nearly universal among people with FM:
For each of these, you’ll be asked to rate your symptoms over the past week on a scale from zero to three.
Symptom Severity Scale: Part A Answers0No problem1Slight or mild problems; generally mild or intermittent2Moderate; considerable problems; often present3Severe; pervasive, continuous, life-disturbing problemsFor Part B, you’ll be asked whether, in the past six months, you’ve had:Pain or cramping in the lower abdomenDepressionHeadacheYou’ll be given one point for each “yes.“Fibromyalgia Symptoms and ComplicationsTotaling the ScoreOnce you’re done with this process, you’ll have two scores, a WPI of between zero and 19 and an SSS of between zero and 12. A diagnosis of FM can be made with two different combinations of scores:WPI = at least 7 and SSS = at least 5WPI = 4 to 6 and SSS = at least 9How to Talk to Your Healthcare ProviderThe symptoms of FM are often life-altering, and going through this long diagnostic process before getting any solid answers can be really hard. And once you get a diagnosis, you’ll need to start makingtreatment decisions.You’re bound to have a lot of questions and may not even know where to start. This guide can help you prepare for your healthcare appointment so you can make the most of your limited time.Fibromyalgia Healthcare Provider Discussion GuideGet our printable guide for your next healthcare’s appointment to help you ask the right questions.Download PDFEmail AddressSign UpThank you, {{form.email}}, for signing up.There was an error. Please try again.Frequently Asked QuestionsAm I more likely to suffer from fibromyalgia if I have certain characteristics?Possibly, yes. Fibromyalgia is most commonly diagnosed in middle-aged women, though anyone can have it. A family history of fibromyalgia may also mean you are more likely to have it.How is fibromyalgia treated?There are a lot of differenttreatment options for fibromyalgiasymptoms, including medications such as analgesics, antidepressants, and anticonvulsants; occupational therapy; and lifestyle changes such as diet and weight loss.A Word From VerywellThis diagnostic process may seem strange, but research shows that it does work for accurately diagnosing fibromyalgia. A correct diagnosis is key for you to get the right treatments, and as grueling as the process can be, it’s worth it if it means understanding what’s going on in your body and, especially, getting on the path toward feeling better and getting back to your life.What to Know About Fibromyalgia
For Part B, you’ll be asked whether, in the past six months, you’ve had:
You’ll be given one point for each “yes.”
Fibromyalgia Symptoms and Complications
Totaling the Score
Once you’re done with this process, you’ll have two scores, a WPI of between zero and 19 and an SSS of between zero and 12. A diagnosis of FM can be made with two different combinations of scores:
How to Talk to Your Healthcare Provider
The symptoms of FM are often life-altering, and going through this long diagnostic process before getting any solid answers can be really hard. And once you get a diagnosis, you’ll need to start makingtreatment decisions.
You’re bound to have a lot of questions and may not even know where to start. This guide can help you prepare for your healthcare appointment so you can make the most of your limited time.
Fibromyalgia Healthcare Provider Discussion GuideGet our printable guide for your next healthcare’s appointment to help you ask the right questions.Download PDFEmail AddressSign UpThank you, {{form.email}}, for signing up.There was an error. Please try again.
Get our printable guide for your next healthcare’s appointment to help you ask the right questions.
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Am I more likely to suffer from fibromyalgia if I have certain characteristics?
Possibly, yes. Fibromyalgia is most commonly diagnosed in middle-aged women, though anyone can have it. A family history of fibromyalgia may also mean you are more likely to have it.
How is fibromyalgia treated?
There are a lot of differenttreatment options for fibromyalgiasymptoms, including medications such as analgesics, antidepressants, and anticonvulsants; occupational therapy; and lifestyle changes such as diet and weight loss.
A Word From Verywell
This diagnostic process may seem strange, but research shows that it does work for accurately diagnosing fibromyalgia. A correct diagnosis is key for you to get the right treatments, and as grueling as the process can be, it’s worth it if it means understanding what’s going on in your body and, especially, getting on the path toward feeling better and getting back to your life.
What to Know About Fibromyalgia
8 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Galvez-Sánchez CM, Reyes Del Paso GA.Diagnostic criteria for fibromyalgia: critical review and future perspectives.J Clin Med. 2020;9(4):1219. doi:10.3390/jcm9041219Häuser W, Sarzi-Puttini P, Fitzcharles MA.Fibromyalgia syndrome: under-, over- and misdiagnosis.Clin Exp Rheumatol; 2019:37 Suppl 116(1):90-97.Kang JH, Choi SE, Park DJ, Lee SS.Disentangling diagnosis and management of fibromyalgia.J Rheum Dis. 2022;29(1):4-13. doi:10.4078/jrd.2022.29.1.4D’Amuri A, Greco S, Pagani M, Presciuttini B, Ciaffi J, Ursini F.Common non-rheumatic medical conditions mimicking fibromyalgia: a simple framework for differential diagnosis.Diagnostics (Basel). 2024;14(16):1758. doi:10.3390/diagnostics14161758National Institutes of Health, U.S. National Library of Medicine: MedlinePlus.Erythrocyte sedimentation rate (ESR).Vincent A, Benzo RP, Whipple MO, McAllister SJ, Erwin PJ, Saligan LN.Beyond pain in fibromyalgia: insights into the symptom of fatigue.Arthritis Res Ther. 2013;15(6):221. doi:10.1186/ar4395Bell T, Trost Z, Buelow MT, et al.Meta-analysis of cognitive performance in fibromyalgia.J Clin Exp Neuropsychol. 2018;40(7):698-714. doi:10.1080/13803395.2017.1422699Pain Treatment Centers of America.Fibromyalgia: FAQs and treatment.Additional ReadingWolfe F, Clauw DJ, Fitzcharles MA, et al.The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity.Arthritis Care Res (Hoboken). 2010;62(5):600-610. doi:10.1002/acr.20140Wolfe F, Clauw DJ, Fitzcharles MA, et al.2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria.Semin Arthritis Rheum. 2016;46(3):319-329. doi:10.1016/j.semarthrit.2016.08.012
8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Galvez-Sánchez CM, Reyes Del Paso GA.Diagnostic criteria for fibromyalgia: critical review and future perspectives.J Clin Med. 2020;9(4):1219. doi:10.3390/jcm9041219Häuser W, Sarzi-Puttini P, Fitzcharles MA.Fibromyalgia syndrome: under-, over- and misdiagnosis.Clin Exp Rheumatol; 2019:37 Suppl 116(1):90-97.Kang JH, Choi SE, Park DJ, Lee SS.Disentangling diagnosis and management of fibromyalgia.J Rheum Dis. 2022;29(1):4-13. doi:10.4078/jrd.2022.29.1.4D’Amuri A, Greco S, Pagani M, Presciuttini B, Ciaffi J, Ursini F.Common non-rheumatic medical conditions mimicking fibromyalgia: a simple framework for differential diagnosis.Diagnostics (Basel). 2024;14(16):1758. doi:10.3390/diagnostics14161758National Institutes of Health, U.S. National Library of Medicine: MedlinePlus.Erythrocyte sedimentation rate (ESR).Vincent A, Benzo RP, Whipple MO, McAllister SJ, Erwin PJ, Saligan LN.Beyond pain in fibromyalgia: insights into the symptom of fatigue.Arthritis Res Ther. 2013;15(6):221. doi:10.1186/ar4395Bell T, Trost Z, Buelow MT, et al.Meta-analysis of cognitive performance in fibromyalgia.J Clin Exp Neuropsychol. 2018;40(7):698-714. doi:10.1080/13803395.2017.1422699Pain Treatment Centers of America.Fibromyalgia: FAQs and treatment.Additional ReadingWolfe F, Clauw DJ, Fitzcharles MA, et al.The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity.Arthritis Care Res (Hoboken). 2010;62(5):600-610. doi:10.1002/acr.20140Wolfe F, Clauw DJ, Fitzcharles MA, et al.2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria.Semin Arthritis Rheum. 2016;46(3):319-329. doi:10.1016/j.semarthrit.2016.08.012
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Galvez-Sánchez CM, Reyes Del Paso GA.Diagnostic criteria for fibromyalgia: critical review and future perspectives.J Clin Med. 2020;9(4):1219. doi:10.3390/jcm9041219Häuser W, Sarzi-Puttini P, Fitzcharles MA.Fibromyalgia syndrome: under-, over- and misdiagnosis.Clin Exp Rheumatol; 2019:37 Suppl 116(1):90-97.Kang JH, Choi SE, Park DJ, Lee SS.Disentangling diagnosis and management of fibromyalgia.J Rheum Dis. 2022;29(1):4-13. doi:10.4078/jrd.2022.29.1.4D’Amuri A, Greco S, Pagani M, Presciuttini B, Ciaffi J, Ursini F.Common non-rheumatic medical conditions mimicking fibromyalgia: a simple framework for differential diagnosis.Diagnostics (Basel). 2024;14(16):1758. doi:10.3390/diagnostics14161758National Institutes of Health, U.S. National Library of Medicine: MedlinePlus.Erythrocyte sedimentation rate (ESR).Vincent A, Benzo RP, Whipple MO, McAllister SJ, Erwin PJ, Saligan LN.Beyond pain in fibromyalgia: insights into the symptom of fatigue.Arthritis Res Ther. 2013;15(6):221. doi:10.1186/ar4395Bell T, Trost Z, Buelow MT, et al.Meta-analysis of cognitive performance in fibromyalgia.J Clin Exp Neuropsychol. 2018;40(7):698-714. doi:10.1080/13803395.2017.1422699Pain Treatment Centers of America.Fibromyalgia: FAQs and treatment.
Galvez-Sánchez CM, Reyes Del Paso GA.Diagnostic criteria for fibromyalgia: critical review and future perspectives.J Clin Med. 2020;9(4):1219. doi:10.3390/jcm9041219
Häuser W, Sarzi-Puttini P, Fitzcharles MA.Fibromyalgia syndrome: under-, over- and misdiagnosis.Clin Exp Rheumatol; 2019:37 Suppl 116(1):90-97.
Kang JH, Choi SE, Park DJ, Lee SS.Disentangling diagnosis and management of fibromyalgia.J Rheum Dis. 2022;29(1):4-13. doi:10.4078/jrd.2022.29.1.4
D’Amuri A, Greco S, Pagani M, Presciuttini B, Ciaffi J, Ursini F.Common non-rheumatic medical conditions mimicking fibromyalgia: a simple framework for differential diagnosis.Diagnostics (Basel). 2024;14(16):1758. doi:10.3390/diagnostics14161758
National Institutes of Health, U.S. National Library of Medicine: MedlinePlus.Erythrocyte sedimentation rate (ESR).
Vincent A, Benzo RP, Whipple MO, McAllister SJ, Erwin PJ, Saligan LN.Beyond pain in fibromyalgia: insights into the symptom of fatigue.Arthritis Res Ther. 2013;15(6):221. doi:10.1186/ar4395
Bell T, Trost Z, Buelow MT, et al.Meta-analysis of cognitive performance in fibromyalgia.J Clin Exp Neuropsychol. 2018;40(7):698-714. doi:10.1080/13803395.2017.1422699
Pain Treatment Centers of America.Fibromyalgia: FAQs and treatment.
Wolfe F, Clauw DJ, Fitzcharles MA, et al.The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity.Arthritis Care Res (Hoboken). 2010;62(5):600-610. doi:10.1002/acr.20140Wolfe F, Clauw DJ, Fitzcharles MA, et al.2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria.Semin Arthritis Rheum. 2016;46(3):319-329. doi:10.1016/j.semarthrit.2016.08.012
Wolfe F, Clauw DJ, Fitzcharles MA, et al.The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity.Arthritis Care Res (Hoboken). 2010;62(5):600-610. doi:10.1002/acr.20140
Wolfe F, Clauw DJ, Fitzcharles MA, et al.2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria.Semin Arthritis Rheum. 2016;46(3):319-329. doi:10.1016/j.semarthrit.2016.08.012
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