How is fibromyalgia diagnosed?

Episode 2 - How is fibromyalgia diagnosed? 
Fibromyalgia is a real, painful condition. The latest guidelines for diagnosis were published in 2016 and you can find them below. To be diagnosed with fibro, you need to have at least three months of widespread pain or pain all over with other fibro symptoms. Other conditions that may mimic fibro need to be excluded, but you can have fibromyalgia  along with other painful conditions, like degenerative disease, chronic back pain, and autoimmune conditions, as well as sleep Apnea and depression. Is it not a diagnosis of exclusion. Accepting the Fibro is real is necessary for your successful treatment.

AMERICAN COLLEGE OF RHEUMATOLOGY
2016 Revisions to the 2010/2011 Fibromyalgia Diagnostic Criteria
https://acrabstracts.org/abstract/2016-revisions-to-the-20102011-fibromyalgia-diagnostic-criteria/

You can see the full transcript:  https://www.buzzsprout.com/1890983/9621860-how-is-fibromyalgia-diagnosed

www.rheumcoach.com - my website

www.rheumcoach.com/FibroCard - Download your free copy of the "Fibromyalgia is real" postcard to share with your family & friends

www.FaceBook/com/rheumcoach - lots more information about fibro 

Disclaimer: This podcast provides information only and does not provide any medical or psychological services or advice. None of the content on this podcast prevents, cures, or treats any mental or medical condition.

Transcript

0:12  
Well hello my friends. You're listening to the Mind Your FIBRO Podcast, episode number two. I'm your host, Dr. Olga Pinkston, and board certified rheumatologist. During the last episode, we talked about fibromyalgia, what it is who gets it, and the fibro symptoms. In this episode, I will focus on how fibro is diagnosed. 

0:37  
During my training to become a rheumatologist, it probably took me a year to become comfortable with diagnostic fibromyalgia. To become a rheumatologist in the US, you need to complete medical school then spend three years of internal medicine residency, and then additional two years studying rheumatology in a fellowship program. I completed my medical school in internal medicine residency at the University of Louisville in Kentucky. I took a year off to work as a hospital doctor, treating sick hospitalized patients before moving to Florida with my family to study rheumatology. I am grateful for my time studying rheumatology at the Mayo Clinic in Florida, not only because it provided me with excellent rheumatology training, but it also exposed me to fibromyalgia, and the chronic pain treatment, the way few programs do. Mayo Clinic has had fibromyalgia clinic before fibro was even recognized by the World Health Organization. Patients from all over us in the world get diagnosed introduced there. It is major fibro research and education center. So I was a fellow site rheumatology over four years out of medical school, finished internal medicine residency already practicing internist, in I found it challenging to diagnose Fibro, I was often the patient's third, fourth fifth rheumatologist. The patients were seeking yet another opinion coming to my clinic, a lot of pressure to get it right. It took a year of listening to my patients exhibiting them learning, but also comparing fibro symptoms to other symptoms of other illogic conditions to learn what fibro was and fibro was not. I want to emphasize that I had to learn all other painful conditions diagnosed many, many patients with other autoimmune conditions to know what fibro is in fibro was not. In them. There's many patients with overlapping or similar symptoms, as fibro can coexist with other painful conditions. So took the time to wrap my mind that people will travel from all over to get the correct diagnosis of fibromyalgia. To recognize that fibro diagnosis is just as valid diagnosis as rheumatoid arthritis or lupus. To learn that living the fibromyalgia is a challenge,  to know it is real. So while I'm probably a bit biased, and I recommend to see rheumatologist for the diagnosis of fibromyalgia, I can also tell you that there are many many doctors who know what fibro is in probably diagnosis, primary care physicians, neurology or pain management. 

3:15  
So let's talk about how Fibromyalgia is diagnosed. The diagnosis of fibromyalgia evolved over time. Like many other disorders, the progress of medical science keeps revising how pharmacology is diagnosed, or the Fibro has been a health problem, dating back 1000s of years, the formal definition of the disorder but the World Health Organization did not happen until 1990. The same year, the American College of Rheumatology published its first guidelines. Since 1990. There have been several editions of the diagnostic guidelines, the latest version published in 2016. Interestingly, several prominent websites and organizations still list 2010 guidelines. You can review the abstract of the guidelines and using the link in the show notes. 

4:03  
So to be diagnosed with fibromyalgia, you must have widespread pain for at least three months. The 2016 guidelines removed the tender point count requires further diagnosis before is there may be absent in some patients. Other symptoms are also now included in the symptom severity, score, fatigue, and refreshed sleep cognitive symptoms like brain fog headaches, IBS type symptoms, pain, cramps in the lower abdomen, in depression. One important change in this version of guidelines is that now the patient who meet these criteria can be diagnosed with fibromyalgia regardless of other diagnoses. It does not exclude the presence of other illnesses. So this is new. Fibromyalgia used to be a diagnosis of exclusion. Now Fibromyalgia diagnosis can be present. If you have other painful conditions. So you may have concurrent RA and Fibro, lupus and Fibro and MS and Fibro, etc.

5:09  
Although the published guidelines may sound straightforward, I caution you to avoid self diagnosis, I recommend evolution by an experienced physician -  rheumatologist, neurologist, pain specialist or primary care. Many of the patients I evaluated were appropriately diagnosed with fibromyalgia by the primary care doctors, who are also well equipped to treat it. During the evaluation, a careful medical history is taken, including past and present health problems, what medications you take, family history. A physical exam should always be performed. Blood tests are often taken to lot other conditions as well as X rays. I often see patients who already had the full workup done by the primary care, so I review the workup results, so I may not even order anything additional. 

6:02  
I often hear this question. Well, how do you know it's not lupus or rheumatoid arthritis? I think our bodies are amazing and conditions in illnesses may have many many patterns. Just like a neurologist can diagnose many types of headaches, like tension migraine cluster sinus, or you as a mom know when your child has a mild cold, stomach bug flu or something more serious. We know the patterns of pain, and rule things in and out based on the story symptoms exam workup results, and prior experience. As a new mom I was terrified of missing something when my first baby was sick and with kid number four, I can tell you I am way more comfortable in less nervous when he is sick/ Experience matter. There is an art to medicine as well as knowledge and experience. The pattern of pain in fibromyalgia  is distinct from the pain of degenerative arthritis or inflammatory arthritis that is seen lupus or rheumatoid arthritis. Pattern recognition is part of my daily medical practice through listening observation, careful examination, I can distinguish a variety of painful conditions. 

7:21  
To diagnose Fibromyalgia usual have pain called widespread pain. The pain should be felt in four out of five body areas, upper and lower parts left and right excluding the abdomen face the fifth, the fifth area can be abdomen chest, neck, upper and lower back. The pain should be present for at least three months at similar intensity. Many patients who are diagnosed with fibromyalgia had pain for years. It can come and go or be persistent. It may or may not move from one area to another. I often hear that everything hurts, joints, muscles, skin, even my hair scalp hurts. You may feel like you have the flu, the body aches and the feeling of rundown. Some describe the feeling or the pain is there the run or by truck. Numbness tingling can accompany the pain but typically, unlike neuropathy it is episodic, its random, it can move around the body. Some patients have tender points places they feel tender when pressed,  some feel knots or tense muscles, but the tender points are no longer required for the diagnosis. The joint pain is never inflammatory - meaning there is no swelling, warmth of redness. The joints may be painful, to the touch stiff, tight or puffy. When I examined the joints, there is no swelling even if you the patient describing the tightness or perceived swelling. It takes a while to learn how to examine joints for feeling of swelling. It is it is part of the training of rheumatologist. 

9:05  
There are other types of pain in Fibro:  tension headaches and migraines are common. These can precede the diagnosis of fibromyalgia or develop over time. Stress, poor sleep quality, erratic sleep schedule, muscle tension, excessive caffeine use due to fatigue and frequent use of pain medications , are typical headaches triggers. 

9:26  
Chest pain is also frequent and can be described as chest tightness, tension or pain in the rib joints or muscles. If you are female, or if you have risk factors for heart disease, see your primary care to make sure the chest pain is not of cardiac origin. You can also have rheumatologic and other conditions - Fibro can be present if you have degenerative disc disease, chronic back pain, autoimmune conditions, sleep apnea, depression, anxiety, so you may have other types of pain in addition to Fibro pain. The symptoms of fibromyalgia  are real, but they are pretty detectable, knowing that you have fibro is the first step towards successful treatment.

10:07  
So let's summarize. Fibromyalgia is a real, painful condition. The latest guidelines for diagnosis were published in 2016 and you can find them in the show notes. To be diagnosed with Fibro, you need to have at least three months of widespread pain or pain all over with other fibro symptoms. Other conditions that may mimic Fibro were already excluded. But you can have fibromyalgia  along with other painful conditions, like degenerative disease, chronic back pain, and autoimmune conditions, as well as sleep Apnea and depression. Accepting the Fibro is real is necessary for your successful treatment. 

10:49  
Now that brings us to the end of this episode. If you enjoyed the show, please subscribe rate and review this podcast in be sure to come back next week for another episode. Until then, this is Dr. Olga Pinkston in don't forget to MIND YOUR FIBRO.