Perhaps one of the most frustrating things for a person with fibromyalgia syndrome (FMS) to have had to endure is the unreasonably long period of time it took to get a definitive diagnosis. The symptoms may have been going on for years, but because the criteria for diagnosing FMS failed to take into account common symptoms like fatigue and lack of mental clarity, the diagnosis was either incorrect or not forthcoming at all.

1990 Diagnosit Criteria for FMS

The diagnostic criteria doctors have been using were initially established in 1990 as a qualifier for clinical studies, not as a diagnostic tool. It consisted of the following factors:

· All other possible causes of symptoms were to be eliminated

· Diagnosis was based entirely upon pain

· Pain had to be on both sides of the body; above and below the waist; along the axial skeleton (head, throat, chest, spine)

· Pain in 11 of 18 tender points

· Symptoms must be present for a minimum of three months

The tender point exam has been a controversial point in the diagnostic criterion because the information is subjective, relying upon a patient’s self-reported pain. It did not take into consideration the fact that symptoms fluctuate and pain moves around the body. Very few FMS victims have unrelenting 24/7 widespread pain to all four quadrants of their bodies. So, the number of tender points may vary from one visit with the doctor to another. If the number fell below 11, then the patient was disqualified from an FMS diagnosis.

Developing a Simple, Practical Criteria To Diagnose FMS

Finally, in May of 2010, the American College of Rheumatology (ACR) proposed a new set of diagnostic criteria for fibromyalgia that recognizes the condition includes more than pain. According to the Abstract, the doctors and researchers wanted to develop simple, practical criteria for clinical diagnosis of fibromyalgia that are suitable for use in primary and specialty care and that do not require a tender point examination, and to provide a severity scale for characteristic fibromyalgia symptoms. At the end of the day, the new criteria is able to identify FMS 88% of the time accurately while the old criteria had only 75% accuracy.

Assessment Tools For Fibromyalgia Diagnosis

The new criteria consider more symptoms and provide a way to monitor the severity of the symptoms. Since the pain threshold of an individual can vary from day to day, measuring pain levels only does not give an accurate picture. There are some aspects of the old criteria that are found in the new criteria: other possible conditions must be ruled out and symptoms must be present for at least three months. However, there are two new assessment tools that have been added to the diagnostic criteria: the widespread pain index (WPI) and the symptom severity (SS) scale score.

The WPI lists 19 areas of the body in which a person may have had pain in the week prior to the examination. The individual identifies the areas of pain to the doctor and the score is between 0-19.

The SS scale score is established as the person ranks specific symptoms associated with FMS on a scale of 0-3:

· 0 = no problem

· 1 = slight or mild problems, generally mild or intermittent

· 2 = moderate, considerable problems, often present and/or at a moderate level

· 3 = severe: pervasive, continuous, life-disturbing problems

These symptoms include:

· Fatigue

· Waking unrefreshed

· Cognitive symptoms

· Somatic symptoms in general

The numbers assigned to each are added up, for a total of 0-12.

Somatic symptoms are physical symptoms, not psycho-somatic as in physical manifestations of a psychological illness. The somatic symptoms that might be considered are myriad – 41 in total. Some of them are:

· muscle pain

· irritable bowel syndrome

· fatigue/tiredness

· thinking or remembering problems

· muscle weakness

· headache

· pain/cramps in the abdomen

· numbness/tingling

· dizziness

· insomnia

· depression

· constipation

· Raynaud’s phenomenon

· hives/welts

· seizures

· dry eyes

· loss of appetite

· rash

The Way to Diagnose FMS

For a diagnosis of fibromyalgia symptoms a person needs EITHER:

1. WPI of at least 7 and SS scale score of at least 5 OR

2. WPI of 3-6 and SS scale score of at least 9

The authors of the new diagnostic criteria concluded their Abstract as follows:

“This simple clinical case definition of fibromyalgia correctly classifies 88% of cases classified by the ACR classification criteria, and does not require a physical or tender point examination. The SS scale enables assessment of fibromyalgia symptom severity in persons with current or previous fibromyalgia, and in those to whom the criteria have not been applied. It will be especially useful in the longitudinal evaluation of patients with marked symptom variability.”

And, all those with FMS who have waited endlessly for a diagnosis said, “Thank Goodness!”

For more about fibromyalgia diagnosis, read our articles in this section.

One of the reasons fibromyalgia is understood so little and under-diagnosed, is due to the fact that physical findings are few and far between. You can’t see fibromyalgia in an x-ray or on a blood test. Physicians must rely on symptoms as patients report them since it is very difficult to measure pain, sleep disturbances, and fatigue. Because of the lack of cold hard test results, some physicians still don’t believe that fibromyalgia is a “real disease.” They subscribe to the theory that “seeing is believing.” For this reason, researchers lust after finding firm physical data that can be reproduced over and over again in relation to fibromyalgia syndrome.

Mysterious Findings

One such finding generated by some such scientific studies is the fact that there is a reduction in gray matter in certain areas of the brain in those people diagnosed with fibromyalgia syndrome. Until recent days, however, the reason behind this particular finding remained a mystery. Scientists from Louisiana State University have reported in The Journal of Pain that they believe the reduction in gray matter in the brains of fibromyalgia patients is due to shifting levels of dopamine, a neurotransmitter.

Dopamine Levels

For the purposes of this study, scientists analyzed the results of magnetic imaging resonance studies (MRI) from 30 women with confirmed diagnoses of fibromyalgia and compared these with similar MRI studies from 20 women of the same age but in good health. The major focus of this research was to reproduce earlier findings about the reduced density of gray matter in a wider sampling of patients with fibromyalgia. In addition, the researchers looked into a possible link between the activity level of dopamine within the metabolism of fibromyalgia patients and the density of the gray matter in certain regions of the brain.

Firm Correlation

The earlier findings of reduced gray matter in fibromyalgia patients was borne out in this larger study, with the 30 fibromyalgia patients showing a significant reduction in gray matter. It was also found that there was a definite and firm correlation between levels of metabolized dopamine and reduced gray matter density in those sections of the brain in which dopamine plays an important role in neurological workings. The scientists believe that pinpointing this link between levels of dopamine and gray matter density may lead to new ideas on the mechanism between fibromyalgia and abnormal findings in brain scans.

ME Think Tank

Blazing a new trail, ten Europe-based experts in Myalgic Encephalomyelitis (ME) also known as Chronic Fatigue Syndrome (CFS) have created a think tank. The scientists hope to jumpstart research that may uncover the mysteries of this crippling condition. The disease afflicts some 1 million US citizens and an even larger number of Europeans.

Though a significant portion of people are affected by ME, there is a dearth of research in the field. ME is spreading across populations at lightning speed, yet medical personnel don’t know much about how to treat the condition.

Professor Luc Montagnier, who was one of the first to discover the HIV virus and is a 2008 winner of a Nobel Prize in medicine, supports the think tank wholeheartedly and says, “Scientists have already uncovered a lot about ME, but this information does not reach professional healthcare personnel, and the disease is still not taken seriously. It is about time this changes.”

Organic Basis

Belgium’s Professor Kenny De Meirleir comments, “There are more than 5000 research papers which show that ME has an organic basis with abnormalities in the immune, nervous and gastrointestinal systems and that it is influenced by genetic and environmental factors. Despite these findings, it has been close to impossible to initiate large-scale research to verify these facts and observations.” De Meirleir hopes that the think tank will lead to more research initiatives on this topic.

The newest biotechnology has led to a greater understanding of the nature of ME, but very little of this information trickles down to health care professionals. Because of this, many patients are not diagnosed or treated when many of their symptoms might be eliminated. It is estimated that ME is responsible for socio-economic costs to the tune of an annual 20 billion euros.

In addition to generating research, the think tank hopes as well to spread knowledge about the condition. ME has a greater impact on the public than other more well-known diseases such as multiple sclerosis and HIV, yet so little is being done to further understanding of the incapacitating condition. Meantime, those with ME experience a lower level in quality of life than do patients with cancer, lupus, HIV, and MS.

Better Understanding

Norway’s Professor Ola Didrik Saugstad comments, “There is a total lack of knowledge and understanding about this disease in the healthcare system. We wish to use our knowledge to educate and train doctors, therapists and other healthcare personnel so they can better understand how to manage an ME-patient.”

The European Society for ME (ESME) is responsible for planting the germ for the idea of the think tank. ESME is a new organization that hopes to organize research on ME as well as disseminate information about the condition to professionals. ESME board member Mrs. Catherine Miller-Duhen explains, “Until now ME organizations have been patient-based and only focused on the needs of the patients, so this is something completely new and unique. We are a group of professionals who want to stimulate new research in the field of ME and to help doctors and healthcare personnel to stay informed about the latest developments in diagnosing and treating ME-patients.”

Pain Specialists

One of the most obvious symptoms of fibromyalgia syndrome is that relentless nerve and muscle pain. Most fibromyalgia sufferers experience chronic and widespread pain that can get worse when they are exposed to certain aggravating factors. Treatment of this chronic pain is essential in order to improve muscle strength, range of motion, and overall quality of life. Unfortunately, treating fibromyalgia pain isn’t always easy. A pain specialist can help to diagnose the cause of your pain and provide you with a comprehensive treatment program thereby reducing your pain symptoms.

What is a Pain Specialist?
A pain specialist is a medical doctor who has expertise in the diagnosis, management, and treatment of both acute and chronic pain. Pain management specialists offer a variety of treatment services, and may design treatment programs that incorporate medical, psychological, and behavioral therapies. Pain specialists usually work out of private pain treatment centers or pain treatment centers affiliated with hospitals or university medical centers.

Qualifications of a Pain Specialist
Pain specialists are typically practicing medical doctors who already have experience in a particular area of medicine, such as neurology, physiatry, anesthesiology, or orthopedics. This means that pain specialists have undergone years of training in basic medical practice and in specialized fields of medicine.

In order to become a pain specialist, doctors must spend at least one year completing intense training in the field of pain management. They must then complete a rigorous exam before becoming certified by the American Board of Anesthesiology or the American Board of Pain Medicine.

What Can a Pain Specialist Treat?
Pain specialists can treat a wide variety of painful injuries and illnesses. They often treat acute pain that occurs after an injury or surgery, but most pain doctors specialize in the treatment of chronic pain. Some conditions that a pain specialist might treat include:

• back pain
• neck pain
• arm and leg pain
• spinal stenosis
• nerve damage
• cancer pain
• neurological pain

How Can a Pain Specialist Help Fibromyalgia?
Fibromyalgia is a very difficult illness to treat, particularly because so few health care practitioners are familiar with its symptoms. Pain specialists are particularly helpful for fibromyalgia sufferers because they are very familiar with the different aspects of the disease. This makes it easier for them to locate and treat sources of pain.

Pain specialists are also more familiar with and have easier access to a wide range of treatment therapies, including opioids. Unlike primary physicians, pain specialists are more willing to aggressively treat pain in order to provide you with relief. Pain specialists are also able to take on a leadership role when it comes to treating you fibromyalgia.

Your pain specialist will likely correspond with your other treatment providers in order to keep them up to date and on track with your treatment regimen.

What Tests Will a Pain Specialist Perform?
In order to diagnose the source and cause of your pain, a pain specialist will likely perform a number of different tests including:

• MRI (magnetic resonance imaging)
• skin temperature monitoring
• muscle and nerve x-rays and imaging

These tests can help pinpoint areas of pain and may help to identify areas where muscles or nerves are operating abnormally.

What To Expect When you See a Pain Specialist
If you decide to see a pain specialist for your fibromyalgia pain, you may be a little nervous. Don’t worry though. The appointment will be much like your typical health care appointments, only in much greater depth.

Your pain specialist will begin by taking a detailed medical history. This will include any illnesses or pain that you may have experienced prior to your fibromyalgia. Your pain specialist will also ask you some specific questions about your pain. Common questions include:

• What does your pain feel like?
• Where is your pain located?
• How long does your pain last?
• What makes your pain better? What worsens your pain?

Your pain specialist will also perform a physical exam and may run some diagnostic tests in order to come up with a treatment regime. Pain management specialists usually offer comprehensive treatment programs, which can include a combination of medications, physical therapy, and psychological therapy. Typical treatments include:

• nerve blocks
• Transcutaneous electrical nerve stimulation (TENS)
• physical therapy and massage
• depression treatment

Finding a Pain Specialist
If you are interested in seeing a pain specialist, you will need to get a referral from your primary health care provider. He will be able to recommend a pain specialist in your area. If you can’t find a pain specialist, speak to the anesthesiology department of your local hospital or contact your local governing board.

Finding the right health care provider to treat your fibromyalgia can be a very challenging process. Not only are there dozens of different types of medical specialists to choose from, few are actually familiar with the terrible symptoms caused by fibromyalgia syndrome. This leaves many fibromyalgia patients suffering needlessly. In the past few decades, though, there has been a surge in the number of fibromyalgia specialists out there. If you are suffering from fibromyalgia aches and pains, a physiatrist may be one specialist that can help you.

What is a Physiatrist?

A physiatrist is a doctor who specializes in physical medicine and rehabilitation (PM&R). Physiatrists are specially trained to diagnose, manage, and treat symptoms of acute and chronic pain. They also treat injuries and diseases of the musculoskeletal and neuromuscular systems. Physiatrists generally practice out of hospitals, private clinics, and rehabilitation centers. They offer comprehensive, non-surgical treatment programs that help to treat your whole body, not just your areas of pain.

Qualifications of a Physiatrist

In order to become a physiatrist, you must undergo years of education and training. All physiatrists must first complete four years of undergraduate study at a college or university. They must then complete four years of medical school, receiving either their M.D. or D.O. (Doctor of Osteopathy). To become physiatrists, these doctors must then complete four additional years of training in the field of physical medicine and rehabilitation. After passing a rigorous written and oral exam, physiatrists are then certified by the American Board of Physical Medicine and Rehabilitation.

What Can a Physiatrist Treat?

Physiatrists are trained to diagnose and treat a number of different injuries and illnesses. From minor aches and pains to chronic diseases, physiatrists have the in-depth knowledge required to effectively treat many medical conditions. In particular, physiatrists often treat:

• muscle injuries and sprains
• low back pain
• neck pain
• tendonitis
• arthritis
• osteoporosis
• multiple sclerosis
• brain injuries, including stroke

Can a Physiatrist Help Fibromyalgia Patients?

Next to pain specialists, physiatrists are one of the leading medical specialists when it comes to treating fibromyalgia. This is because of their understanding of both the neurological and musculoskeletal systems in your body. Because fibromyalgia involves both of these systems, a physiatrist has the knowledge required to make educated treatment recommendations for fibromyalgia sufferers.

Physiatrists also make excellent fibromyalgia health care providers because they offer comprehensive treatment programs directed at caring for your whole body. And because fibromyalgia syndrome doesn’t just affect one part of your body, these treatment programs can work wonders. Physiatrists are also qualified to take a leadership role in the overall treatment of your fibromyalgia. Physiatrists can help to put together a team consisting of a physical therapist, an occupational therapist, and a pain specialist to help improve your overall function and quality of life.

Tests Performed by Physiatrists

In order to get a better picture of your pain, physiatrists rely on imaging tests to help make accurate diagnoses and treatment decisions. In particular, physiatrists rely on electrodiagnostic studies to provide information about how your nerves and muscles are working inside of your body. Electrodiagnostic studies can locate areas of weakness and numbness, or pain and cramping. Common electrodiagnostic studies include:

• EMG (Electromyography)
• NCS (Nerve Conduction Studies)
• SSEP (Somatosensory Evoked Potentials)

What to Expect When You See A Physiatrist

At your first appointment, your physiatrist will take a detailed medical history from you and will ask you to describe your symptoms in detail. You will be asked how your symptoms have affected your quality of life and your physical function. Your physiatrist will also perform a physical exam, which may include palpation or massage of particular areas of your body. Diagnostic tests can also be performed in order to locate any muscles or nerves that may be functioning irregularly. By performing these exams, your physiatrist will be able to get a better picture of your injuries and pain.

Your physiatrist may come up with a treatment plan right away or decide to consult with another physiatrist before offering treatment. Physiatrists offer comprehensive treatment programs that address the whole body, not just the areas affected by pain or stiffness. Treatment programs typically involve:

• pain medications
• trigger point injections
• physical therapy
• occupational therapy
• exercise
• acupuncture

Finding a Physiatrist

Finding a physiatrist is usually fairly straightforward – just ask your general practitioner or regular health care provider for a referral to one in your area, or contact your local hospital for information. If you are having trouble finding a physiatrist, try contacting the board responsible for their certification (in the United States it is the American Board of Physical Medicine and Rehabilitation).

Family Physician

If you have just been diagnosed with fibromyalgia syndrome, than you are probably looking to start up a treatment program to help ease the symptoms of your illness. One of the most important facets of an effective fibromyalgia treatment program involves finding health care providers that are knowledgeable about all aspects of the syndrome. A family physician can help you to successfully manage all of your physical symptoms, as well as improve your mental and emotional wellbeing.

What is a Family Physician?
A family physician is a health care professional who provides clients with primary medical care. Sometimes known as a general practitioner (or a GP), a family physician possesses concrete knowledge in all aspects of general medicine, including pediatrics, obstetrics, and internal medicine. Capable of treating men and women of all ages, your family doctor will be able to diagnose, treat, and follow up a range of common medical problems and physical injuries.

What Qualifications Do Family Physicians Have?
Family physicians are qualified medical doctors. They have completed a four-year undergraduate degree at a recognized college or university and have then gone on to complete four years of medical school. In order to become an accredited family doctor, each physician must then go on to complete a three-year internship in family medicine.

In order to practice medicine legally, all family physicians must be certified in family medicine In the United States, certification is offered by the American Academy of Family Physicians (AAFP) or by the American Osteopathic Board of Family Medicine (AOBFP). In order to get this certification, all family doctors must pass a series of rigorous exams. Family physicians must also be re-certified every seven years.

What Does a Family Physician Do?
A family doctor can diagnose and treat a wide range of health problems. In particular, family doctors assess, diagnose, and treat:

• acute illnesses
• chronic illnesses
• physical injuries
• mental health issues

Another important responsibility of a family physician is to provide preventative care to his patients. Preventative care may include vaccinations, nutritional advice, weight management tips, and other health advice.

Family Physicians and Fibromyalgia
Though family physicians are not always recognized as being good care providers for those suffering from fibromyalgia, your family doctor can provide you with solid care for a variety of your fibromyalgia symptoms. The key is to find a family doctor who is familiar with the syndrome and it’s possible causes. Thanks to new research in the area, family doctors are now becoming much more aware of fibromyalgia and the effects that the syndrome can have on a person’s mental and physical state.

Personalized Treatment
Family physicians are an excellent type of health care provider to have on your fibromyalgia treatment team. Family physicians are there to provide you with ongoing health care throughout all the stages of your life. This means that you can develop a close and ongoing relationship with your family physician, unlike other health care providers. And because family physicians are more accessible than specialists, your family physician will be able to monitor your various symptoms and revise treatment programs according to your needs.

Wide Ranging Treatments
Because family physicians have training in multiple types of physical and mental illnesses, she will also be able to provide you with more comprehensive treatment. In particular, she will be able to provide medical treatment for:

• widespread pain
• fatigue
• sleep disorders
• depression
• irritable bowel syndrome

What To Expect
When you visit your family physician for the first time, he will probably want to find out more about your medical and personal history. You may be asked to fill out a number of forms describing any illnesses that you have, including your fibromyalgia. Your family doctor will also want to know what other health care providers you are seeing and what kind of treatments they have recommended.

Each time you visit with your family physician, you can expect her to perform a quick physical exam to evaluate the progression of your symptoms. She may check your weight, blood pressure, and heart rate, and will probably evaluate your joints for range of motion. Your family doctor will also look more closely at any particular symptoms that are bothering you.

After assessing your symptoms, your family doctor will be able to provide you with various suggestions for treatment. Family doctors can write prescriptions for various pain medications, sleeping aids, and other pharmacological treatments. Your family doctor can also refer you to another treatment provider should you require more specialized treatment.

Finding a Family Physician
Unfortunately, it can be difficult to find a good family physician who is accepting new patients. If you are looking for a new family doctor, you may want to ask your other health care specialists for a referral. Alternatively, you can contact your insurance provider for a list of family physicians in your area. Your local fibromyalgia support group may also be able to provide you with the names of some family physicians who are particularly familiar with fibromyalgia that are close by.