ChiroACCESS Clinical Review

Fibromyalgia: Diagnosis

This information is provided to you for use in conjunction with your clinical judgment and the specific needs of the patient.

Lead Author(s): 

Dwain M. Daniel, D.C.


How this evidence was rated:

Strength of Recommendation Taxonomy (SORT)

Published on

October 1, 2006

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On initial examination fibromyalgia appears to be a relatively straight-forward diagnostic procedure. The patient presents with spontaneous, widespread soft tissue pain, sleep disturbances, fatigue and widely distributed tender points evaluated by procedures developed by the American College of Rheumatology (ACR) (1). Although diagnosis may seem rather simple it can, in fact, be challenging. A recent paper found only 34% of patients diagnosed with FM received an accurate diagnosis (2). Hypothyroidism, drug-induced myopathies (often associated with statins, lipid-lowering drugs), myofascial pain syndrome, lupus and other rheumatic conditions can mimic fibromyalgia. Often the diagnosis is made, at least in part, by elimination of other conditions. One must take a very careful history, perform a skilled examination and use astute observation over time. Additionally the ACR states the diagnosis of FM cannot be made until lab testing returns negative. To rule out the above mentioned conditions, the following tests are recommended: red blood cell count with differential, thyroid function tests, metabolic screening panel, C-reactive protein, erythrocyte sedimentation rate, Lyme test and rheumatic profile (3).

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Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL et al. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum 1990; 33(2):160-172.


Fitzcharles MA, Boulos P. Inaccuracy in the diagnosis of fibromyalgia syndrome: analysis of referrals. Rheumatology (Oxford) 2003; 42(2):263-267.


Schneider MJ, Brady DM, Perle SM. Commentary: differential diagnosis of fibromyalgia syndrome: proposal of a model and algorithm for patients presenting with the primary symptom of chronic widespread pain. J Manipulative Physiol Ther 2006; 29(6):493-501.