Fibromyalgia (FM) is a condition that typically has a slow, gradual onset that starts out mild and gradually worsens. The symptoms associated with FM include generalized pain all over the body (above and below the waist including neck, shoulders, chest, upper back, arms, hips, buttocks, legs, and feet). The pain can be symmetrical or more intense on the left or right side AND it can vary from day to day. To top it all off, the pain is “chronic” and is usually present for three or more months, sometimes for years, before the FM patient might even mention it to their healthcare provider. The onset can be so gradual that other issues often become the center of focus until the intensity gets to the point where the patient FINALLY complains.
To better appreciate the complexity of FM, there are two types of FM: primary and secondary. Primary FM has no specific cause while secondary FM is linked to something such as trauma associated with a car accident or sports injury, a condition such as irritable bowel syndrome (IBS), chronic fatigue syndrome, restless leg syndrome (RLS), and others. Either way, it is often NOT the kind of thing many patients “bring up” during the discussion of history with their healthcare provider, especially if something else is bothering them that may be more pressing
So, how does one explain the symptoms of FM? Words such as a deep ache, burning, tingling, shooting, tender, pins and needles, stiffness, and flu-like symptoms are often utilized when describing FM symptoms. Almost always, these complaints have been present for a long time – or for at least three months. Often, the patient is reluctant and almost embarrassed to mention it due to the difficulty in describing the symptoms and the fact that they often don’t know the cause. Equally, many doctors have an attitude that is negative and/or non-supportive of the diagnosis of FM making it even more likely FM patients won’t pursue the condition with other healthcare providers. This polarization by physicians is a very common issue and often the reason FM sufferers continue to “put up” with their condition rather than consult with others.
The KEY to the diagnosis of FM includes the following: 1) widespread pain NOT limited to one area of the body; 2) greater than three months of symptom duration; 3) symptoms including fatigue, sleep disturbance, depression/anxiety, as well as memory and/or concentration complaints; 4) symptoms severe enough that they interfere with daily living activities/daily life; and 5) difficulty finding an answer to the cause of the symptoms, USUALLY involving more than one healthcare provider. Even though awareness by both the general population and healthcare providers has improved in the last few years, research has shown that 92% of FM patients have talked to their doctor about their complaints, but this resulted in only 24% being diagnosed.
Another challenge confronting healthcare providers in making a diagnosis of fibromyalgia is because it can’t be seen on an x-ray or as an alteration on a blood test. Other diseases have to be “ruled out” before the diagnosis is even considered, but as was previously stated, secondary FM results from other conditions making it ALL the more challenging! It boils down to a very careful history and a physical exam has to be performed by the healthcare provider and the provider MUST believe in the diagnosis of FM. Tools such as the Fibromyalgia Pain Assessment can also be very helpful AND it’s available online for the FM patient to access. Bring those results with you to the provider for added help in making the diagnosis!