Written by Tracey Kellett

Fibromyalgia is diagnosed based on symptoms and examination. There are usually no signs of Fibromyalgia on physical examination other than muscle tenderness. Your healthcare provider will consider all the possible causes of your symptoms and decide whether you need tests to rule out other causes. 

There are no X-rays, scans or blood tests that can check for Fibromyalgia. If your symptoms fit what is known about Fibromyalgia and not the symptoms of another illness, then a diagnosis can be made. You can have Fibromyalgia AND another condition with similar or crossover symptoms.  

There are many different sets of diagnostic criteria. The ones healthcare providers in New Zealand use currently are the 2010 American College of Rheumatology criteria.

Three main criteria need to be met for a diagnosis: 

• Your score on the Widespread Pain Index (WPI) is 7 or higher, and Symptom Severity Score (SSS) is 5 or higher. Or your WPI is between 3 to 6 and your SSS is 9 or higher.  The WPI and SSS are questionnaires which your healthcare provider will work through with you. They consider how many areas of the body you experience pain and how much trouble your other symptoms cause. 
• Symptoms have been present at a similar level for at least three months. 
• There is no other disorder that would otherwise explain the pain. 

The International Classification of Diseases, 11th revision identifies Fibromyalgia as chronic widespread pain (CWP), which is diffuse pain in at least 4 of 5 body regions and is associated with significant emotional distress (anxiety, anger/frustration or depressed mood) or functional disability (interference in daily life activities and reduced participation in social roles). 

CWP is multifactorial: biological, psychological and social factors contribute to the pain syndrome. The diagnosis is appropriate when the pain is not directly attributable to a nociceptive process in these regions, and there are features consistent with nociplastic pain and identified psychological and social contributors. 

How long does it take to get a diagnosis?

It can often take 5-7 years from the time a person first reports symptoms to when they get a formal Fibromyalgia diagnosis. This can be partly because the pain in Fibromyalgia can move around and come and go and increase and decrease in intensity. People living with this type of pain can sometimes dismiss it as not something to be concerned about and think it will go away so they may underreport symptoms to their clinician.

Another reason it can take up to 7 years is that the symptoms overlap with other conditions; patients can present with non-specific complaints. Because there are no specific tests for Fibromyalgia, this can make it very difficult to diagnose.

General practitioners (GPs) and other health professionals may have a limited amount of knowledge about Fibromyalgia, which also lengthens the time to get a diagnosis. If you’re wondering if you could have Fibromyalgia and it hasn’t been discussed, it is good to ask directly so you and your healthcare provider can explore this together.

Who can diagnose Fibromyalgia?

A GP or an experienced nurse practitioner can make a diagnosis. Sometimes, your GP will feel uncomfortable providing more certainty and will refer you to a rheumatologist (joint specialist) or, in areas where there is no rheumatologist, to a general physician.

What is the pattern of symptoms?

Someone with Fibromyalgia is likely to experience some, but not necessarily all, of these symptoms: 

• Widespread pain without an injury 
• Tension headaches 
• Tender points on your body 
• Fatigue – no energy or struggle to recharge 
• Difficulty with getting to sleep or staying asleep 
• Trouble concentrating or remembering things. Often called “fibro fog.” 
• Depression or anxiety 
• Digestive problems 
• Irritable or overactive bladder 
• Pelvic pain 
• Jaw pain

Read more about how to manage Fibromyalgia here: Fibromyalgia – Arthritis New Zealand