Diagnosis of Fibromyalgia

Fibromyalgia is diagnosed based primarily on having pain all over the body, along with other symptoms. Currently, there are no specific laboratory or imaging tests for fibromyalgia. The main symptoms—pain and fatigue—are shared with many other conditions, so doctors typically try to rule out other causes for your symptoms.

Doctors may do the following to diagnose fibromyalgia:

• Take your medical history. Your doctor will likely ask about the location, severity, and duration of pain, and whether you have experienced severe fatigue or cognitive problems, such as confusion or memory issues. They may also ask if you have other conditions, because some people with fibromyalgia have other diseases at the same time.
• Perform a physical exam. Your doctor will examine your joints to see if you may have another condition, such as rheumatoid arthritis or systemic lupus erythematosus.

Your doctor may order laboratory or imaging tests to help rule out other diseases and conditions.

Treatment of Fibromyalgia

There is no cure for fibromyalgia, so treatment focuses on relieving the symptoms. Your treatment plan will likely include a combination of psychological and behavioral therapy, medications, and self-management approaches, such as physical exercise and other movement therapies like yoga or tai chi.

Cognitive behavioral therapies. A type of therapy called cognitive behavioral therapy, which aims to change the way you think about pain, can be helpful, especially when combined with other types of treatment. This type of therapy can be either one-on-one or in groups with a therapist. Other types of mental health counseling may also be helpful.

Medications. A number of medicines can help relieve the pain and improve sleep. You may be prescribed more than one type of medication at the same time.

• Antidepressants. Drugs that treat depression may also work for fibromyalgia even if you are not depressed. Doctors may prescribe one of several classes of antidepressants.
• Anti-seizure medicines. These medicines can lessen pain and improve sleep. They work by interfering with the transmission of pain signals to the brain.
• Analgesics (pain-relieving medicines). These may be used for people who need additional pain relief. Anti-inflammatory pain medications are usually not effective because fibromyalgia does not cause tissue inflammation, but they may help with other painful conditions that may coexist with fibromyalgia. 

You may need to try different drug combinations and dosages before finding relief from symptoms, and improvement is often gradual.

Complementary and Integrative medical therapies. Some people seek therapies such as acupuncture, massage, and hypnosis, but many of these have not been well tested in people with fibromyalgia. Before using these therapies, talk to your doctor about the best options for you.

Who Treats Fibromyalgia?

Fibromyalgia treatment often requires a team approach, but it is primarily treated by:

• Rheumatologists, who specialize in arthritis and other diseases of the bones, joints, and muscles. Fibromyalgia is not a form of arthritis, nor does it damage the bones, joints, or muscles, but rheumatologists usually treat it because the symptoms are similar to those of arthritis.

Other health care professionals who may be involved in your care include:

• Exercise physiologists, who are trained in understanding the body’s response to physical activity.
• Mental health professionals, who help people cope with difficulties in the home and workplace that may result from their medical conditions. A counselor trained in cognitive behavioral therapy can help you learn skills and techniques to better control the pain.
• Pain management specialists, who are trained in the evaluation and treatment of pain.
• Physical therapists, who improve quality of life through prescribed exercise, hands-on care, and patient education.
• Primary health care providers, including family doctors, internists, or pediatricians, who coordinate care between the different health care providers and treat other problems as they arise.
• Sleep specialists, who address problems related to sleep, sleep disorders, and sleep health.