Diagnosis and Assessment of Disease
Diagnosis ÎThe diagnosis of fibromyalgia is based on a history of pain affecting all four body quadrants and the spinal area, above and below the waist and on both left and right sides for at least three consecutive months.5, 6
ÎPain must be present at 8-10 (11 of 18 for research criteria) specific anatomic locations (Figure 1) when palpated with a force of 8.8 lbs (4 kg) (Table 1).6
ÎFor an anatomic point to be considered positive, the patient must report that the palpation was painful. Tender is not considered painful.6
Classification ÎPrimary (idiopathic) fibromyalgia: Absent an inciting or precipitating event
ÎSecondary fibromyalgia: Subsequent to an illness, such as an infectious disease or rheumatic disorder
ÎPosttraumatic fibromyalgia: Result of an injury, such as a fall or motor vehicle accident.
Assessment
ÎHistory and physical exam, focusing on conditions that can mimic fibromyalgia (Table 3).5
ÎSeverity of other medical and cognitive symptoms, including fatigue, sleep disturbance, and mood disorder. Refer suspected mood disorders for psychological testing.5
ÎBlood tests include complete blood count, erythrocyte sedimentation rate, muscle enzymes, liver function, thyroid function, viral titers (eg, Epstein- Barr, parvovirus, hepatitis), Lyme serology and other tests to rule out conditions with similar symptoms (Table 3).5
Figure 1. Specific Location of Tender Points in Fibromyalgia Control sites
Low cervical: bilateral, as C5-C7
Second rib: bilateral, at second costochondral
Greater trochanter: bilateral, posterior to the trochanteric prominence
Knees: bilateral, at the medial fat pad proximal to the joint line
7 8 1 3 5 6 2 4 15 17 18 11 9 13
10 12 14
16
Occiput: bilateral, as the subocciptal
Trapezius: bilateral, at the mid- point of the upper border
Supraspinatus: bilateral, above the scapular spine near the medial borders
Lateral epicondyle: bilateral, 2 cm distal to the epicondyles
Gluteal: bilateral, upper outer- quadrants of buttocks in the anterior fold of muscle
