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Fibromyalgia Part 1: The Complexities of Diagnosis

Fibromyalgia affects more than half a million Canadians, according to the most recent data available from Statistics Canada1. Of those who suffer from this medical condition, the vast majority (four out of five) are women over the age of 40 years2.

Characterized by diffuse chronic pain, sleep impairment and psychological dysfunction, fibromyalgia presents a number of challenges when it comes to diagnosis. First among these is the uncertainty surrounding what, exactly, triggers this condition in patients. Formally identified in the mid-1970s, current medicine recognizes that fibromyalgia most likely arises from an equal combination of environmental factors as well as the genetic makeup of each individual patient.

Another, more direct barrier facing those performing an assessment has to do with the variety, and variance of reporting in terms of symptoms. While pain is the common factor - often taking the form of muscle aches, both acute and persistent - fibromyalgia sufferers also frequently describe fatigue, nausea, memory, concentration, and cognitive issues, sleeplessness, muscle stiffness, dizziness, and increased sensitivity to visual and auditory stimuli.

Symptoms may wax and wane over time, but it's rare for a patient to report being completely symptom free at any given moment. Within the context of an examination, the fact that this wide range of symptoms are often associated with other medical problems, including arthritis, multiple sclerosis, hypothyroidism, and chronic fatigue syndrome, can make it difficult to narrow the diagnosis to fibromyalgia. Further complicating matters is the absence of an accepted laboratory diagnostic criteria for the condition.

What does the latter mean when performing an assessment? The Canadian Fibromyalgia Guidelines Committee recommends that any lab testing be directed towards ruling out other potential causes for the symptoms described by a patient, rather than used to confirm a fibromyalgia diagnosis3. The same Committee has also advocated against the further use of the tender point examination in diagnosing fibromyalgia. This protocol, which has its roots in research, rather than clinical practice, relied on a manual examination of 18 soft tissue 'tender points,' and was eliminated by the American College of Rheumatology from its diagnostic criteria in 20104.

In its place, medical professionals are encouraged to rely on a multidimensional assessment of symptoms rather than a specific criterion when diagnosing this condition. This is a role suitable for general practitioners, with specialists reserved for the confirmation that symptoms are not associated with unrelated medical conditions. Given this approach, early diagnosis becomes an important tool in minimizing the impact of fibromyalgia for each patient, as most treatment plans consist of addressing individual symptoms and reducing their impact on the daily life of the patient.

  1. Statistics Canada. June 6, 2014. Canadian Community Health Survey, 2014. https://www.statcan.gc.ca/daily-quotidien/150617/dq150617b-eng.htm (accessed April 6, 2018). Annual.
  2. Rusu C, Gee MG, Lagacé C, et al. Chronic fatigue syndrome and fibromyalgia in Canada: prevalence and associations with six health status indicators. Health Promot Chronic Dis Prev Can 2015;35(1):3-11.
  3. Fitzcharles MA, Ste-Marie PA, Goldenberg DL, et al. 2012 Canadian guidelines for the diagnosis and management of fibromyalgia syndrome: executive summary. Pain Research & Management 2013;18(3):119-26
  4. Wolfe F, Clauw DJ, Fitzcharles MA, et al. The American College of Rheumatology
    Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity. Arthritis Care & Research 2010;62(5):600-10