From the Guidelines
The workup for fibromyalgia should involve a comprehensive clinical evaluation, focusing on a history of widespread pain, fatigue, sleep disturbances, and cognitive difficulties, as well as a physical examination to identify tender points and rule out other conditions 1. The diagnosis of fibromyalgia is primarily based on clinical criteria, including a history of widespread pain lasting at least three months, along with symptoms like fatigue, sleep disturbances, and cognitive difficulties.
- Key aspects of the workup include:
- Comprehensive clinical evaluation
- History of widespread pain
- Fatigue, sleep disturbances, and cognitive difficulties
- Physical examination to identify tender points
- Laboratory tests to rule out other conditions, such as complete blood count, comprehensive metabolic panel, thyroid function tests, erythrocyte sedimentation rate, C-reactive protein, and vitamin D levels
- Screening for common comorbidities like depression, anxiety, and irritable bowel syndrome
- According to the EULAR revised recommendations for the management of fibromyalgia, the workup should aim to understand the patient's pain, function, and psychosocial context, and recognize fibromyalgia as a complex and heterogeneous condition with abnormal pain processing and other secondary features 1.
- The workup should also consider the patient's preferences and comorbidities, and involve a multidisciplinary approach with a combination of non-pharmacological and pharmacological treatment modalities tailored according to pain intensity, function, and associated features such as depression, fatigue, and sleep disturbance 1.
From the Research
Diagnostic Workup for Fibromyalgia
The diagnostic workup for fibromyalgia involves a comprehensive clinical assessment to avoid under-, over-, and misdiagnosis 2. The following steps are recommended:
- Complete medical history and physical examination to identify potential causes of chronic widespread pain (CWP) and to consolidate the diagnosis of fibromyalgia or identify features that may point to another condition 3, 4
- Screening for CWP, unrefreshed sleep, and fatigue, which are major symptoms of fibromyalgia 2
- Limited simple laboratory testing to screen for possible other diseases, such as complete blood count, measurement of C-reactive protein, serum calcium, creatine phosphokinase, thyroid-stimulating hormone, and 25-hydroxyvitamin D levels 3
- Use of diagnostic criteria, such as the American College of Rheumatology criteria or the Analgesic, Anesthetic, and Addiction Clinical Trial Translations Innovations Opportunities and Networks-American Pain Society Pain Taxonomy diagnostic criteria, to confirm the diagnosis of fibromyalgia 5
Red Flags and Differential Diagnosis
Red flags that suggest another medical condition should be identified, and additional laboratory or radiographic testing should be performed as needed 3. The differential diagnosis of fibromyalgia should include other chronic overlapping pain conditions and mental disorders, as fibromyalgia often co-occurs with these conditions 2.
Assessment of Severity and Treatment Approaches
The severity of fibromyalgia should be assessed to direct treatment approaches and inform the likely outcome for an individual patient 2. A multidisciplinary approach that incorporates nonpharmacologic therapies and medications to address problematic symptoms is most effective 5. Patient education, exercise, and cognitive behavior therapy can improve pain and function, and medications such as duloxetine, milnacipran, pregabalin, and amitriptyline may be effective for fibromyalgia 5, 6.