By Lana Barhum
Because of newer, comprehensive methods for treating fibromyalgia, including lifestyle approaches and medication, the prognosis for fibromyalgia patients is slowly improving. But first a doctor needs to make an accurate diagnosis, which isn’t easy.
On average, it takes 2 to 3 years to get a diagnosis, and research shows that people with fibromyalgia typically see many doctors before getting one. Even with a doctor who is knowledgeable about fibromyalgia, it still takes time.
While much research has been devoted to fibromyalgia, a syndrome defined by debilitating widespread muscle pain, cognitive impairment, lack of restorative sleep and extreme fatigue, it is still contested by some in the medical community. Moreover, there remains considerable disagreement about fibromyalgia's cause, whether it is psychological or physical, and how to treat it.
That lack of conformity is unfair to the millions living with the real pain and sickness fibromyalgia brings in its wake. Fibromyalgia takes a toll on mental and physical health, relationships and quality of life.
“People with fibromyalgia suffer from severe, daily pain that is widespread throughout the body,” says Dr. Leslie J. Crofford, an NIH-supported researcher at Vanderbilt University. “Their pain is typically accompanied by debilitating fatigue, sleep that does not refresh them, and problems with thinking and memory.”
Why Does a Diagnosis Take So Long?
The one thing the medical community does agree on, is that fibromyalgia is difficult to diagnose. But why does it take so long? Here are some possible explanations.
Fibromyalgia is not considered a disease. It is a syndrome, which means a cluster of signs and symptoms that occur together, and create an abnormality or condition.
Fibromyalgia symptoms often don’t make much sense. Sleep issues, extreme fatigue, anxiety, headaches, widespread pain and so much more could be attributed to any number of health conditions or bad habits, such as insomnia, stress, not drinking enough water, or smoking. Additionally, symptoms vary from person-to-person and their severity is constantly changing.
There are also no universally accepted labs or diagnostic tests for fibromyalgia, so doctors must rely on symptoms to make a diagnosis. Physicians also have to make sure the symptoms are not caused by another health condition.
Criteria for Diagnosing Fibromyalgia
In 1990, the American College of Rheumatology’s (ACR) diagnostic criteria involved physical examination of specific tender points on the bodies of fibromyalgia patients. If patients had at least 11 or 18 tender points, they were given a diagnosis of fibromyalgia. It was the only method available at the time for diagnosing fibromyalgia, but studies would later point out the limitations of this method.
The 2010 ACR diagnostic criteria, updated in 2011, utilizes a widespread pain index criteria and a symptom severity score. In 2016, researchers updated the criteria yet again, reporting their revisions at the ACR's annual meeting in September.
They determined that a doctor who is knowledgeable about fibromyalgia can make a diagnosis based on symptoms that include widespread pain lasting more than 3 months, as well as other symptoms, such as debilitating fatigue. Moreover, the doctor must consider the number of areas on the body where the patient has had pain over the past few days and the severity. Lastly, he or she must rule out other potential causes of the patient's pain and symptoms.
It wasn’t until late 2015 that fibromyalgia was finally recognized as an official diagnosis and given a new ICD-10 code (10th revision to International Statistical Classification of Diseases and Related Health Problems, a medical classification list by the World Health Organization). This came as a result of many medical advances over the last decade in understanding and acknowledging fibromyalgia.
Regardless of how far we have come in research and awareness, until there are conventional methods for testing fibromyalgia, it will continue to remain a diagnosis of exclusion. Doctors will continue to rely on a description of symptoms and pain from patients, which can be difficult to articulate for most people.
In late 2008, I was finally diagnosed with fibromyalgia based on the 1990 criteria. I know firsthand that living with a cluster of deliberating symptoms and unexplained pain can be frustrating.
I don’t recall the exact date I was diagnosed, the onset of my symptoms, or what triggered my illness. What I do recall is that for ten very long years, I visited countless doctors as my pain worsened and the list of symptoms continued to grow. I would inform doctors I was hurting and extremely exhausted. Some mornings, I couldn’t even get out of bed. Some treated my symptoms as psychosomatic and others tried treating my physical symptoms. And of course, there were the ones who viewed me as drug-seeking.
Despite my difficult and frustrating experiences, I took responsibility for my health and finding answers. All I ever wanted during that ten year period was to be believed, but it took a lot of physical and emotional pain to get that.
I know anyone struggling to find answers feels the pain and sentiment in my saying that a diagnosis finally gave me my life back. It truly did, and even though finding successful treatments has proved challenging, having an actual diagnosis has made life a whole lot easier.
Medicine has come a long ways in diagnosing fibromyalgia, but doctors still need to rely on descriptions of symptoms and pain from patients, which is challenging. As a patient, it's up to you to keep track of all your symptoms. Write them down. Note what causes them or worsens them or decreases their intensity. Most importantly, be aware of how symptoms and pain affect your life. This will assist your doctor in determining what is wrong and how best to treat it.
Remember to trust your instincts, stand up for yourself, keep looking for answers and don’t be deterred.
Lana Barhum lives and works in northeast Ohio. She is a freelance medical writer, patient advocate, legal assistant and mother.
Having lived with rheumatoid arthritis and fibromyalgia since 2008, Lana uses her experiences to share expert advice on living successfully with chronic illness. She has written for several online health communities, including Alliance Health, Upwell, Mango Health, and The Mighty.
To learn more about Lana, visit her website.