A physician with experience with fibromyalgia will usually make the correct diagnosis without any uncertainty. However, in special cases, the diagnosis may be difficult. The suggestions below can then be considered.

• Localized muscle pain
  • Not as widespread symptoms
• Polymyositis
  • Muscle weakness
  • CK in the blood sample is high
• Muscular Dystrophy (Hereditary progressive muscle diseases)

• Glycogen storage disease type V: McArdle's disease / phosphorylase deficiency
  • Pain / cramps after activity
• Glycogen storage disease type II, Adult acid maltase deficiency (Pompes disease)
• Electrolyte shortage
  • Hypokalemia
  • Hypocalcemia
  • Hypomagnesaemia
• Carnitine-palmitoyltransferase II deficiency
  • Muscle pain

• Polymyalgia rheumatica
  • Age over 50 years
  • High erythrocyte sedimentation rate (ESR) and CRP
• Low metabolism
  • High TSH and low f-T4 in blood test
• High metabolism (hyperthyroidism)
  • Make TSH and High f-T4 in blood test
• Hyperparathyreosis
  • High parathymone (PTH) and calcium in blood samples
• Vitamin B12 deficiency
  • Make B 12 in blood test, macrocytosis (MCV high)
• Parkinsonism
  • Stiffness, less pain
• Stiff person syndrome
• Depression
• Complex regional pain syndrome (CRPS)

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