The basis for the diagnosis Fibromyalgia

• Chronic (daily) pain in both arms, both legs, neck and / or back
• Painful at pressure
• No obvious underlying disease explanation
• Most common in adult women

Disease history

• Chronic pain

  • Duration of pain
  • Location of pain
    • Generalized (Chronic widespread pain). Includes both arms, legs and neck and / or back
  • Better in warm climate

• Treatment up to now

  • Physical
  • Exercises
  • Activity and self-training
  • Relaxation
  • heat Application
  • Medication

Clinical examination

• Pain relief at pressure to at least 11 of 18 defined points (illustration here).
  • Pressures equal to up to 4 kg when one uses thumb on the bathroom weight

Exclude another disease

• Examine joints to exclude Arthritis or pronounced Osteoarthrtitis
• Muscle strength and blood test with CK to exclude Myositis / myopathy
• Blood samples (CRP) to exclude Polymyalgia rheumatica
• Orienteering investigations to rule out infections or cancer
• Exclude signs of neurological disease (Parkinsson, MS)

Blood test results

• Blood tests are expected to be normal in fibromyalgia
• Blood tests to rule out similar conditions
  • Hemoglobin
  • White blood cells
  • CRP
  • Erythrocyte sedimentation rate (ESR)
  • Thyroid function: TSH, FT₄
  • Calcium (hyper-parathyroidism)
  • Antinuclear Antibodies (ANA)
  • CCP / ACPA antibody (rheumatoid arthritis)
  • Creatine kinase (CK, myositis)
  • Vitamin B₁₂, Methylmalonic acid, homocysteine
• Please see also Differential diagnosis here

 Referral to specialist

• Fibromyalgia is not an inflammatory connective tissue disease, and the referral is not usually prioritized by rheumatological hospital departments due to capacity problems
• General practitioners are competent to investigate, diagnose and follow up patients with fibromyalgia
• In case of a claim for specialist declarations or for special illnesses, referral to rheumatologist may be applicable
  • Hospital out-patient clinics and departments prioritize inflammatory diseases first (Right to health care)
  • References for the assessment of fibromyalgia are therefore often rejected from hospitals

Usually, the general practitioner can do Medical examination, give patient Information and start current measures. Specialists do not have special medication or other treatment options

Reference to practicing rheumatologist may be relevant where these have free capacity

• Norwegian Directorate of Health (Supervisor for referrals)

Fibromyalgia, BINDEVEVSSYKDOMMER.no