Diagnosing Fibromyalgia: Common Misdiagnoses

The Tender Points of Pain With Fibromyalgia

While it's not clear what exactly triggers fibromyalgia, researchers are homing in on the basic mechanisms. Fibromyalgia patients have higher levels of two substances -- a nerve chemical called substance P, and nerve growth factor in the spinal fluid. They also have lower than normal levels of the brain chemical serotonin, as is also true with people suffering from depression and anxiety. 

All this produces a dysfunction in the body's ability to process pain -- and creates supersensitive nerves throughout the body, explains Andrew J. Holman, MD, a rheumatology specialist at the University of Washington in Seattle. To make things worse, people with Fibromyalgia have difficulty getting a good night's sleep -- so they constantly wake up feeling fatigued.

The result: Everyday sensations of discomfort and pain are amplified beyond the norm. Slight bumps and touches can cause disabling pain if you have Fibromyalgia. This pain can be aggravated by outside factors -- noise, weather changes, and stress.

To figure out what's going on, doctors diagnose fibromyalgia by examining specific "tender points" on the body. "There are 18 specific tender points -- specific locations that are tender for everyone," Holman tells KB120. "But for people with Fibromyalgia, these points are significantly more tender. People are more sensitive at those points. A dysfunction in the central pain processing amplifies their sensations."

Tenderness or pain in at least 11 of these 18 points is the hallmark of Fibromyalgia, says Holman. Also, the pain is widespread on both sides of the body -- neck, buttocks, shoulders, arms, upper back, and chest. Tender points are around the elbows, shoulders, knees, hips, back of the head, and the breast bone.

Doctors test these tender points to make the Fibromyalgia diagnosis. Yet it's not always so clear-cut what the widespread pain indicates. It takes a careful ear to discern what's really going on, explains Martin Grabois, MD, chairman of physical medicine and rehabilitation at Baylor College of Medicine in Houston.

"Physicians are used to diagnoses like a Herniated Disc, where there's pain in a specific location," Grabois tells KB120. "That's not so with fibromyalgia. Some pain is above the waist, some below the waist, at the shoulders, etc., and there are sleep disturbances, fatigue. These are symptoms of a number of diseases. They are not isolated to Fibromyalgia." 

The muscle pain can range from mild discomfort to severe enough that it limits a person's everyday life -- including work and social activities. The pain is often described as burning, gnawing, throbbing, stabbing, or aching. When the person relaxes, the pain may be more noticeable -- and less so when they're active.

Sleep Dysfunction Affects Pain Sensitivity

The sleep problems associated with Fibromyalgia -- insomnia and fragmented sleep -- may be the root of the pain, says Holman. It deprives people of stage IV deep sleep, the non-rapid-eye-movement sleep that helps us feel refreshed in the morning.

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