Diagnosing Fibromyalgia

Content provided by the Faculty of the Harvard Medical School

Diagnosing Fibromyalgia

Question:

What type of doctor is the best to diagnose fibromyalgia? Can your primary doctor or would a specialist be a better choice?

Answer:

Fibromyalgia is a chronic, painful condition of unknown cause. Any type of doctor can diagnose it when the symptoms and signs are "classic" and other diagnoses have been ruled out. However, when there is uncertainty, it makes sense to see a rheumatologist (arthritis specialist), pain specialist or other doctor with expertise in chronic pain.

The most important thing is that the diagnosis is correct. Overlooking fibromyalgia or treating for fibromyalgia while overlooking a readily reversible cause of pain may contribute to avoidable suffering.

Doctors establish the diagnosis when there are typical signs and symptoms with no other explanation. Common symptoms and signs include:

• Widespread pain in the joints, muscles and spine

• Soreness to touch in certain locations (called "tender points")

• Poor quality sleep

• Fatigue

• Headaches

• Difficulty concentrating

Rheumatologists have extensive experience seeing people with fibromyalgia. They also have experience with many of the other diseases that cause similar symptoms. For example, it's common that rheumatologists diagnose fibromyalgia in people suspected of having rheumatoid arthritis or lupus. Other conditions that may mimic fibromyalgia include thyroid disease and vitamin D deficiency.

Robert Shmerling, M.D., is associate physician and clinical chief of rheumatology at Beth Israel Deaconess Medical Center and an associate professor in medicine at Harvard Medical School. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program and has been a practicing rheumatologist for over 25 years.

Last updated:	July 20, 2009