A complicated process
Question
Why won’t my doctor diagnose me with fibromyalgia??
I have been very sick since few months, my doctor is testing me for a lot of diseases, but I have read a lot about fibromyalgia on internet and I think all of my symptoms fit in fibromyalgia.
I shared this with my doctor and he said that fibromyalgia is not the thing to be brought up yet. Now I am really frustrated and confused, he can’t diagnose anything even after repeated tests. Why my doctor is not considering me about diagnosing with fibromyalgia?
Answer
Fibromyalgia is not one those diagnoses that are straight forward unluckily, may be your doctor is reluctant to diagnose you with fibromyalgia, or may it is because of other factors, it depends on your doctor.
Firstly some doctors does not ready to accept that fibromyalgia is a real condition so they are unwilling to bring it up yet, you may ask your doctor directly if this is the reason. If all your tests leave you unable to find any answer then you can find another doctor who believes fibromyalgia is a real condition. Some people have to change the doctor to get the accurate diagnosis.
However the conditions is gaining wider acceptance in the medical community, so that should be encountered less and less. If some doctors do not accept fibromyalgia diagnosis in your case, then they may think it due to a couple of reasons.
The most important among them, under a widely used set of diagnostic criteria for fibromyalgia, you should have symptoms one a more or less continuous basis for a minimum of 3 months. May be simple your doctor is waiting that enough time should b passed. If that is the case you should re visit the idea in a couple of months.
Before diagnosing fibromyalgia your doctor has to test you for other illness with similar symptoms, as fibromyalgia is a diagnosis of exclusion. That can take a lot of time and test especially some similar conditions can be difficult to diagnose and in some cases it may take time and multiple rounds of testing to eliminate them with certainty.
The diagnostic test is very simple as soon as your doctor is ready to consider it. It requires a tender point examination or a questionnaire, no blood work or imaging at all.
One of the effective ways to treat and manage your condition is a proper diagnosis. No matter how hard it is, you need to be patient and let your doctor take the appropriate tests and make sure the end diagnosis is the right one.
Fibromyalgia diagnosis
Fibromyalgia is a very tough condition to diagnose. Up till we do not have a specific lab test that is accepted by the medical community and no scans and imaging can confirm the diagnosis either, due to all reasons fibromyalgia is known as diagnosis of exclusion.
The doctors need to rule out a number of other illnesses with similar symptoms before diagnosing fibromyalgia.
Who diagnoses fibromyalgia ???
Rheumatologist typically diagnoses and treat fibromyalgia also some neurologists and general practitioners can also diagnose it even so it can be difficult to find a doctor who is willing and able to effectively diagnose and treat fibromyalgia.
The American College of Rheumatology in 1990 established the first diagnostic criteria for fibromyalgia.
Then in may 2010 ACR put out new provisional criteria not to replace the old ones but to address certain limitations. The goal was to provide a more practical approach that allows doctor to get a better understanding of your unique set of symptoms as well as how sick your are overall.
1990 fibromyalgia diagnostic criteria
>>>Pain all the four quadrants of the body and in axial skeleton has been present for at least 3 months.
>>>pain in at least 11 out of 18 tender points which are specific spots on the body that hurt when pressure is applied.
Eliminating possibilities
The doctor should advise blood tests for multiple conditions before a doctor diagnosis fibromyalgia. These can include:
>>>hypothyroidism
>>>infections
>>>rheumatoid arthritis
>>>lupus
>>>polymyalgia rheumatic
Depending on your symptoms, doctors can advise other lab and imaging tests.
Fibromyalgia diagnostic criteria
The new fibromyalgia diagnostic criteria take into account many more symptoms have a built-in way for doctors to monitor your symptoms severity. They also provide some flexibility, one weakness of the tender point exam is that your pain threshold can fluctuate, meaning you will have different results at different times, the researchers behind this method say the new criteria is 88 percent accurate.
For the SS scale score the patient rank specific symptoms on a scale of 0-3, these symptoms include:
>>fatigue
>>waking unrefreshed
>>cognitive dysfunction
>>somatic symptoms in general like headache, weakness, bowel problem, nausea, dizziness, numbness
The numbers assigned to each are added up to a total of 0-12.
After the diagnosis
It’s time to start exploring treatment options once you are diagnosed with fibromyalgia. This can also be a long and complicated process but the good news is that now you know what you are fighting which gives you a place to start.
-Dr. Muneeba, MD FUMDC.
For reference:By Adrienne Dellwo via Verywell
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