# What should be excluded before fibro is concluded?



## SteveE (Jan 7, 1999)

As you can see from my profile, I am a veteran of the IBS board. I've had IBS for 13 years and counting. Now my wife faces a possible diagnosis of fibromyalgia and we need some help understanding it--particularly the diagnosis part as we are sure whether to accept that diagnosis yet or not. That's not to say that we necessarily think it's a wastebasket diagnosis. Although, to be honest, it took me years before I accepted that IBS might not be a wastebasket diagnosis. I still have doubts that all of the people who are diagnosed with IBS actually have it, though.Anyway, back to my wife...our skepticism of her diagnosis is because she doesn't come very close to meeting the criteria and from a lack of understanding about what tests should be performed to exclude other possibilities. Yes, she has pain in a variety of areas--hands, feet, neck, back, hip, occasionally fingers and knees, and rarely headaches. But that's where the similarities end...she doesn't have fatigue, sleep problems, IBS, and the tender-point test is questionable at best.She's had a partial bone scan of certain areas, MRI of the lower back and hip (those were the worst areas at first), x-rays, multiple blood tests (especially to rule-out RA since her sister has RA). What else makes sense to try before she decides she does, indeed, have fibro???The possibility that we both might have chronic illness is hard for both of us to accept, but I'm willing to listen to what those of you with more experience have to say.Thanks & best wishes,Steve


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## M&M (Jan 20, 2002)

Hi Steve,Welcome to our forum!







This is actually a pretty common question, and the good news is that it's a fairly simple question to answer!Fibromyalgia has very specific diagnostic criteria, and is NOT a disorder that is a diagnosis based on ruling out other disorders. (Unlike ME/CFS, which is a more elusive diagnosis, and which is arrived at through a process of "ruling out".)This is an excerpt from the various links in the "Fibro FAQ":*****************...upon physical examination, the fibromyalgia patient will be sensitive to pressure in certain areas of the body called tender points. To meet the diagnostic criteria, patients must have: A. Widespread pain in all four quadrants of their body for a minimum of three monthsB. At least 11 of the 18 specified tender points(see diagram)These 18 sites used for diagnosis cluster around the neck, shoulder, chest, hip, knee and elbow regions. Over 75 other tender points have been found to exist, but are not used for diagnostic purposes. While many chronic pain syndromes display symptoms that overlap with fibromyalgia, the 1990 ACR multi-center criteria study (published in the February 1990 issue of Arthritis and Rheumatism) evaluated a total of 558 patients, of which 265 were classified as controls. These control individuals weren't your typical healthy "normals." They were age and sex matched patients with neck pain syndrome, low back pain, local tendinitis, trauma-related pain syndromes, rheumatoid arthritis, lupus, osteoarthritis of the knee or hand, and other painful disorders. These patients all had some symptoms that mimic FMS, but the trained examiners were not foiled--they hand-picked the FMS patients out of the "chronically ill" melting pot with an accuracy of 88%. FMS is not a wastebasket diagnosis! ****************************These tender points will hurt when pressed, but the pressure will not cause pain in any other part of the body. The physician applies a standardized amount of pressure (4 kgs of pressure). Remember, a tender point has to be painful at palpation, not just "tender." When pressed, these areas tend to feel like bruises in various stages of healing. Also, a tender point is different from what you may know as a trigger point. Tender points hurt, trigger points hurt and refer pain to other body parts. Trigger points cause myofascial pain syndrome, which often coexists with fibromyalgia, but can be treated with massage, physical therapy, or gentle stretching. When muscles feel hard and pressing on them causes a response elsewhere in the body, or even nausea, trigger points are responsible. Tender points are caused by an unknown mechanism, and their severity is often cyclic. Tender points do not generally respond to physical therapy, often becoming more painful with pressure. **************************As you can see, Fibromyalgia is a very specific diagnosis. The treating specialist is a rheumatologist, but preferably a rheumatologist specializing in Fibromyalgia. Diagnosing Fibro does not require ruling anything else out. You just have to meet the diagnostic criteria.That being said, LOTS of other syndromes and illnesses can mimic the Fibro symptoms. The one thing that will separate them though, is the presence of the Tender Spots. They are in VERY specific locations, and will be the same on every single Fibro patient, regardless of their other symptoms.It is also possible to have Fibro in addition to various other pain syndromes, or illnesses.I hope this information has helped! If you have any more questions, concerns, or problems, feel free to post them! We've got lots of great members in our forum!


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## SteveE (Jan 7, 1999)

Thanks for the detailed reply. The doctor she saw was listed in "America's Top Doctors" several years running. We selected him in part because of his reputation and in part because of rheumatoid and fibro specializations. I attended her most recent appointment and asked him specifically how he can say that she has fibro when she doesn't have fatigue and she doesn't have the tender points. He actually told me that the tender points don't matter! "Then how do you define fibro?" I asked. "Well, she has all of these pains and there's no other causes, we don't see anything there. Some doctors might recommend you see a psychiatrist. Would you like to do that?" I must admit, my arm was shaking with anger. I'm not a violent man, but I wanted to knock him across the room. I didn't even raise my voice, though, because obviously this "top doctor" was an idiot.


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## M&M (Jan 20, 2002)

Oh my! Yes I do believe that doctor deserves a firm swat!!!I am so sorry that happened to both of you. Sadly, there are a LOT of doctors out there like that. I've been through countless doctors who have discredited me, some who have even made me cry! Unfortunately it does happen.I can imagine how frustrated you both must feel! But your wife does NOT need to see a psychiatrist. I do think this so-called "doctor" might benefit from a visit to a psychiatrist though!!I hope you can find another doctor in your area. This guy is obviously an idiot!


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