Diagnosing Fibromyalgia

Fibromyalgia is a clinical diagnosis, meaning that it is based on signs and symptoms and a patient’s medical history rather than on results of lab or imaging tests.

“Fibromyalgia is often a diagnosis of exclusion; there is no test that detects this disease, but lab tests or X-rays are often performed to rule out other health problems. Other conditions such as hypothyroidism, polymyalgia rheumatica, RA, lupus, and other inflammatory or autoimmune disorders sometimes mimic fibromyalgia, but these conditions can be ruled out by a physical exam and blood tests,” explains Dr. Witkin.

Because the symptoms of fibromyalgia are often vague and are common to many other medical conditions, it often takes months, or even years, to receive a diagnosis. In one national survey, one-quarter of respondents said they suffered fibromyalgia symptoms for at least five years before being diagnosed. Early diagnosis is important in fibromyalgia, because patients diagnosed within a year of developing the condition are less likely to experience severe symptoms in the future.

Fibromyalgia Medications

According to Dr. Witkin, first-line treatment is the use of SNRI medications including duloxetine (Cymbalta), milnacipran (Savella), and venlafaxine (Effexor), anticonvulsants such as pregabalin (Lyrica) and gabapentin (Neurontin), and tricyclic antidepressants such as amitriptyline (Elavil).

Other options include SSRIs such as fluoxetine (Prozac) and sertraline (Zoloft), and the muscle relaxants cyclobenzaprine (Flexeril) and tizanidine (Zanaflex).

Fibromyalgia Treatment Options

Dr. Lisa Within emphasizes the importance of physical exercise in addition to fibromyalgia medications “The most benefit [is] gained from aerobic exercises,” she notes. “Other body-based therapies, including tai chi and yoga, can be helpful, as well as regular stretching/strengthening exercises,” [/caption]Fibromyalgia treatment shouldn’t end with medications. “Physical exercise should be used in addition to any drug treatment, with the most benefit gained from aerobic exercises,” Dr. Witkin says. “Other body-based therapies, including tai chi and yoga, can be helpful, as well as regular stretching/strengthening exercises.”

Cognitive behavioral therapy and relaxation techniques can help patients learn skills that lessen pain.

Complementary and alternative therapies, such as acupuncture, chiropractic, and massage therapy, can be useful, but Dr. Witkin notes that many of these treatments have not been well tested in patients with fibromyalgia.

Lifestyle modifications including avoiding stimulants, caffeine, and nicotine, and practicing good sleep hygiene are strongly recommended.

“While no cure exists for fibromyalgia and we are still learning a lot about causes and best treatments, education, lifestyle changes, and appropriate medication management by a specialist can help patients achieve significant improvement in symptoms and overall quality of life,” says Dr. Witkin.

Originally published in Weill Cornell Medical College Women’s Health Advisor in February 2017 and updated.