Diagnoses of Exclusion
Diagnosing fibromyalgia and chronic fatigue syndrome is difficult -- we don't have a blood test that reliably detects either condition, and their primary symptoms are similar to those of a long list of diseases. In fact, pain and fatigue are among the most common complaints doctors hear.
Before you can get a diagnosis, you have to be sick (to varying degrees) for awhile -- 3 months for fibromyalgia, 6 months for chronic fatigue syndrome. That can be frustrating and feel downright cruel when you're the patient, but doctors need to know that your symptoms won't resolve on their own before they can label you with a chronic illness.
One important step, which can also be frustrating, is ruling out other possible causes for your symptoms. The specific ones will vary depending on your symptoms -- for example, doctors will usually test for hypothyroidism, rheumatoid arthritis and lupus before diagnosing fibromyalgia; but if the patient has a lot of neurological symptoms (i.e., numbness, tingling), they may also check for multiple sclerosis. This kind of testing can be time consuming, not to mention costly. Many people say it gets aggravating to get back negative result after negative result when they know something is wrong.
Fibromyalgia and chronic fatigue syndrome share many symptoms. Depending on your symptoms, it may be difficult to tell them apart. Also, some people have both conditions.
You can help your doctor with this process by getting to know your symptoms and symptom triggers. To get an accurate picture, you first need to know the range of possible symptoms. Then, it can help to keep a symptom diary so you can spot the things that make you feel better or worse.
A lot of questions and problems can come up along the road to diagnosis. This article can help you navigate some of the common ones:
Once other causes have been ruled out and the requisite time has passed, your doctor can consider a fibromyalgia or chronic fatigue syndrome diagnosis, based on standard diagnostic criteria.
The Fibromyalgia Diagnosis
Fibromyalgia is typically diagnosed and treated by rheumatologists. The American College of Rheumatology in 1990 established the first criteria for diagnosing fibromyalgia, but it issued supplemental criteria in May 2010. For a look at both sets of criteria and the reasons behind the change, see:
The Chronic Fatigue Syndrome Diagnosis
To date, no medical specialty has "claimed" chronic fatigue syndrome, so it often falls to general practitioners to recognize possible cases. However, not all doctors are trained to recognize the symptoms, and some may not be comfortable making the diagnosis. It's up to you to find a doctor who's knowledgable about the condition.
For a look at current diagnostic criteria, see:
American College of Rheumatology, 2007. "1990 Criteria for the Classification of Fibromyalgia"
Regina P. Gilliland, MD, Department of Internal Medicine; Division of Rehab Medicine, Mobile Infirmary Medical Center. "Fibromyalgia"
Centers for Disease Control and Prevention, May 3, 2006. "Diagnosing CFS"