eMedicine Specialties > Physical Medicine and Rehabilitation > Muscle Pain Syndromes

Fibromyalgia: Differential Diagnoses & Workup

Author: Regina P Gilliland, MD, Department of Internal Medicine; Division of Rehab Medicine, Mobile Infirmary Medical Center
Contributor Information and Disclosures

Updated: Aug 13, 2009

Differential Diagnoses

Cervical Disc Disease
Meralgia Paresthetica
Cervical Myofascial Pain
Myofascial Pain
Cervical Sprain and Strain
Osteoarthritis
Chronic Pain Syndrome
Postpolio Syndrome
Complex Regional Pain Syndromes
Rheumatoid Arthritis
Hypothyroid Myopathy
Systemic Lupus Erythematosus
Lumbar Degenerative Disk Disease
Lumbar Facet Arthropathy
Mechanical Low Back Pain

Workup

Laboratory Studies

  • No tests accurately identify fibromyalgia.
  • A new blood test involving antipolymer antibodies was developed.
    • These antibodies are present in approximately 50% of people with fibromyalgia.
    • This biologic marker may provide conclusive evidence for a subgroup of people with fibromyalgia.
  • Routine laboratory studies and radiographs are helpful in ruling out other diseases or in diagnosing coexisting conditions.

Imaging Studies

  • Regarding the diagnosis of fibromyalgia, some investigators state that imaging studies are helpful only in ruling out other diseases or in diagnosing coexisting conditions.

More on Fibromyalgia

Overview: Fibromyalgia
Differential Diagnoses & Workup: Fibromyalgia
Treatment & Medication: Fibromyalgia
Follow-up: Fibromyalgia
References
[ CLOSE WINDOW ]

References

  1. Starlanyl D, Copeland ME. Fibromyalgia and Chronic Myofascial Pain Syndrome: a Survival Manual. Oakland, Calif: New Harbinger Pubs; 1996:7-264.

  2. Burgmer M, Pogatzki-Zahn E, Gaubitz M, et al. Altered brain activity during pain processing in fibromyalgia. Neuroimage. Sep 24 2008;[Medline].

  3. Chaitow L. Fibromyalgia and Muscle Pain. Thorsons Pub; 1995:1-205.

  4. Clauw DJ. Fibromyalgia: more than just a musculoskeletal disease. Am Fam Physician. Sep 1 1995;52(3):843-51, 853-4. [Medline].

  5. Tander B, Gunes S, Boke O, et al. Polymorphisms of the serotonin-2A receptor and catechol-O-methyltransferase genes: a study on fibromyalgia susceptibility. Rheumatol Int. May 2008;28(7):685-91. [Medline].

  6. Russell IJ, Orr MD, Littman B, et al. Elevated cerebrospinal fluid levels of substance P in patients with the fibromyalgia syndrome. Arthritis Rheum. Nov 1994;37(11):1593-601. [Medline].

  7. Bazzichi L, Giannaccini G, Betti L, et al. ATP, calcium and magnesium levels in platelets of patients with primary fibromyalgia. Clin Biochem. Sep 2008;41(13):1084-90. [Medline].

  8. Griep EN, Boersma JW, de Kloet ER. Altered reactivity of the hypothalamic-pituitary-adrenal axis in the primary fibromyalgia syndrome. J Rheumatol. Mar 1993;20(3):469-74. [Medline].

  9. Crofford LJ. Neuroendocrine aspects of fibromyalgia. J Musculoskelet Pain. 1994;2:125-33.

  10. Cuatrecasas G, Riudavets C, Güell MA, et al. Growth hormone as concomitant treatment in severe fibromyalgia associated with low IGF-1 serum levels. A pilot study. BMC Musculoskelet Disord. Nov 30 2007;8:119. [Medline]. [Full Text].

  11. Olson J. Mapping Genes for Fibromyalgia. National Institute of Arthritis and Musculoskeletal and Skin Diseases; Aug 2004. Spotlight on Research, Fibromyalgia: Summaries of Research. [Full Text].

  12. Buskila D, Sarzi-Puttini P. Biology and therapy of fibromyalgia. Genetic aspects of fibromyalgia syndrome. Arthritis Res Ther. Jul 28 2006;8(5):218.

  13. Arnold LM, Crofford LJ, Mease PJ, et al. Patient perspectives on the impact of fibromyalgia. Patient Educ Couns. Oct 2008;73(1):114-20. [Medline].

  14. Pellegrino M. Physical medicine and a rehabilitation approach to treating fibromyalgia. In: Chaitow L, ed. Fibromyalgia Syndrome: a Practitioner's Guide to Treatment. New York, NY: Churchill Livingstone; 2000:121-30.

  15. Gilliland RP. A medical perspective on fibromyalgia. In: Chaitow L, ed. Fibromyalgia Syndrome: a Practitioner's Guide to Treatment. New York, NY: Churchill Livingstone; 2000:111-9.

  16. Starz TW, Turk DC. The Manual Tender Point Survey. Supplement: CME Continuing Medical Education. Fibromyalgia Aware. 2004.

  17. Lue FA. Sleep and fibromyalgia. J Musculoskelet Pain. 1994;2:89-100.

  18. Yunus MB. Fibromyalgia syndrome: clinical features and spectrum. J Musculoskelet Pain. 1994;2:5-21.

  19. Yunus MB. Suffering, science, and sabotage. J Musculoskelet Pain. 2004;12(2):3-18.

  20. WebSciences International and Sleep Research Society (United States). Basics of Sleep Behavior. Available at http://www.sleephomepages.org/sleepsyllabus/.

  21. Bigatti SM, Hernandez AM, Cronan TA, et al. Sleep disturbances in fibromyalgia syndrome: relationship to pain and depression. Arthritis Rheum. Jul 15 2008;59(7):961-7. [Medline].

  22. Hong CZ, Hsueh TC. Difference in pain relief after trigger point injections in myofascial pain patients with and without fibromyalgia. Arch Phys Med Rehabil. Nov 1996;77(11):1161-6. [Medline].

  23. Moldofsky H. A chronobiologic theory of fibromyalgia. In: Jacobsen S, Danneskiold-Samsoe B, Lund B, eds. Musculoskeletal Pain, Myofascial Pain Syndrome, and Fibromyalgia Syndrome. New York, NY: Haworth Medical Press; 1993:49-59.

  24. Travell JG, Simons DG. Myofascial Pain and Dysfunction: the Trigger Point Manual. Baltimore, Md: Lippincott Williams & Wilkins; 1983.

  25. Baldry PE. Acupuncture, Trigger Points, and Musculoskeletal Pain: a Scientific Approach to Acupuncture for Use by Doctors and Physiotherapists in the Diagnosis and Management of Myofascial Trigger Point Pain. 2nd ed. New York, NY: Churchill Livingstone; 1993.

  26. Dick BD, Verrier MJ, Harker KT, et al. Disruption of cognitive function in fibromyalgia syndrome. Pain. Aug 6 2008;[Medline].

  27. Russell IJ. Fibromyalgia syndrome: diagnosis, pathogenesis, and management. Phys Med Rehabil Clin North Am. 1997;8:213-26.

  28. Wolfe F, Smythe HA, Yunus MB, et al. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum. Feb 1990;33(2):160-72. [Medline].

  29. Havermark AM, Langius-Eklof A. Long-term follow up of a physical therapy programme for patients with fibromyalgia syndrome. Scand J Caring Sci. Sep 2006;20(3):315-22.

  30. [Best Evidence] Häuser W, Bernardy K, Arnold B, et al. Efficacy of multicomponent treatment in fibromyalgia syndrome: a meta-analysis of randomized controlled clinical trials. Arthritis Rheum. Feb 15 2009;61(2):216-24. [Medline].

  31. [Best Evidence] Ekici G, Bakar Y, Akbayrak T, et al. Comparison of manual lymph drainage therapy and connective tissue massage in women with fibromyalgia: a randomized controlled trial. J Manipulative Physiol Ther. Feb 2009;32(2):127-33. [Medline].

  32. Gowans SE, Dehueck A, Silaj A, et al. Six-month and one-year followup of 23 weeks of aerobic exercise for individuals with fibromyalgia. Arthritis Rheum. 2004;Dec 15;51(6):890-8.

  33. Ingber RS. Position paper on trigger point injections. ProHealth Inc. Available at http://www.prohealth.com/fibromyalgia/library/.

  34. Buckelew SP. Behavioral interventions and fibromyalgia. J Musculoskelet Pain. 1994;2:153-61.

  35. Goldenberg DL. Multidisciplinary modalities in the treatment of fibromyalgia. J Clin Psychiatry. 2008;69 Suppl 2:30-4. [Medline].

  36. Bennett R, Nelson D. Cognitive behavioral therapy for fibromyalgia. Nat Clin Pract Rheumatol. Aug 2006;2(8):416-24. [Medline].

  37. Bootzin RR, Lahmeyer HW, Lilie JK. Easy Steps to Help You Sleep. Chicago, Ill: Searle Pharmaceuticals; 1994:1-34.

  38. Eisinger J, Plantamura A, Ayavou T. Glycolysis abnormalities in fibromyalgia. J Am Coll Nutr. Apr 1994;13(2):144-8. [Medline].

  39. Logan AC. Is there a fibromyalgia diet. Fibromyalgia Aware. Dec 2004-Mar 2005;8:46-9.

  40. Arthritis Foundation. Delivering on the Promise in Fibromyalgia. Washington, DC: Arthritis Foundation; 2004.

  41. Chaitow L. Conditions associated with fibromyalgia. In: Chaitow L, ed. Fibromyalgia Syndrome: a Practitioner's Guide to Treatment. New York, NY: Churchill Livingstone; 2000:31-59.

  42. Dadabhoy D, Clauw DJ. Therapy Insight: fibromyalgia--a different type of pain needing a different type of treatment. Nat Clin Pract Rheumatol. Jul 2006;2(7):364-72. [Medline].

  43. Fischer AA. New approaches in the treatment of myofascial pain. Phys Med Rehabil Clin North Am. 1997;8:153-69.

  44. Goldenberg DL, Burckhardt C, Crofford L. Management of fibromyalgia syndrome. JAMA. Nov 17 2004;292(19):2388-95. [Medline]. [Full Text].

  45. Goldstein JA. Betrayal by the Brain: the Neurologic Basis of Chronic Fatigue Syndrome, Fibromyalgia Syndrome, and Related Neural Network Disorders. New York, NY: Haworth Medical Press; 1996.

  46. Gracely RH, Geisser ME, Giesecke T, et al. Pain catastrophizing and neural responses to pain among persons with fibromyalgia. Brain. Apr 2004;127:835-43. [Medline]. [Full Text].

  47. Holman AJ. Fibromyalgia and dopamine. Fibromyalgia Aware. Dec-2005 Mar 2004;8:42-4.

  48. Imamura ST, Fischer AA, Imamura M. Pain management using myofascial approach when other treatment failed. Phys Med Rehabil Clin North Am. 1997;8:179-96.

  49. Johnson K. Fibromyalgia disturbs sensory volume control. Internal Medicine News. Jun 1 2004;[Full Text].

  50. Lemstra M, Olszynski WP. The effectiveness of multidisciplinary rehabilitation in the treatment of fibromyalgia: a randomized controlled trial. Clin J Pain. Mar-Apr 2005;21(2):166-74. [Medline].

  51. Longley K. Hands across the ocean. Fibromyalgia Aware. Dec 2004-Mar 2005;8:64-5.

  52. Mathias S, Wetter TC, Steiger A, et al. The GABA uptake inhibitor tiagabine promotes slow wave sleep in normal elderly subjects. Neurobiol Aging. Mar-Apr 2001;22(2):247-53. [Medline].

  53. Russell IJ. Biochemical abnormalities in fibromyalgia syndrome. J Musculoskelet Pain. 1994;2:101-15.

  54. Simms RW. Muscle studies in fibromyalgia syndrome. J Musculoskelet Pain. 1994;2:117-23.

  55. Teitelbaum J. For physicians. In: From Fatigued to Fantastic!. Garden City Park, NY: Avery Pub; 1996:93-115.

  56. Vecchiet L, Giamberardino MA. Referred pain: clinical significance, pathophysiology, and treatment. Phys Med Rehabil Clin North Am. 1997;8:119-36.

  57. Wood PB. A reconsideration of the relevance of systemic low-dose ketamine to the pathophysiology of fibromyalgia. J Pain. Sep 2006;7(9):611-4. [Medline].

  58. Zohn DA. Relationship of joint dysfunction and soft-tissue problems. Phys Med Rehabil Clin North Am. 1997;8:69-86.

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

fibromyalgia, myofascial pain, fibromyalgia symptoms, fibromyalgia pain, treatment fibromyalgia, symptoms of fibromyalgia, fibromyalgia syndrome, chronic fibromyalgia, fibromyalgia fatigue, interstitial myofibrositis, muscular hardening, muscular rheumatism, musculorheumatism, myofibrositis, myogelosis, myositism, nodular rheumatism, nonarticular rheumatism, rheumatic muscle callus, rheumatic muscle hardening, rheumatic myalgia, rheumatic pain modulation disorder, tension myalgia, fibromyositis, fibrositis, idiopathic myalgia

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Regina P Gilliland, MD, Department of Internal Medicine; Division of Rehab Medicine, Mobile Infirmary Medical Center
Regina P Gilliland, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Medical Association of the State of Alabama, and Southern Medical Association
Disclosure: Acorda Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching; Forest Honoraria Speaking and teaching; Solstice Honoraria Speaking and teaching; Allergan Honoraria Speaking and teaching

Medical Editor

Martin K Childers, DO, PhD, Associate Professor, Department of Neurology, Wake Forest University Health Services
Martin K Childers, DO, PhD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Congress of Rehabilitation Medicine, American Osteopathic Association, Christian Medical & Dental Society, and Federation of American Societies for Experimental Biology
Disclosure: Allergan pharma Consulting fee Consulting

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Patrick M Foye, MD, FAAPMR, FAAEM, Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain Service (Tailbone Pain Service: www.TailboneDoctor.com), University of Medicine and Dentistry of New Jersey, New Jersey Medical School
Patrick M Foye, MD, FAAPMR, FAAEM is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, and International Spine Intervention Society
Disclosure: Nothing to disclose.

CME Editor

Kelly L Allen, MD, Regional Medical Director, IMX-Medical Management Services
Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Alegent Health Care, Immanuel Rehabilitation Center
Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.