Approach Considerations

The patient’s history and physical examination guide the laboratory workup for fibromyalgia syndrome (FMS). Because the presentation and diagnosis by exclusion of other physical problems are often confusing, children with FMS may be evaluated by numerous physicians who perform various batteries of tests. Studies may include laboratory tests, diagnostic imaging, and polysomnography.

Lab Studies

Most laboratory tests are expected to produce findings within the reference range when FMS is diagnosed. Studies to consider in a child presenting with a clinical picture consistent with fibromyalgia syndrome and expected findings are discussed below.

Complete blood count (CBC) - Findings are normal.
Erythrocyte sedimentation rate (ESR) - 15 mm/h.
Rheumatoid factor - Findings are negative.
C-reactive protein and antinuclear antibody (ANA) - Findings may be positive. However, because of the high incidence of ANA in the general population, ANA testing should be avoided unless the history and physical examination indicate features and abnormalities not found in FMS.
Serum prolactin - Findings are negative.
Serum electrolytes - levels are within the reference range.
Liver function tests - Results are normal.
Muscle enzymes - levels are within the reference range.
Purified protein derivative - Findings are negative.
Blood and urine cultures - Results are negative.
Thyroid function tests - Results are normal.
Serotonin, substance P growth hormone, and cortisol - Characteristic changes in serotonin, substance P growth hormone, and cortisol suggest autonomic and neuroendocrine system dysregulation.

Diagnostic Imaging

Plain radiography of the chest, ribs, and back reveals normal findings, as does ultrasonography of the abdomen, pelvis, and paravertebrae. Bone scanning also reveals normal findings, and the results of computed tomography (CT) scanning and magnetic resonance imaging (MRI) are typically normal as well.

Polysomnography

Polysomnography, including periodic limb movement in sleep (PLMS) assessment, which is used to evaluate possible sleep disorders, reveals normal findings.

Treatment & Management

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Media Gallery

Illustration of 9 paired tender points identified in the 1990 statement of the American College of Rheumatology on fibromyalgia. They are as follows: (a) insertion of nuchal muscles into occiput, (b) upper border of trapezius, (c) muscle attachments to upper medial border of scapula, (d) anterior aspects of the C5–C7 intertransverse spaces, (e) second rib space 3 cm lateral to the sternal border, (f) muscle attachments to lateral epicondyle 2 cm below bony prominence, (g) upper outer quadrant of gluteal muscles, (h) muscle attachments just posterior to greater trochanter, and (i) medial fat pad of knee proximal to joint line.

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Author

Eileen R Giardino, RN, MSN, PhD, ANP-BC, FNP-BC Associate Professor of Nursing, Department of Family Nursing, University of Texas Health Sciences Center Houston, School of Nursing

Eileen R Giardino, RN, MSN, PhD, ANP-BC, FNP-BC is a member of the following medical societies: American Association of Nurse Practitioners, American College Health Association, American Nurses Association, American Professional Society on the Abuse of Children, International Society for the Prevention of Child Abuse and Neglect

Disclosure: Nothing to disclose.

Coauthor(s)

Angelo P Giardino, MD, PhD, MPH, FAAP Wilma T Gibson Presidential Professor and Chair, Department of Pediatrics, University of Utah School of Medicine; Chief Medical Officer, Intermountain Primary Children's Hospital

Angelo P Giardino, MD, PhD, MPH, FAAP is a member of the following medical societies: Academic Pediatric Association, American Academy of Pediatrics, American Professional Society on the Abuse of Children, Harris County Medical Society, International Society for the Prevention of Child Abuse and Neglect, Ray E Helfer Society

Disclosure: Nothing to disclose.

Chief Editor

Lawrence K Jung, MD Chief, Division of Pediatric Rheumatology, Children's National Medical Center

Lawrence K Jung, MD is a member of the following medical societies: American Association for the Advancement of Science, American Association of Immunologists, American College of Rheumatology, Clinical Immunology Society, New York Academy of Sciences

Disclosure: Nothing to disclose.

Acknowledgements

Herbert S Diamond, MD Adjunct Professor of Medicine, Division of Rheumatology, University of Pittsburgh School of Medicine; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital

Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, and Phi Beta Kappa

Disclosure: Merck Ownership interest Other; Smith Kline Ownership interest Other; Zimmer Ownership interest Other

Gregory F Keenan, MD, Director of Medical Affairs, Department of Immunology, Centocor, Inc

Gregory F Keenan, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Rheumatology

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.