Doctors often attempt to rule out other causes of symptoms before diagnosing fibromyalgia. There are no x-rays or blood tests that clearly identify this disorder; however, complete blood counts, hepatic/renal panels and metabolic panels are conducted to illuminate other possible conditions.

In 1990, The American College of Rheumatology established diagnostic criteria for fibromyalgia. These criteria include widespread pain in all four of the body's quadrants for a minimum duration of three months. Pain must also be present in at least 11 of the designated 18 tender points in the body. These tender points are located in areas of the body where muscles are attached to joints. Common areas include: the neck, lower back, shoulder blades, elbows, knees, hips, chest, buttocks and biceps.

Tender Point Areas
Fibromyalgia Tender Point Areas
(American College of Rheumatology)

Tender point sensitivities are assessed by applying pressure with the first two fingers of the hand, or the thumb. Tender points are bilaterally palpated at each side of the body. The examiner applies firm pressure until the patient tells him to stop or shows overt signs of pain. The patient then notifies the examiner whether the palpitation was tender or painful.

A positive rating of the tender point will be given if the patient affirms that the point was “painful,” not just “tender.” While there is some subjectivity to this method, it continues to be useful in the clinical assessment of the disorder (Nielson, 2007). The tender point observations are documented in the patient's medical record utilizing the universal fibromyalgia pain scale assessment:

Fibromyalgia Tender Point Pain Scale

0 - No tenderness

1 - Tenderness with no withdraw

2 - Tenderness with withdraw

3 - Tenderness with proncounced withdraw

4 - Untouchable due to pain


Before diagnosing a patient with fibromyalgia, doctors investigate several other possible related conditions. The symptoms of the following conditions often mimic fibromyalgia:


The treatment of fibromyalgia involves a multidisciplinary approach that includes family physicians, general internists, rheumatologists, physical therapists, occupational therapists, nursing staff and other healthcare professionals. The treatment program will also include a multifaceted approach that is managed with medication, patient education, physical therapy, aerobic conditioning, supplementation and alternative therapies.