A great deal of the pain and fatigue from fibromyalgia can be relieved by obtaining a complete diagnosis that emphasizes finding those conditions that can be treated and then reducing the total number of things that interfere with getting well.

We do not really know what causes fibromyalgia, however it is not a progressive disease. Numerous factors seem to aggravate it and there are a wide variety of associated symptoms. Chronic muscle, ligament and joint pain can prevent suffers from enjoying daily activities and, in many cases, from getting a good nights sleep. In severe cases it can be debilitating. People do not simply wake up one day with fibromyalgia; rather its onset is often insidious. While the presence of either a major or minor inciting event is common, it is not required.

Just because someone who was pain free suffers from a recent injury and complaints persist does not mean that they now have or did have previously "asymptomatic" fibromyalgia. This can be frustrating as doctors may tell the afflicted that they do have fibromyalgia simply because an x-ray shows little or no evidence of arthritis (see Arthritis) or disk disease (see Oh My Aching Back and Backache) and symptoms have been present for over three to six months.

Frequently missed conditions that are treatable (unlike primary fibromyalgia where the source for the problem can not be found) include ligamentous strain (see Prolotherapy), muscular spasm (see Myofascial Syndrome), reflex sympathetic dystrophy (see RSD) and thoracic outlet syndrome (see Thoracic Outlet Syndrome). Peripheral neuropathy (see Peripheral Neuropathy), radiculopathy, diabetes, cardiovascular or peripheral arterial disease (see PAD), hormonal imbalance (see Hormonal Therapy), nutritional deficiencies and toxic environmental exposure (see Disease Management) are additional diagnoses that are commonly missed. If one of these problems is present then fibromyalgia is not primary, but rather secondary to the underlying cause.

There are many other confounding factors in the diagnosis of fibromyalgia. These include symptoms of numbness and tingling, muscle twitching, impaired coordination, morning stiffness, skin sensitivity, pain without boundaries, sleep disorders, headache or jaw pain, mental or physical fatigue, cognitive impairment and memory problems. Associated conditions include autonomic dysfunction, swollen extremities, irritable bowel syndrome, irritable bladder and PMS. Perpetrating factors of depression, stress or anxiety, nutritional or metabolic insufficiency, weather sensitivity and hormonal imbalance may exist as well.

No single test can detect fibromyalgia; however there is at least one telltale sign on physical exam: a pattern of specific "tender spots"- muscles and tendons that are painful when touched. They cannot be located in any single anatomical distribution, must be present for at least three months and must include 11of 18 defined locations (figure 1). Proper diagnosis requires a doctor with expertise in neuro-musculoskeletal medicine. There is a device called an Alogometer that can be used to measure just how tender the sites involved are (figure 2), however the majority of doctors relieve upon their physical exam skills to determine this.

Fortunately there are numerous non-surgical specialty care techniques that are effective in the treatment of both primary and secondary fibromyalgia (see Pain Cure and We Help What Hurts). If you experience unexplained achiness, persistent fatigue, headache and difficulty sleeping for three months or more then you should visit with your doctor.