Unlike other conditions, fibromyalgia cannot be measured or seen on X-rays, blood tests, or biopsies. That's why getting a diagnosis for fibromyalgia has always been so difficult. Although further delving has proven that fibro sufferers do have chemical differences — such as increased spinal fluid levels of the neural hormone substance P (a compound that increases pain sensitivity) — those tests are costly and currently restricted only to research.

For years, fibromyalgia was diagnosed purely on the subjective report of the patient. That is, the doctor made a diagnosis based on what the patient told him. In fact, the condition didn't even have a distinct name until the 1980s. Although descriptions had been documented in medical texts for centuries, the condition was known by other names such as fibrositis, chronic rheumatism, chronic muscle pain syndrome, and psychogenic rheumatism.

In 1980, a group of physicians got together and set out to create an official way to define fibromyalgia. They broke up into two groups and evaluated patients who had complained of widespread pain and who had also been told by their physicians that they did indeed have fibromyalgia.

Not surprisingly, symptoms varied widely. The most common finding between the two groups was widespread pain, with fatigue and sleep problems close behind. One clear finding was that the patients were much more tender to even light touch than normal people. As a result, the researchers chose eighteen specific spots to test for this type of tenderness. If the spot hurt when the doctor pressed on it — just hard enough with his thumb to make the nail turn white — it was considered a positive tender point. Among patients who had fibromyalgia, nearly 89 percent had widespread pain and sensitivity in at least eleven of the eighteen tender points. Although the effort was initially meant to make it easier to classify fibromyalgia for the purposes of research, these findings eventually became the diagnostic criteria set by the American College of Rheumatology.

The American College of Rheumatology Criteria

You're wracked with pain, but is the pain bad enough to qualify for a diagnosis of fibromyalgia? According to the American College of Rheumatology (ACR), an organization that focuses on diseases involving the muscles, tendons, or joints, the pain must be widespread — on the left and right sides of the body, above and below the waist. The pain should also have been present for at least three months.

In addition to widespread pain, a diagnosis of fibromyalgia requires that you be tender in at least eleven of eighteen tender point sites. These sites are all around the body in specific locations. To make matters even more precise, the pain must be felt during digital palpation, which means pain is caused when an examiner applies 4 kg/cm2 of force — the equivalent of eight pounds — to the tender point, just enough pressure for the health-care provider's fingernail to turn white. The tender points occur on both sides of the body and above and below the waist. For an illustration of the tender point locations on your body, check out the ACR description of fibromyalgia at www.rheumatology.org.

Other Telltale Signs

While the ACR criteria are the formal measure for determining whether you have fibromyalgia, they are by no means the only indicators. For instance, you might have only eight tender points but be achy all over and suffering from poor sleep. You may also have memory problems, morning stiffness, and irritable bowel syndrome. Some FMS sufferers experience chronic headaches, joint pains, and swelling.

In the quest to pin down a diagnosis, a good doctor will ask you about these symptoms. How are you sleeping? Are you stiff when you wake up? Where else do you hurt? If the doctor doesn't ask, take the initiative and tell him. The more information you provide, the better equipped your doctor is to make a diagnosis.

Just because you may not qualify for a diagnosis of FMS doesn't mean you shouldn't be treated. People can have nine tender points but be miserable with pain, fatigue, and sleep disruption. Whether or not you qualify for the label of fibromyalgia is not the most important issue. Instead, the goal of treatment should be to make life livable again. The same treatments used for fibromyalgia can probably help you, even if you don't fit the strict diagnostic criteria.