How is fibromyalgia diagnosed? There is no single blood test or scan for it. A provider makes the diagnosis by looking at where you hurt, how severe your other symptoms are and how long they have lasted, then uses tests to rule out conditions that can look similar.
Many people wait a long time for answers. Knowing how the process works can help you speak up, share the right details and feel less lost at your appointment.
Why There Is No Single Test
Fibromyalgia does not damage joints, muscles or organs. It comes from changes in how the nervous system processes pain. Because of that, standard blood work and X-rays usually look normal.
Normal results can be frustrating, but they are expected. They do not mean your pain is not real. They simply mean the diagnosis is based on a careful look at your symptoms, not on one lab number.
You may see “fibromyalgia blood tests” advertised online. Cleveland Clinic notes that these are generally not accurate enough to diagnose most people.
How Is Fibromyalgia Diagnosed Using the 2016 Criteria?
Most providers use criteria from the American College of Rheumatology (ACR). They were first published in 2010 and updated in 2016. The 2016 version has two scores plus a few extra checks.
Score 1: The Widespread Pain Index (WPI)
The WPI counts where you have had pain in the past week. Your provider goes through a list of 19 body areas. You get one point for each area that hurt. Areas include:
- Left and right jaw
- Left and right shoulder
- Left and right upper arm and lower arm
- Left and right hip or buttock
- Left and right upper leg and lower leg
- Neck, upper back and lower back
- Chest and belly
Your WPI score is the number of areas that hurt, from 0 to 19.
Score 2: The Symptom Severity Scale (SSS)
The SSS measures how much your other symptoms affect you. It has two parts.
Part A rates three symptoms over the past week, each from 0 (no problem) to 3 (severe, constant and life-disturbing):
- Fatigue
- Waking up unrefreshed
- Thinking or memory problems
Part B adds one point each if, over the past six months, you have had:
- Headaches
- Pain or cramps in the lower belly
- Depression
Your SSS score can range from 0 to 12.
Putting the scores together
Under the 2016 criteria, fibromyalgia fits if all of these are true:
| Check | What it means |
|---|---|
| Scores | WPI of 7 or more with SSS of 5 or more, or WPI of 4 to 6 with SSS of 9 or more |
| Widespread pain | Pain in at least 4 of 5 body regions (left upper, right upper, left lower, right lower and the trunk) |
| Time | Symptoms at a similar level for at least 3 months |
One more important point: the 2016 update says a fibromyalgia diagnosis is valid even if you have another condition. You can have fibromyalgia along with arthritis, lupus or another illness. Having one does not cancel out the other.
What about tender points?
You may have heard about pressing on 18 “tender points.” That exam was part of older criteria from 1990. The newer criteria do not require it, though your provider may still check for tenderness during a physical exam.
Tests to Rule Out Look-Alike Conditions
Several conditions can cause widespread pain, fatigue or poor sleep. Your provider will want to check for these before or along with a fibromyalgia diagnosis. Which tests you need depends on your symptoms, age and history.
Hypothyroidism (underactive thyroid)
A slow thyroid can cause tiredness, muscle aches, feeling cold, weight changes and slow thinking. A simple blood test (often a TSH level) can check thyroid function.
Rheumatoid arthritis (RA)
RA is an autoimmune disease that causes joint inflammation. Clues include swollen, warm joints and morning stiffness that lasts a long time. Blood tests and a joint exam help sort this out.
Lupus
Lupus is another autoimmune disease. It can cause joint pain, fatigue, rashes, fevers and problems with organs like the kidneys. Blood tests, such as an ANA test, are often a first step.
Polymyalgia rheumatica (PMR)
PMR mostly affects adults over 65 and rarely anyone under 50. It causes pain and stiffness in both shoulders and hips, usually worst in the morning. Blood tests for inflammation are often high. PMR is linked to giant cell arteritis, so new headaches, jaw pain with chewing or vision changes need prompt care.
Sleep apnea
Sleep apnea causes breathing pauses during sleep. It can leave you exhausted, foggy and achy even after a full night in bed. Loud snoring, gasping at night and daytime sleepiness are clues. A sleep study can check for it.
Vitamin D deficiency
Low vitamin D can cause bone pain and muscle weakness. A blood test can check your level.
Statin myopathy
Statins are cholesterol medicines. A small number of people get muscle aches, weakness or tiredness from them. If your pain started after beginning a statin, tell your provider. Do not stop the statin on your own. Your provider can help decide whether a dose change, a break or a different medicine makes sense.
Common blood tests
Depending on your situation, your provider may order:
- A complete blood count (CBC)
- Inflammation markers, such as ESR and CRP
- Thyroid tests
- A metabolic panel (kidney, liver and blood sugar)
- Vitamin D level
- Autoimmune tests, such as ANA or rheumatoid factor, if symptoms point that way
Which Doctor Diagnoses Fibromyalgia?
Many people are diagnosed by their primary care provider. According to NIAMS, primary care providers manage most cases.
You may be referred to a rheumatologist, a doctor who specializes in joints, muscles and autoimmune diseases. A rheumatologist can be especially helpful when it is unclear whether something like RA, lupus or PMR is also present.
Other team members may include a sleep specialist, physical therapist, pain specialist or mental health professional.
How to Prepare for Your Visit
A good appointment starts before you walk in. Here is what to bring and do:
- Keep a symptom log for two to four weeks. Note where you hurt, how bad it is (0 to 10), how you slept and how tired you felt.
- Mark your pain areas. A simple body outline with shaded areas makes the WPI easier.
- List your other symptoms. Include headaches, belly pain, mood changes, memory problems, numbness or tingling.
- Note when it started. Was there an illness, injury or major stress around that time?
- Bring every medicine and supplement. Include doses. This helps spot side effects, like statin muscle aches.
- Share your family history. Include relatives with fibromyalgia, thyroid disease or autoimmune conditions.
- Write your questions down. It is easy to forget them once you are in the room.
- Bring someone with you if you can. A second set of ears helps.
Questions you might ask:
- Do my symptoms meet the criteria for fibromyalgia?
- What other conditions have you ruled out, and how?
- Do I need any more tests?
- Should I see a rheumatologist or sleep specialist?
- What is our first step for treatment?
Frequently Asked Questions
Can a blood test diagnose fibromyalgia?
No. There is no standard blood test that confirms fibromyalgia. Blood tests are used to rule out other conditions that can cause similar symptoms.
How long does it take to be diagnosed?
Symptoms need to be present for at least three months to meet the criteria. Beyond that, the time varies. Bringing a clear symptom log can help your provider move faster.
Can I have fibromyalgia and another condition at the same time?
Yes. The 2016 criteria say fibromyalgia can be diagnosed even when another condition is present, such as arthritis or lupus. Each one needs its own treatment plan.
Do I need to see a rheumatologist?
Not always. Many primary care providers diagnose and treat fibromyalgia. A rheumatologist is helpful when the picture is unclear or another rheumatic disease is possible.
The Bottom Line
Fibromyalgia is diagnosed by looking at how many body areas hurt, how severe your other symptoms are, and how long they have lasted. Blood tests and other checks help rule out look-alike conditions such as thyroid problems, RA, lupus, PMR, sleep apnea, low vitamin D or statin side effects. You can have fibromyalgia along with another condition. Coming prepared with a symptom log and your questions can make your visit far more useful.
Sources
- Fibromyalgia – Diagnosis and treatment (Mayo Clinic)
- Fibromyalgia: What It Is, Symptoms & Treatment (Cleveland Clinic)
- Fibromyalgia: Diagnosis, Treatment, and Steps to Take (NIAMS)
- Fibromyalgia (American College of Rheumatology)
- Polymyalgia rheumatica – Symptoms and causes (Mayo Clinic)
- Statin side effects: Weigh the benefits and risks (Mayo Clinic)
New from Anna Curran, RN
Fibromyalgia: A Nurse’s Guide to Less Pain, Better Sleep and More Good Days
A plain-language guide to medicines, pacing, sleep, gentle movement, flares, work and family life, with trackers and planners. Paperback, hardcover and Kindle.
This article is for general education only and is not medical advice. Talk with your own doctor or licensed provider before you start, stop or change any treatment. In an emergency, call 911. In crisis, call or text 988. See our medical disclaimer.