Ask The Expert: Is Your Chronic Pain Fibromyalgia?

man red joint pain

There are approximately five million Americans living with fibromyalgia and yet it’s a disorder that’s extremely difficult to diagnose. Fibromyalgia is characterized by widespread muscle pain and tenderness and fatigue. Symptoms can include muscle spasms and tightness, TMJ, sleep difficulties, and headaches and migraines. Although misunderstood by many, the pain that fibromyalgia patients experience is very real. recently spoke with Dr. Kyrin Dunston, a board-certified medical doctor with more than 20 years of experience, who used to suffer from fibromyalgia, about this debilitating disorder. She says that fibromyalgia is something she sees frequently. Here’s what she had to say about it:

BDO: Do you have to have widespread pain in the body in order to have fibromyalgia?

Dr. Kyrin Dunston: Yes you do. Fibromyalgia means pain (myalgia) in the fibers (fibro) of the body, which are muscles and tissues that hold the body together. Although it’s a recognized diagnosis by the American Medical Association and most all health insurance carriers, it’s really a description of a constellation of symptoms and does not define what is causing the symptoms.

The 1990 American College of Rheumatology criteria identifies fibromyalgia patients with an 88 percent accuracy. The requirements to be diagnosed with fibromyalgia include two criteria that must be met:

  1. There must be widespread pain in all four quadrants of the body for a minimum of three months (four quadrants are defined by dividing the body in four parts with a cross, so the four quadrants are right upper, right lower, left upper and left lower).
  1. At least 11 out of 18 specified sites must be painful for the past three months and tender on examination. A tender myofascial point is called a trigger point and generally is a firm nodule present in a tight muscle that hurts when pressed and often radiates or shoots pain into other more widespread areas. A simply tender area is different from a trigger point in that the pain from pressure there generally does not radiate elsewhere and the painful area can often be relieved with local measures like massage and warm baths and does not persist. Also, trigger points can decrease your ability to move normally. The 18 sites used for the fibromyalgia diagnosis cluster around the neck, shoulder, chest, hip, knee, and elbow regions. A positive trigger point is noted when the clinician presses a finger on the spot firmly enough so that her nail bed turns white or blanches.

BDO: What if the pain only occurs on one side of the body?  

Dr. Dunston: By the traditional definition, above pain on only one side of the body would not qualify as pain in all four quadrants is required. However, the more relaxed and inclusive clinically used diagnostic criteria above would include pain on one side of the body. It’s not uncommon to see unilateral pain in fibromyalgia patients often due to handed dominance. However, a full evaluation to rule out other causes of the syndrome should be undertaken.

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