By Celeste Cooper
Presently, the American College of Rheumatology states there is no biological test for diagnosing fibromyalgia. But, is that true?
The FM/a blood test, a bloodspot-based diagnostic test, and a loss of heart rate variability have been considered as potential biological markers, but the American College of Rheumatology says there is no test. So this article is about what tests are available to support a diagnosis of fibromyalgia (FM).
What’s the difference between subjective and objective?
Subjective is a statement that has been colored by the character of the speaker or writer. It often has a basis in reality, but reflects the perspective through with the speaker views reality. It cannot be verified using concrete facts and figures.
Objective is a statement that is completely unbiased. It is not touched by the speaker’s previous experiences or tastes. It is verifiable by looking up facts or performing mathematical calculations.
The American College of Rheumatology (ACR) now suggests there are four elements for assessing fibromyalgia:
- Pain and symptoms over the past week, based on the total of number of painful areas out of 19 parts of the body
Plus level of severity of these symptoms:
- Waking unrefreshed
- Cognitive (memory or thought) problems
Plus number of other general physical symptoms
Subjective evidence such as this relies solely on input from the subject (patient).
What Are Objective Tests?
Objective tests are done to rule out other disorders, such as blood tests, radiographic tests, etc., but ruling out other disorders that can mimic fibromyalgia does not mean fibromyalgia is a diagnosis of last resort. Fibromyalgia can, and often does, occur with other disorders, and according to the ACR, we are at higher risk if we have another rheumatic disorder. There is objective evidence to explain the body-wide pain often associated with muscle fatigue and spasm, fatigue, non-restorative sleep, and cognitive dysfunction. This is important because most researchers agree these four elements are important in diagnosing fibromyalgia.
Objective Tests that Support a Diagnosis of Fibromyalgia by Each Element
Body-wide pain, muscle fatigue, and spasm
- A physical exam to check for knotted up pieces of muscle fiber (called trigger points) that can be felt by the examiner or by using ultrasound and thermal patterns. This is important because there is a difference between fibromyalgia tender points and myofascial trigger points, yet the presence of trigger points do not rule out fibromyalgia. Some experts believe myofascial pain syndrome is a peripheral pain generator in fibromyalgia.
- A Surface Electro-Myography (SEMG) provides objective evidence for wide-ranging muscle spasm and peripheral spastic soft tissues found in fibromyalgia that lead to body-wide pain. Electrodes are placed on the skin to measure electrical activity of muscles, and like an EMG, the test shows amplified activity that is analyzed by a computer.
A sleep study using an EEG where electrodes are placed on the scalp looks for diminished delta waves, which leads to non-restorative, non-refreshing, sleep. It is during these slow wave stages of sleep that micro healing occurs, and abnormal sleep patterns affect fibromyalgia.
Loss of or abnormally low heart rate variability (HRV) is known to contribute to fatigue. And using EKG tracings of the heart during sleep (along with non-restorative sleep) can be an objective measure for fatigue associated with FM. Several studies show FM is associated with a loss of heart rate variability, meaning there is little to no variation between beats. This does not mean you can feel the variances with your pulse, however. It takes an EKG tracing that shows variance in milliseconds. According to a leading fibromyalgia researcher, Dr. Roland Staud, heart rate variability analysis of FM patients can be used to assess autonomic nervous system dysfunction and could be a potential biomarker.
A neurocognitive exam looks at particular parts of brain function with specific relation to cognitive deficits. This exam is performed by an advanced trained psychologist who does many tests throughout a day to look for memory, attention, problem solving, motor processing speed, language, emotion, and visual perception of where objects are in relationship to our space.
Having objective tests to diagnose any illness is important. These objective tests are important for validating symptoms, so that not only the appropriate treatments are identified, but also to confirm that the symptoms are not all in our heads. It is also important for you to know that the FM/a blood test, according to Dr. Bruce Gillis at EpicGenetics, is now covered by most insurance and Medicare.
So, if you feel you have problems in any of these areas, be sure to discuss them with your physician.
A bloodspot-based diagnostic test for fibromyalgia
Loss of heart rate variability
American College of Rheumatology Criteria
Ultrasound and thermal patterns for identifying trigger points.
Effects of treatment of peripheral pain generators in fibromyalgia patients.
Heart rate variability in patients with fibromyalgia and patients with chronic fatigue syndrome: a systematic review.
Heart rate variability as a biomarker of fibromyalgia syndrome.
Celeste Cooper, RN, is a frequent contributor to ProHealth. She is an advocate, writer and published author, and a person living with chronic pain. Celeste is lead author of Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain and Broken Body, Wounded Spirit, and Balancing the See Saw of Chronic Pain (a four book series). She spends her time enjoying her family and the rewards she receives from interacting with nature through her writing and photography. You can learn more about Celeste’s writing, advocacy work, helpful tips, and social network connections at CelesteCooper.com.