Fast Five Quiz: Commonly Misdiagnosed Conditions

B.S. Anand, MD; Michael Stuart Bronze, MD; Herbert S. Diamond, MD; Helmi L. Lutsep, MD


June 02, 2021

By definition, fibromyalgia is a disorder of chronic, widespread pain and tenderness. Chronic indicates the pain and tenderness have been present continuously for ≥ 3 months. Widespread means the pain and tenderness are on both sides of the body, above and below the waist, including the axial spine (usually the paraspinal, scapular, and trapezius muscles).

In addition to chronic, widespread pain and tenderness, diagnostic criteria from the American College of Rheumatology (ACR) require that patients have significant symptoms of fatigue, unrefreshed sleep, and cognitive dysfunction (difficulties with thinking and remembering), along with numerous somatic symptoms. However, fibromyalgia is a diagnosis of exclusion, and patients must be thoroughly evaluated for the presence of other disorders that could be the cause of symptoms before a diagnosis of fibromyalgia is made.

Clinical assessment may reveal objective evidence for a discrete or comorbid illness, such as the following:

  • Hypothyroidism

  • Rheumatoid arthritis

  • Systemic lupus erythematosus

  • Polymyalgia rheumatic

  • Other inflammatory or autoimmune disorders

  • Serious cardiac conditions in those with chest pain, dyspnea, and palpitations

At a clinical level, fibromyalgia is much more than widespread pain. It overlaps substantially with other central sensitivity syndromes, such as the following:

  • Chronic fatigue syndrome (systemic exertion intolerance disease)

  • Irritable bowel syndrome (IBS)

  • Chronic pelvic pain syndrome/primary dysmenorrhea

  • Temporomandibular joint pain

  • Tension-type headaches/migraine

  • Posttraumatic stress disorder

  • Multiple chemical sensitivity

  • Periodic limb movement disorder/restless legs syndrome

  • Interstitial cystitis

Read more clinical information about fibromyalgia.