Why it’s important to correctly diagnose fibromyalgia

Written by: Dr Shankar Ramaswamy
Edited by: Laura Burgess

Fibromyalgia is a chronic pain condition that leads to widespread musculoskeletal pain and tenderness. It can leave you feeling exhausted and with difficulty in concentrating on your normal daily activities thanks to what’s known as ‘fibro fog.’ That’s why it’s very important to have a formal diagnosis of the condition so that a specialist can help you to move forward with a treatment plan.

Pain management specialist Dr Shankar Ramaswamy explains more about how fibromyalgia is diagnosed and why it’s useful to get the correct diagnosis.

How is fibromyalgia diagnosed?

With regard to diagnosis, it would be best to see your GP in the first instance and discuss the symptoms. You will then be referred (if needed) to a pain specialist with multidisciplinary input, including a physiotherapist and psychologist.

The pain specialist will help with the diagnosis but often patients may need to be seen by other specialists, such as rheumatologists, to rule out any underlying inflammatory conditions. The diagnosis is made based on the patient’s history and clinical examination in accordance with the American College of Rheumatology 2016 criteria.

It’s important to look for and rule out other conditions such as inflammatory disease as that can be treated with specific anti-inflammatory medications. For that reason, blood tests are often done. There are no specific scans which can diagnose fibromyalgia.

Is it useful to have a formal diagnosis of fibromyalgia?

Having a formal diagnosis of fibromyalgia is useful but can be a double-edged sword. For most patients, as well as health care providers, having a formal diagnosis can help them move forward with treatment strategies. It reassures them that there isn’t anything sinister or life-threatening to explain their multitude of symptoms. This would help them to engage with the treatment strategies as they feel more reassured.

In a small number of patients, it could promote illness behaviour resulting in a downward spiral. It is important that this is addressed at the time of diagnosis and strategies are put in place to prevent or avoid this.

Unfortunately, there are still a small group of patients who continue to look for an alternative diagnosis, as essentially fibromyalgia is a diagnosis of exclusion with no specific tests proven to make a diagnosis. 

Hopefully, this can be effectively addressed by reiterating the condition by the multiple team members. It is important to continuously reassure such patients as constantly seeking an alternative diagnosis can deter them from engaging with proposed treatments and they ultimately tend to do worse. 

In WHO’s International Classification of Disease ICD-11, chronic pain is classified as a disease in its own right. This means it is acceptable to have a formal chronic pain diagnosis such as fibromyalgia without a known underlying pathology.

Specifically, to point out, there are other chronic conditions such as diabetes or hypertension, for which there is no underlying cause in the vast majority (barring few secondary causes).

You can book an appointment with Dr Ramaswamy via his Top Doctor’s profile here and if you’re currently unable to go far because of the coronavirus ‘stay at home’ measures, he is available via video call thanks to our e-Consultation tool.

By Dr Shankar Ramaswamy
Pain medicine

An important note with regard to the COVID-19 pandemic: We are offering video consultations to all patients at flexible times and at short notice. This is authorised by all insurance providers. Our team also offers physiotherapy via video consultation and we are able to offer interventions quickly for 'low risk' patients at safe premises in London. We will risk-assess all patients prior to this.

Dr Shankar Ramaswamy is a leading consultant in anaesthesia, pain management and neuromodulation based in Central London, Southeast London and Kent. Among the wide range of conditions that he manages are neck and back pain, headache and facial pain, cancer pain, neuropathic pain, musculoskeletal pain including fibromyalgia and joint pain, abdominal and pelvic pain, sports injury and trauma and accident-related pain including whiplash injury.

He is the clinical lead for the busy inpatient pain service at the Royal London Hospital and also the lead for pain management for the Newham MSK Collaboration. He is also the lead for education in pain management for Barts Health and QMUL and a course director and honorary senior lecturer for MSc Pain Management, University of Edinburgh.

His first qualifications and training in the field of anaesthesia were earned in India, including at one of the most prestigious medical and research institutions in India, the PGIMER. Once in the UK, he continued his anaesthetic training and then underwent the Advanced Pain Fellowship at the renowned Imperial Healthcare, London.

Over the duration of his career, he has garnered extensive experience that he uses to provide care of the highest quality to his patients. He commits to providing comprehensive pain management plans that are centred on each patient's individual needs. He uses a variety of techniques including self-management advice, pharmacotherapy, and cutting-edge (X-ray-guided and ultrasound-guided) interventions such as epidural, facet joint injections, peripheral joint injections (e.g. hips, knees, shoulder), radiofrequency, laser disc therapy, regenerative medicine (PRP) and neuromodulation. He is part of a large multi-disciplinary team to facilitate and individualise pain management approach.

Dr Ramaswamy has also received training in medico-legal report writing and is familiar with civil procedure protocols including CPR part 35 and PD 35 protocol. He can provide detailed insights into causality, prognosis, assessing capacity to work understanding specific roles, assess the ability to function and also comment on the prospect of achieving pain relief. He also offers medicolegal appointments at short notice and can produce a report with a quick turn around time. He sees patients for personal injury claims and criminal negligence claims.

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