Evaluation of a patient with suspected Fibromyalgia
• History: pain severity (typically described as deep and aching), fatigue severity, sleep disturbances, snoring and other symptoms of sleep apnea, mood disturbances, cognitive dysfunction, paresthesias, hypersensitivity (odors, bright lights, loud noises), other central sensitivity syndromes (see Question 4), and triggers (see Question 8).
Family history of central sensitivity syndromes: first degree relatives are eight times more likely to have FM.
• Physical examination: general exam, joint exam including back, tender point evaluation for allodynia, manual muscle strength, neurologic exam including deep tendon reflexes
Neck size: large necks suggest sleep apnea (males, >17 inches; females, >16 inches).
Oral exam: receding jaw or tongue obscuring posterior pharynx increases risk of sleep apnea.
Blood pressure (BP) cuff use: complaints of excessive pain due to pressure from inflated cuff used to take BP.
Achilles tendon pinch: complaints of excessive pain when tendon pinched for > 4 seconds.
• Laboratory examination: complete blood count, complete metabolic panel, C-reactive protein, creatine phosphokinase, thyroid-stimulating hormone, 25-hydroxy vitamin D.
Do not get rheumatoid factor or antinuclear antibody unless there is objective joint swelling or laboratory abnormalities suggesting inflammation.
