Physical Examination
Physical examination of a patient with fibromyalgia is often unremarkable, except for the presence of tenderness. Tenderness may be present anywhere in the body. Laboratory testing is generally not useful except for differential diagnosis (determining which of two diseases with similar symptoms is the one from which the patient is suffering) when there is acute (rapid onset and severe or intense) or subacute (of moderate duration and severity) onset of symptoms.
Simple testing should include complete blood count and chemistries, along with thyroid stimulating hormone and sedimentation rates. Erythrocyte sedimentation rate is the measurement of how long mature, red blood cells take to separate from plasma (the liquid part of the blood) within a specific time period. Often, this test is used to diagnose disease or inflammation in the body. Serologic studies (measuring either antigens or antibodies) such as antinuclear antibodies and rheumatoid factor assays or tests, should generally be avoided unless there are historical features not seen in fibromyalgia or abnormalities upon physical examination. Another reason this type of testing should be used with some thought and interpreted cautiously is that there is some evidence that tests such as ANA may be more frequently positive in this spectrum of illness (Bates, D. W. et al., 1995) (Pincus, T., 1993).
Reference list
Bates, D. W., Buchwald, D., Lee, J., Kith, P., Doolittle, T., Rutherford, C., Churchill, W. H., Schur, P. H., Wener, M., & Wybenga, D. (1995). Clinical laboratory test findings in patients with chronic fatigue syndrome. Archives of Internal Medicine, 155, 97-103.
Pincus, T. (1993). A pragmatic approach to cost-effective use of laboratory tests and imaging procedures in patients with musculoskeletal symptoms. Primary Care, 20, 795-814.
