■ Panic attacks (American Pain Society [APS], 2005; D'Arcy & McCarberg, 2005; Rao et al., 2008; Wolfe et al., 1990)

New diagnostic criteria are being reviewed by the American College of Rheumatology that incorporate the use of a patient questionnaire that can be used to derive a symptom severity index to augment the use of the tender point examination. Given the wide variety of presentations ofFMS and the skepticism of some health care providers about the condition, the patient who is diagnosed with FMS generally has been through a long period of uncertainty and numerous tests to rule out other conditions, such as rheumatoid arthritis or lupus. Because there is no test that can definitively prove a diagnosis of FMS, the negative results of all the testing can erode the patient's confidence. These patients require an empathic approach to get the full benefit of treatment and interventions. Other diagnoses to exclude are:

■ Rheumatoid arthritis

■ Systemic lupus erythematosus

■ Osteoarthritis

■ Ankylosing spondylitis

■ Other soft-tissue disorders, such as myofascial pain

■ Hypothyroidism

■ Spinal stenosis

■ Cervical myelopathy

■ Major depressive disorder

■ Use of statins (HMG-CoA reductase inhibitors)

It may take as long as 5 years for a patient to get a diagnosis of FMS. To get the diagnosis, the patient with fibromyalgia seeks help from a number of practitioners. Forty-six percent of the patients consult between 3 and 6 health care providers, whereas 25% see more than 6 consultants.

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