Hi Friend

I hope you are all doing well. This week I have below included a flow chart I use my self before I consider a fibromyalgia diagnosis. It looks at conditions that need to be ruled out before a fibromyalgia diagnosis, I have also included tests I do as an initial work up. Please remember this is a guide only and all your symptoms and signs are unique to you. Fibromyalgia is a very real condition and it is one I think about alot and really am trying to help people with. Part of that is understanding the condition better and what leads to a diagnosis. Please let me know if there are any other topics you would like me to cover. Next week I will cover in more depth why some people get fibromyalgia and what the causes could be.

So here is the flow chart I use to help direct me to rule out other conditions before a fibromyalgia diagnosis.

Here is a list of tests I also generally look to do:

Common Tests to Rule Out Other Conditions

1. Blood Tests

   • Complete Blood Count (CBC) – Checks for anaemia and infections.

   • Erythrocyte Sedimentation Rate (ESR) & C-Reactive Protein (CRP) – Detects inflammation (not usually present in fibromyalgia).

   • Thyroid Function Tests (TSH, T3, T4) – Rules out hypothyroidism, which can cause fatigue and muscle pain.

   • Vitamin D & B12 Levels – Deficiencies can cause fatigue and muscle pain.

   • Rheumatoid Factor (RF) & Anti-CCP Antibodies – Checks for rheumatoid arthritis.

   • ANA (Antinuclear Antibody) Test – Helps rule out lupus and autoimmune diseases.

2. Sleep Studies – If sleep disorders like sleep apnea are suspected.

3. Electromyography (EMG) & Nerve Conduction Studies – If nerve damage or neuropathy is suspected.

Why These Tests?

Fibromyalgia symptoms (widespread pain, fatigue, brain fog) overlap with conditions like rheumatoid arthritis, lupus, multiple sclerosis, hypothyroidism, and chronic fatigue syndrome. These tests help eliminate other causes before confirming fibromyalgia.

In most cases, fibromyalgia diagnosis is clinical, meaning it's based on symptoms rather than a specific test. However, depending on the patient’s symptoms, additional tests may be done to rule out other conditions.

Additional Tests That May Be Needed

🔹 Iron Studies & Ferritin – To check for anemia, which can cause fatigue.
🔹 Magnesium & Calcium Levels – Imbalances can lead to muscle pain and cramps.
🔹 Cortisol Levels – To rule out adrenal insufficiency.
🔹 Creatine Kinase (CK) – Checks for muscle diseases like myositis.
🔹 Lyme Disease Test – If there’s a history of tick exposure and joint pain.
🔹 Hepatitis B & C Tests – Chronic infections can cause fatigue and joint pain.
🔹 Small Fiber Neuropathy Testing – If burning pain or numbness is present.

Scans That May Be Used

🩻 X-rays – To check for arthritis or bone problems.
🧪 MRI (Magnetic Resonance Imaging) – Used if multiple sclerosis (MS), nerve damage, or other neurological conditions are suspected.
🦴 DEXA Scan (Bone Density Test) – If osteoporosis is a concern, especially in postmenopausal women.
🔬 Ultrasound – To check for inflammation in muscles or joints if conditions like polymyalgia rheumatica are suspected.

Why Are Scans Sometimes Used?

Fibromyalgia itself does not cause visible changes on scans, but imaging can help rule out conditions like:
✔️ Arthritis (rheumatoid or osteoarthritis)
✔️ Multiple sclerosis (MS)
✔️ Spinal issues (herniated discs, nerve compression)
✔️ Autoimmune diseases (lupus, myositis)

If no abnormalities are found and symptoms match fibromyalgia criteria, a diagnosis can be confirmed clinically.

I hope this was useful. Alot more people have joined the newsletter this week, so if you missed the email last week about the new criteria to get a diagnosis of fibromyalgia here it is:

Community Update

As you may be aware I am deep in setting up a truly unique platform for fibromyalgia suffers. This will allow access to online live therapies every day, (these will be tailored to your specific case as I have thought of a way to identify your triggers, which will enable a focussed plan) aswell as having daily check ins with me and other doctors. The forum will allow everyone to connect and not feel alone and to discuss problems, solutions, advice and guidance. I am am also trying to make links with trusted medical clinics to help provide low dose naltrexone and medicinal CBD at a reduced cost to those who need it. This week I have had 20 meetings with amazing therapists (somatic, nutritionists, emdr, pacing experts) all specialising in fibromyalgia, and some are absolutely awesome and will be part of the platform when it launches. I will be doing another webinar to share the latest updates and also provide support to everyone and answer questions about their fibromyalgia. This is a community for you, if you have any strong opinions or ideas I would love to hear them and implement them.

As always, thank you for your time, stay well and I will be in touch again next week.

Regards

Dr Ahmed