How to Test for Fibromyalgia

Manhattan Physical Therapy
A woman having Fibromyalgia

Fibromyalgia isn’t diagnosed with a single scan or lab value. That’s often frustrating for patients, especially when the pain, fatigue, and brain fog are very real. Testing for fibromyalgia is a process of careful evaluation, where a healthcare provider listens to your symptoms, rules out other conditions, and applies established clinical criteria.

Understanding how fibromyalgia is identified can reduce anxiety, shorten delays in diagnosis, and help you feel more confident advocating for yourself during medical visits.

What Is Fibromyalgia?

Fibromyalgia is a chronic pain condition that causes widespread musculoskeletal pain, tenderness, fatigue, and sensitivity throughout the body. Symptoms often fluctuate, with periods of relative stability followed by flare-ups triggered by stress, illness, sleep disruption, or routine changes.

Although fibromyalgia does not damage joints or organs, it changes how the nervous system processes pain. Research suggests the brain and spinal cord amplify pain signals, making sensations feel more intense and persistent than they should. Key characteristics include:

  • Long-lasting, widespread pain

  • Heightened pain sensitivity

  • Fatigue that doesn’t improve with rest

  • Sleep disturbances

  • Cognitive difficulties often described as “fibro fog”

Fibromyalgia is a legitimate medical condition recognized by major organizations, including the American College of Rheumatology.

Who Is Most Affected by Fibromyalgia?

Fibromyalgia can affect anyone, including children and teenagers, but it is most commonly diagnosed in adults.

Patterns seen in clinical data:

  • More common in women

  • Frequently diagnosed between ages 40 and 60

  • Often occurs alongside conditions like migraines, irritable bowel syndrome (IBS), anxiety, or depression

  • Higher risk if a biological parent has fibromyalgia or chronic pain conditions

In the United States alone, an estimated 4 million people live with fibromyalgia. Despite this, many patients spend years seeking answers before receiving a diagnosis.

Symptoms That Lead Doctors to Test for Fibromyalgia

Doctors begin testing for fibromyalgia when symptoms follow a specific pattern, especially when pain cannot be explained by injury, arthritis, or inflammation.

Common Physical Symptoms

  • Widespread muscle pain or deep aching

  • Tenderness to touch or pressure

  • Ongoing fatigue

  • Jaw or facial pain (including TMJ-related pain)

  • Frequent headaches or migraines

  • Digestive issues such as bloating, constipation, or diarrhea

  • Bladder urgency or discomfort

Cognitive and Emotional Symptoms

  • Memory lapses or difficulty concentrating

  • Poor sleep or non-restorative sleep

  • Anxiety or low mood

  • Increased sensitivity to noise, light, or temperature

For many people, new, unexplained pain is the first warning sign. If symptoms persist, recur, and interfere with daily life for several months, clinicians begin evaluating for fibromyalgia rather than isolated injuries or short-term conditions.

How Doctors Test for Fibromyalgia

Testing for fibromyalgia follows a clinical, evidence-based approach rather than a single diagnostic test. Healthcare providers look at symptom patterns, duration, and how pain affects daily life. The goal is to confirm fibromyalgia while ruling out other conditions that can mimic its symptoms.

Modern diagnosis is based on guidelines from the American College of Rheumatology (ACR). These guidelines moved away from older “tender point” exams and now focus on the full symptom picture. To consider fibromyalgia, a doctor will typically confirm that:

  • Pain is widespread, affecting multiple areas of the body

  • Symptoms have been present for at least three months

  • Pain and fatigue are not explained by another medical condition

This approach reduces misdiagnosis and ensures patients receive appropriate care rather than unnecessary treatments.

Diagnostic Criteria Used Today

Widespread Pain Index (WPI)

The WPI measures how many areas of the body are painful. Patients indicate whether they’ve experienced pain in specific regions over the past week. A higher score suggests more widespread pain involvement.

Symptom Severity Scale (SSS)

The SSS evaluates how intense key symptoms are, including:

  • Fatigue

  • Unrefreshing sleep

  • Cognitive difficulties (“fibro fog”)

  • Other physical symptoms such as headaches or digestive issues

A diagnosis of fibromyalgia is made when both pain distribution and symptom severity meet defined thresholds, and symptoms have remained consistent for at least three months. This system allows clinicians to quantify how fibromyalgia affects real life—not just where pain is located.

Physical Exam: What Doctors Look For

A physical exam remains an important part of fibromyalgia testing, but it’s used to assess patterns, not to confirm inflammation or structural damage.

During the exam, your provider may:

  • Check for pain in five major body regions

  • Observe posture, movement, and muscle guarding

  • Assess joint mobility and muscle flexibility

  • Look for signs that point to arthritis, nerve compression, or injury

The five pain regions include:

  1. Upper left (shoulder, arm, or jaw)

  2. Upper right (shoulder, arm, or jaw)

  3. Lower left (hip, buttock, or leg)

  4. Lower right (hip, buttock, or leg)

  5. Central region (neck, back, chest, or abdomen)

Pain in at least four of these five regions supports a fibromyalgia diagnosis when combined with symptom history.

Can Blood Tests Detect Fibromyalgia?

There is no single blood test that confirms fibromyalgia. However, blood work plays a critical role in excluding other conditions that cause similar symptoms. Doctors often order:

  • Complete blood count (CBC)

  • Erythrocyte sedimentation rate (ESR)

  • C-reactive protein (CRP)

  • Thyroid function tests

  • Antinuclear antibody (ANA) testing when autoimmune disease is suspected

Normal inflammatory markers alongside widespread pain often strengthen the case for fibromyalgia.

What About the FM/a Blood Test?

Emerging research suggests that some people with fibromyalgia show altered cytokine activity in immune cells. The FM/a test measures this response, but it is not yet widely accepted as a standalone diagnostic tool. Most clinicians still rely on established ACR criteria.

Conditions That Must Be Ruled Out First

Fibromyalgia shares symptoms with several other disorders, making differential diagnosis essential.

Rheumatoid Arthritis (RA)

RA causes joint inflammation, swelling, and stiffness. Blood tests such as RF and anti-CCP, along with imaging, help distinguish RA from fibromyalgia.

Lupus

Lupus can cause joint pain, fatigue, and rashes. ANA testing and specific antibody markers help identify lupus rather than fibromyalgia.

Chronic Fatigue Syndrome

Both conditions involve fatigue, but fibromyalgia is defined by widespread pain, whereas chronic fatigue syndrome centers more on post-exertional exhaustion.

Ruling out these conditions ensures patients receive the right treatment, not unnecessary medications or procedures.

Why Physical Therapy Matters After Diagnosis

Once fibromyalgia is identified, treatment focuses on improving function, reducing pain sensitivity, and restoring confidence in movement.

At Manhattan Physical Therapy, fibromyalgia care emphasizes:

  • Gentle, progressive exercise programs

  • Manual therapy to reduce muscle tension

  • Postural correction and movement retraining

  • Education on pacing and flare-up prevention

Physical therapy is not about “pushing through pain.” It’s about retraining the nervous system to move safely again.

Aquatic therapy, walking programs, and low-impact strengthening are often especially effective for patients with fibromyalgia.

Retraining the Pain Response

Fibromyalgia involves the brain’s interpretation of pain signals. Addressing this requires a whole-person approach.

Key strategies include:

  • Identifying stressors that worsen symptoms

  • Gradual exposure to movement without fear

  • Education about how pain works

  • Building consistency rather than intensity

Over time, this approach can reduce pain sensitivity and improve daily functioning.

When to Seek Physical Therapy

If you’re experiencing widespread pain, fatigue, or recurring flare-ups that interfere with daily life, early intervention matters. Physical therapy can help break the pain–inactivity cycle that often accompanies fibromyalgia.

At Manhattan Physical Therapy, care is personalized, evidence-based, and focused on helping you move with less fear and more confidence—right here in New York City.

What Do They Say About Us?

Alexander Liu

"Everyone on the team at Manhattan Physical Therapy is super nice and caring. They were able to pretty quickly diagnose my knee and hip problems and immediately put me to work to reduce the pain.."

Henry Myerberg

"You're not just a patient when you come to the Manhattan Physical Therapy. You feel like family there. In particular, Erica with her colleagues John, Lidia and Joe not only fix and improve you physically, they make you feel welcomed and cared for.."

Hakyung Kim

"Everyone is so kind and helpful! my knee and hip pain have improved massively since starting Manhattan PT, highly recommend to anyone. special thanks to Bianca, Lidia, Joe, and John!"


Manhattan Physical Therapy

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(212) 213-3480

Address: 385 5th Ave, Suite 503, New York, NY 10016