When widespread muscle pain is felt in many parts of the body at the same time, the assessment does not rest on a single test; it draws on the duration and distribution of the pain, sleep routine, accompanying symptoms and the exclusion of other conditions. This process may take time and usually requires more than one consultation.
Musculoskeletal complaints are common. The World Health Organization (opens in a new tab) reports that around 1.71 billion people worldwide have a musculoskeletal condition and that these conditions are the group contributing most to disability. Within this group, which covers more than 150 conditions, the same source separately mentions fibromyalgia as a widespread pain condition. It also reports that low back pain (opens in a new tab), which falls within this group, affected 619 million people worldwide in 2020 and is the single leading cause of disability.
Patients who present with widespread pain tend to share one experience: having gone a long time without an answer. The sentence “everything hurts but my tests come back normal” is often heard. This does not mean the complaint is not real; it means the assessment needs to be approached differently.
What the assessment covers
The duration and distribution of the pain. How long it has been going on, which parts of the body it covers, and whether it is on both sides at once are asked about.
Sleep routine. Difficulty falling asleep, waking frequently at night and waking unrefreshed are asked about separately. Sleep and widespread pain are most often seen together.
Fatigue. The level of fatigue accompanying the pain, and the extent to which it affects daily life, are assessed.
Accompanying symptoms. Morning stiffness and its duration, swelling or redness of the joints, rash, dryness of the mouth and eyes, fever and weight change are asked about.
Assessment of other conditions. Thyroid function, anaemia, vitamin D status, blood sugar, liver and kidney function and markers of inflammation are looked at. The aim is to distinguish conditions that produce similar symptoms.
Current medication. Some medicines may cause muscle pain; cholesterol medicines in particular are asked about for this reason.
Mental state and the burden of stress. The level of stress and any psychological strain are asked about. This does not mean that the pain is “in your head”; it is an ordinary part of assessing widespread pain.
How does the assessment proceed?
- Detailed medical history. The history of the pain, sleep, fatigue and the effect on daily life are recorded.
- Physical examination. The joints, muscles and tender areas are examined; whether there are signs of joint inflammation is assessed.
- Laboratory assessment. Investigations are requested in order to distinguish conditions that produce similar symptoms. There is no single test that shows widespread pain itself.
- Referral to the relevant specialty if necessary. Where the findings suggest joint inflammation, a rheumatology assessment may be requested.
- Drawing up the plan. Sleep routine, activity and pain management are planned together; the follow-up interval is determined.
In which patients is it assessed differently?
In the situations below, the assessment proceeds differently.
- In patients in whom fever, night sweats and weight loss accompany the pain (a detailed assessment is needed as a priority)
- In patients with swelling, redness and increased warmth in the joints (inflammatory joint conditions are investigated separately)
- In patients over 50 with new-onset widespread pain and stiffness of the shoulder and hip girdle (this is assessed with a separate clinical picture in mind)
- In patients with a history of cancer (the pain is assessed separately and as a priority)
- In patients taking cholesterol medicine (muscle pain related to the medicine is assessed separately; do not stop the medicine on your own initiative)
- In pregnant patients (the medicines that can be used are limited)
- In patients with thyroid disease or vitamin D deficiency (these are addressed first)
- In patients under 18 years of age (assessment lies within the field of paediatrics; this content has been prepared for adults)
Points to be aware of
A diagnosis is not made with a single test. Widespread pain is assessed by excluding conditions that produce similar symptoms. For this reason more than one consultation may be needed.
Tests coming back normal does not mean that there is no complaint. In widespread pain conditions, laboratory results are most often within the healthy range.
Inactivity may keep the pain going. Stopping activity altogether because of pain is generally not advised; what level of activity is suitable is determined after the examination.
Do not start a medicine or a supplement on your own initiative. Products recommended for widespread pain may interact with your current medication if used without consulting a physician.
Results vary from person to person. The path to be followed and the response are not the same in every patient.
When should you see a physician without delay?
If you notice these symptoms, consult a physician without delay:
- Fever accompanying the pain
- Unintentional weight loss or night sweats
- Swelling, redness and increased warmth in the joints
- Morning stiffness lasting longer than an hour
- Muscle weakness (difficulty climbing stairs or combing your hair)
- A skin rash, or dryness of the mouth and eyes, developing alongside
In the case of widespread and severe muscle pain together with darkening of the urine, go directly to the emergency department.
Frequently asked questions
Why does my pain continue when my tests are normal?
In widespread pain conditions, laboratory results most often come back within the healthy range. This does not mean that there is no complaint. The aim of the investigations is to distinguish other conditions that produce similar symptoms; there is no single test that shows the pain itself.
How is a diagnosis of fibromyalgia made?
The diagnosis is made through the duration and extent of the pain, the accompanying symptoms and the exclusion of other conditions that may lead to a similar clinical picture. It is not made with a single blood test or imaging study. The assessment may require more than one consultation.
Can I start exercising while I have pain?
Keeping active is generally advised, but the type and the level are determined for each person. Intense exercise started suddenly may make the complaint worse. The level suitable for you is planned after the examination.
Does vitamin D deficiency cause pain?
Vitamin D status is one of the areas looked at in the assessment of widespread pain. However, finding a deficiency does not show that this is the only cause of the pain; the other factors are addressed alongside it. Supplement use is planned with a physician’s assessment.
Could my cholesterol medicine be causing muscle pain?
It could; that is why your current medication is asked about at the examination. However, do not stop the medicine on your own initiative. Tell your physician about your complaint; if necessary, an adjustment is made following the assessment.
Does widespread pain go away with time?
The course varies from person to person and no length of time can be given in advance. A plan is drawn up in which sleep routine, activity and pain management are addressed together; the plan is reviewed at follow-up appointments.
Sources
- World Health Organization, Musculoskeletal health fact sheet, 14 July 2022. https://www.who.int/news-room/fact-sheets/detail/musculoskeletal-conditions (opens in a new tab)
- World Health Organization, Low back pain fact sheet, 19 June 2023. https://www.who.int/news-room/fact-sheets/detail/low-back-pain (opens in a new tab)
