What are the diagnostic criteria for Fibromyalgia (Fibromyalgia Syndrome)?

From the Guidelines

Fibromyalgia is diagnosed using criteria that focus on widespread pain and associated symptoms, with the current diagnostic approach requiring widespread pain lasting at least 3 months, defined as pain in at least 4 of 5 body regions, along with moderate to severe sleep problems, fatigue, and cognitive difficulties, as recommended by the most recent study 1. The diagnostic criteria for fibromyalgia have evolved over time, with the American College of Rheumatology (ACR) classification criteria being the most commonly used in clinical and therapeutic research 1.

Key Diagnostic Criteria

• Widespread pain lasting at least 3 months, defined as pain in at least 4 of 5 body regions (left upper, right upper, left lower, right lower, and axial)
• Moderate to severe sleep problems, fatigue, and cognitive difficulties
• Physicians may use the Widespread Pain Index (WPI) to count painful body areas (score 0-19) and the Symptom Severity Scale (SS) to rate symptom intensity (score 0-12)
• A diagnosis typically requires either a WPI ≥7 and SS ≥5, or WPI 4-6 and SS ≥9

Exclusion of Other Conditions

• Other conditions that might explain the pain must be excluded through appropriate testing, including blood tests to rule out inflammatory disorders, thyroid dysfunction, and vitamin deficiencies 1. The diagnostic process has evolved from earlier criteria that relied heavily on tender point examination, moving toward a more comprehensive assessment of symptoms, recognizing fibromyalgia as a central sensitization syndrome where the central nervous system amplifies pain signals, explaining why patients experience widespread pain without observable tissue damage 1.

Importance of Comprehensive Assessment

• A full understanding of fibromyalgia requires comprehensive assessment of pain, function, and psychosocial context, as emphasized by the EULAR revised recommendations for the management of fibromyalgia 1.
• Optimal management requires prompt diagnosis and a multidisciplinary approach with a combination of non-pharmacological and pharmacological treatment modalities tailored according to pain intensity, function, associated features, and patient preferences 1.

From the Research

Fibromyalgia Diagnostic Criteria

• The diagnostic criteria for fibromyalgia include the presence of pressure sensitivity in at least 11 of the 18 tender points, in addition to the presence of widespread musculoskeletal pain for a period longer than 3 months and a general assessment of the patient's health status 2.
• The American College of Rheumatology 2010 criteria are also used to diagnose fibromyalgia, which includes the Widespread Pain Index (WPI) and other symptoms such as fatigue, sleep disturbances, and cognitive dysfunction 3.
• The diagnosis of fibromyalgia is often based on a combination of clinical characteristics, medication use, and patient-reported outcomes, as there is no definitive test for the condition 4.

Clinical Characteristics

• Fibromyalgia patients often experience a range of symptoms, including back pain, hypertension, headache, depression, and sleep disorders 4.
• The condition is characterized by chronic widespread pain, fatigue, and sleep disturbances, as well as cognitive dysfunction and depression 5, 6.
• Patients with fibromyalgia may also experience multiple comorbidities and use a range of medications to manage their symptoms 4, 2.

Treatment Options

• Treatment options for fibromyalgia include medications such as amitriptyline, duloxetine, gabapentin, and pregabalin, which are often used to manage pain and other symptoms 4, 2, 5, 3, 6.
• Combination therapy, such as the use of pregabalin and duloxetine together, may be more effective than monotherapy for some patients 6.
• The choice of treatment should be based on the individual patient's needs and symptoms, as well as their medical history and other factors 2, 3.