From the Guidelines
Fibromyalgia is diagnosed primarily through clinical evaluation, and the current diagnostic criteria focus on widespread pain lasting at least three months, along with other symptoms like fatigue, cognitive difficulties, and unrefreshing sleep, as recommended by the 2017 EULAR revised recommendations for the management of fibromyalgia 1.
Diagnostic Criteria
The diagnostic criteria for fibromyalgia include:
- Widespread pain lasting at least three months
- Fatigue
- Cognitive difficulties
- Unrefreshing sleep
- A Widespread Pain Index (WPI) scoring pain in 19 body regions and a Symptom Severity Scale (SS) measuring fatigue, cognitive symptoms, and other somatic symptoms, as per the 2016 revised criteria from the American College of Rheumatology.
Diagnostic Methods
The diagnostic methods for fibromyalgia include:
- Clinical evaluation
- Laboratory and radiological exams to exclude treatable comorbidities, as recommended by the 2017 EULAR revised recommendations for the management of fibromyalgia 1
- Referral to other specialists, such as rheumatologists or pain specialists, if necessary
- Physical examination to reveal multiple tender points, though the formal tender point examination is less emphasized in current practice
- Sleep studies if sleep disorders are suspected
Importance of Ruling Out Other Conditions
Before diagnosing fibromyalgia, doctors must rule out other conditions that could cause similar symptoms through:
- Blood tests like complete blood count, thyroid function tests, vitamin D levels, and inflammatory markers
- A thorough medical history
- Sometimes consultation with rheumatologists or pain specialists is necessary for accurate diagnosis, as recommended by the 2017 EULAR revised recommendations for the management of fibromyalgia 1.
From the Research
Diagnostic Criteria for Fibromyalgia
The diagnostic criteria for fibromyalgia include generalized musculoskeletal pain associated with other symptoms, especially sleep and mood disorders, fatigue, and cognitive dysfunctions 2. The American College of Rheumatology (ACR) criteria or the Analgesic, Anesthetic, and Addiction Clinical Trial Translations Innovations Opportunities and Networks-American Pain Society Pain Taxonomy diagnostic criteria can diagnose fibromyalgia 3. The ACR 1990 classification criteria emphasized tender points and widespread pain as the key features of fibromyalgia syndrome (FMS), while the 2010 criteria abandoned the tender point count and placed increased emphasis on patient symptoms 4.
Methods for Testing for Fibromyalgia
The methods for testing for fibromyalgia include:
- Clinical approach and known diagnostic criteria 2
- Radiographic, magnetic resonance, or laboratory analyses to exclude other conditions 2
- The Fibromyalgia Rapid Screening Tool, a helpful screening method for patients with diffuse chronic pain 3
- A stepwise diagnostic work-up of patients with chronic widespread pain (CWP) in primary care, including:
- Complete medical history including medication
- Complete medical examination
- Basic laboratory tests to screen for inflammatory or endocrinology diseases
- Referral to specialists only in case of suspected somatic diseases
- Assessment of limitations of daily functioning
- Screening for other functional somatic symptoms and mental disorders
- Referring to mental health specialists in case of mental disorder 4
Key Features of Fibromyalgia
The key features of fibromyalgia include:
- Generalized musculoskeletal pain
- Sleep and mood disorders
- Fatigue
- Cognitive dysfunctions
- Widespread pain
- Tender points (according to the ACR 1990 classification criteria)
- Patient symptoms, such as pain, fatigue, and sleep disturbances (according to the ACR 2010 criteria) 2, 3, 4
Treatment of Fibromyalgia
The treatment of fibromyalgia typically involves a multidisciplinary approach that incorporates nonpharmacologic therapies and medications to address problematic symptoms 3. Patient education, exercise, and cognitive behavior therapy can improve pain and function, while medications such as duloxetine, milnacipran, pregabalin, and amitriptyline may be effective in managing symptoms 3, 5, 6.