Can the fibromyalgia diagnostic criteria be performed over the phone or does it require a physical exam?

From the Guidelines

Fibromyalgia diagnosis cannot be performed adequately over the phone and requires an in-person physical examination. The current diagnostic criteria involve both a thorough physical examination to assess for widespread pain and tenderness at specific tender points throughout the body, as well as evaluation of associated symptoms like fatigue, cognitive issues, and sleep disturbances 1. During the physical exam, a healthcare provider needs to apply specific pressure to designated tender points to evaluate pain response, which cannot be done remotely.

Additionally, the provider must rule out other conditions with similar symptoms through physical assessment and possibly laboratory tests, such as those recommended by the EULAR revised recommendations for the management of fibromyalgia 1. While a preliminary discussion of symptoms can occur by phone, and questionnaires about symptom severity and impact can be completed remotely, these are only supplementary to the required in-person examination. The physical examination is essential because fibromyalgia is fundamentally a diagnosis of exclusion that requires direct patient assessment to confirm the characteristic pain patterns and rule out alternative explanations for symptoms.

Some key points to consider in the diagnosis of fibromyalgia include:

• The need for laboratory and radiological exams to exclude treatable comorbidities 1
• The possibility of referral to other specialists if needed 1
• The importance of a thorough physical examination to assess for widespread pain and tenderness 1
• The evaluation of associated symptoms like fatigue, cognitive issues, and sleep disturbances 1

From the Research

Fibromyalgia Diagnostic Criteria

The diagnostic criteria for fibromyalgia involve a comprehensive clinical assessment, including:

• A complete medical history
• A complete physical examination
• Screening for chronic widespread pain (pain in four of five body regions) (CWP)
• Screening for additional major symptoms of FM: unrefreshed sleep and fatigue
• Limited simple laboratory testing to screen for possible other diseases

Diagnostic Tools and Criteria

The following diagnostic tools and criteria can be used to diagnose fibromyalgia:

• The Fibromyalgia Rapid Screening Tool
• The American College of Rheumatology criteria
• The Analgesic, Anesthetic, and Addiction Clinical Trial Translations Innovations Opportunities and Networks-American Pain Society Pain Taxonomy diagnostic criteria
• The 2016 criteria

Requirement for Physical Exam

According to the studies, a physical exam is required to diagnose fibromyalgia, as it involves a comprehensive clinical assessment, including a complete physical examination 2. While some screening tools can be used over the phone, a physical exam is necessary to consolidate the diagnosis of FM or identify features that may point to some other condition that may have a presentation similar to FM.

Key Points

• Fibromyalgia is a chronic, centralized pain syndrome characterized by disordered processing of painful stimuli 3
• The diagnosis of fibromyalgia requires a comprehensive clinical assessment, including a complete medical history, a complete physical examination, and screening for CWP and additional major symptoms of FM 2
• A multidisciplinary approach that incorporates nonpharmacologic therapies and medications to address problematic symptoms is most effective in managing fibromyalgia 3