From the Research
The diagnostic criteria for fibromyalgia have evolved to focus on a comprehensive approach, including widespread pain index (WPI) and symptom severity scale (SSS) assessments, as outlined in the most recent study from 2023 1. To diagnose fibromyalgia, patients should have: WPI ≥ 7 and SSS ≥ 5, or WPI 4-6 and SSS ≥ 9; symptoms present at similar level for at least 3 months; and no other disorder that would otherwise explain the pain. The WPI measures pain in 19 body regions, while the SSS evaluates fatigue, waking unrefreshed, cognitive symptoms, and somatic symptoms on a scale of 0-12. Some key points to consider in the diagnosis of fibromyalgia include:
- The Fibromyalgia Rapid Screening Tool is a helpful screening method for patients with diffuse chronic pain 1.
- The American College of Rheumatology criteria or the Analgesic, Anesthetic, and Addiction Clinical Trial Translations Innovations Opportunities and Networks-American Pain Society Pain Taxonomy diagnostic criteria can diagnose fibromyalgia 1.
- Clinicians should also rule out other conditions that might explain symptoms, such as rheumatoid arthritis, lupus, or hypothyroidism through appropriate laboratory testing (complete blood count, comprehensive metabolic panel, thyroid function tests, and inflammatory markers) 1.
- No single test confirms fibromyalgia; diagnosis remains clinical. The shift away from tender point examination reflects understanding that fibromyalgia is a central sensitization syndrome involving abnormal pain processing rather than a peripheral musculoskeletal disorder, as supported by studies from 2011 2, 2013 3, and 2009 4, but most recently confirmed in 2020 5 and 2023 1. This approach acknowledges the condition's neurological basis and recognizes the importance of non-pain symptoms in the overall clinical picture. A multidisciplinary approach that incorporates nonpharmacologic therapies and medications to address problematic symptoms is most effective, with patient education, exercise, and cognitive behavior therapy improving pain and function, and medications such as duloxetine, milnacipran, pregabalin, and amitriptyline potentially effective for fibromyalgia 1.