From the Guidelines
Diagnosing fibromyalgia involves a comprehensive clinical evaluation, including laboratory and radiological exams if needed to exclude treatable comorbidities, as recommended by the 2017 EULAR revised recommendations for the management of fibromyalgia 1. The diagnostic examination for fibromyalgia syndrome is a multifaceted approach that requires a detailed medical history, physical examination, and assessment of widespread pain lasting at least three months.
Key Components of Diagnostic Examination
- Laboratory tests, such as complete blood count, erythrocyte sedimentation rate, thyroid function tests, and vitamin D levels, may be ordered to rule out other conditions that may cause similar symptoms 1.
- Imaging studies like X-rays or MRIs are not diagnostic for fibromyalgia but may be used to exclude other disorders.
- The physician may use questionnaires like the Fibromyalgia Impact Questionnaire or the Brief Pain Inventory to assess symptom severity and impact on daily functioning.
Importance of Comprehensive Assessment
The 2017 EULAR revised recommendations for the management of fibromyalgia emphasize the importance of a comprehensive assessment of pain, function, and psychosocial context in diagnosing and managing fibromyalgia 1.
Recent Recommendations
The EULAR recommendations also suggest that optimal management requires prompt diagnosis and a graduated approach with a combination of non-pharmacological and pharmacological treatment modalities tailored according to pain intensity, function, associated features, and patient preferences and comorbidities 1.
Diagnostic Criteria
While the 2016 revised diagnostic criteria consider symptom severity scores for fatigue, waking unrefreshed, cognitive symptoms, and somatic symptoms, the 2017 EULAR recommendations prioritize a comprehensive clinical evaluation and assessment of treatable comorbidities 1.
From the Research
Diagnostic Examination for Fibromyalgia
The diagnostic examination for fibromyalgia involves a combination of clinical evaluation, patient history, and diagnostic criteria. Some key points to consider include:
- 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 be used to diagnose fibromyalgia 2.
- The Fibromyalgia Rapid Screening Tool is a helpful screening method for patients with diffuse chronic pain 2.
- A stepwise diagnostic work-up of patients with chronic widespread pain (CWP) in primary care is recommended, 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 3.
- Diagnosis is based on a clinical approach and known diagnostic criteria, while additional methods, such as radiographic, magnetic resonance, or laboratory analyses, can be useful to exclude other conditions 4.
Diagnostic Criteria
The diagnostic criteria for fibromyalgia have undergone changes over the years. Some key points to consider include:
- The ACR 1990 classification criteria emphasized tender points and widespread pain as the key features of FMS 3.
- In 2010, the ACR proposed preliminary diagnostic criteria for fibromyalgia that abandoned the tender point count and placed increased emphasis on patient symptoms 3.
- A later modification of the ACR 2010 criteria for use in surveys employed a self-report questionnaire (Fibromyalgia Survey Questionnaire FSQ) to assess patient symptoms 3.
Challenges in Diagnosis
The diagnosis of fibromyalgia can be challenging due to the nonspecific nature of the symptoms and the presence of comorbid conditions. Some key points to consider include:
- The heterogeneity of FM significantly impacts both diagnosis and treatment, as it presents a wide spectrum of symptoms that vary in severity, combinations, and underlying contributing factors 4.
- The presence of mental illness or other comorbid conditions can complicate the diagnosis and treatment of fibromyalgia 3, 5.
- A holistic, comprehensive, multidisciplinary, patient-centered approach is recommended for the diagnosis and treatment of fibromyalgia 4.