From the Guidelines
Fibromyalgia diagnosis should be made through a comprehensive clinical evaluation, focusing on widespread pain lasting at least three months, along with symptoms like fatigue, cognitive difficulties, and sleep problems, and ruling out other conditions that might cause similar symptoms, as recommended by the 2017 EULAR revised recommendations for the management of fibromyalgia 1.
Key Considerations
- The diagnostic process may involve multiple healthcare visits and can be challenging because symptoms often overlap with other conditions.
- There is no specific blood test or imaging study that can definitively diagnose fibromyalgia.
- Doctors typically use the 2016 diagnostic criteria, which includes assessment of pain in multiple body regions using the Widespread Pain Index (WPI) and evaluation of symptom severity using the Symptom Severity Scale (SS).
- A diagnosis is considered when a patient has WPI ≥ 7 and SS ≥ 5, or WPI 4-6 and SS ≥ 9.
Diagnostic Approach
- Laboratory and radiological exams may be needed to exclude treatable comorbidities, as suggested by the 2017 EULAR revised recommendations for the management of fibromyalgia 1.
- Referral to other specialists may also be necessary.
- Patients should keep a detailed symptom journal noting pain locations, severity, and associated symptoms to help their healthcare provider make an accurate diagnosis.
Evidence-Based Recommendations
- The 2017 EULAR revised recommendations for the management of fibromyalgia provide a comprehensive approach to diagnosis and management, including non-pharmacological and pharmacological treatment modalities 1.
- The 2008 EULAR evidence-based recommendations for the management of fibromyalgia syndrome also provide guidance on diagnosis and treatment, including the use of antidepressants, analgesics, and other pharmacological agents 1.
From the Research
Diagnosis of Fibromyalgia
- Fibromyalgia is a syndrome characterized by chronic and widespread musculoskeletal pain, often accompanied by other symptoms such as fatigue, intestinal disorders, and alterations in sleep and mood 2.
- A diagnosis of fibromyalgia is typically made by a rheumatologist when the patient describes a history of pain spreading in all quadrants of the body for at least three months and when pain is caused by digital pressure in at least 11 out of 18 allogenic points, called tender points 2.
- The Fibromyalgia Rapid Screening Tool is a helpful screening method for patients with diffuse chronic pain, and 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 3.
Evaluation and Assessment
- A comprehensive medical evaluation of patients with fibromyalgia syndrome is essential to make a proper diagnosis, assess severity, recognize aggravating and relieving factors of symptoms, appraise psychologic factors, evaluate relevant associated or concomitant conditions, and document individualized problems in a given patient 4.
- Taking a complete medical history and performing a thorough physical examination, including a complete laboratory assessment, can be very helpful in confirming the diagnosis or establishing an alternate diagnosis 5.
- A multidisciplinary approach that incorporates nonpharmacologic therapies and medications to address problematic symptoms is most effective in managing fibromyalgia 3.
Diagnostic Considerations
- Fibromyalgia does not involve organic damage, and several diagnostic approaches have been developed in recent years, including the analysis of genetic, epigenetic, and serological biomarkers 2.
- Other potential causes of the patient's symptoms, such as mood disorders, sleep disorders, and daytime fatigue, must be considered in the patient's evaluation, as well as physical conditions that can mimic fibromyalgia, including endocrine conditions, neurologic disorders, musculoskeletal diseases, and medication-related side effects 5.