What Is Fibromyalgia and Can Doctors Agree On the Diagnosis?

Fibromyalgia (FM) has long been considered a condition involving the soft tissues of the body, that is, the muscles, ligaments, tendons and fascia. It is defined as “a chronic, generalized pain condition associated with symptoms of fatigue, stiffness, and sleep disturbance and is characterized by the physical findings of local tenderness in many specific but widely dispersed sites. Fibromyalgia is the most common cause of widespread pain. The prevalence of this disorder in the general population is between 3% and 5%... Most patients with fibromyalgia remain symptomatic for several years, and no cure has been identified." Disturbances in the central nervous system (CNS) has also been linked to this condition.

In one study, 168 FM patients had the CNS evaluated by hearing tests, eye movement tests, and a test that evaluates balance/dizziness. Abnormal findings were common in the FM patient group compared to non-FM subjects. Another study utilized an electrical current treatment approach through the skull to stimulate part of the brain to see if that would help a group of patients with FM. Two different parts of the brain were stimulated as well as a sham or fake treatment approach. One of two parts of the brain that was stimulated resulted in reductions of pain that lasted for three weeks and mild improvements in quality of life were reported.

Comparing 287 general practitioners (GPs), 160 orthopedists, 160 physiatrists, and 160 rheumatologists, evaluating a patient injured in a motor vehicle crash, those most likely to diagnose FM were rheumatologists (83%) with physiatrists and GPs in the middle at 60% and 71%, respectively. Orthopedists were least likely at 29%. There were five factors found to be important in the respondent's agreement or disagreement with the FM diagnosis:
1. The number of FM cases diagnosed weekly by the respondent (strong predictor).
2. The patient's gender (females > males was a strong predictor).
3. The force of the initial impact (least important).
4. The patient's psychiatric history before the trauma (more important).
5. The initial injury severity (least important).
This information is important as the shift from considering FM to be strictly a condition of the muscles and other soft tissues to being a condition of the central nervous system will affect our future treatment strategies. Obtaining multiple opinions from various types of practitioners will most likely result in a variety of opinions. Previous reports of treatment benefit utilizing chiropractic approaches, exercise, and strategies to facilitate sleep restoration remain strong in the management process of FM.