Confirming the diagnosis of fibromyalgia (FM) is challenging, as there are no blood tests to verify accuracy of the diagnosis like so many other disorders. However, blood tests are needed when FM is suspected to “rule in/out” something else that may be mimicking FM symptoms. Also, FM is often associated with other disorders that are diagnosed by blood testing, so it is still necessary to have that blood test. So what is the CURRENT recommendation for diagnosing FM?
The American College of Rheumatology
(ACR) developed criteria for diagnosing FM in 1990 and has updated it since
then. The original 1990 criteria included the following: 1) A history of
widespread (whole body) pain for three months or more; and 2) The presence of
pain at 11 or more of 18 tender points which are spread out over the body. The
main criticism regarding this approach has come from the poor accuracy and/or
improper methods of testing the 18 tender points. As a result, this examination
portion of the two main criteria has been either skipped, performed wrong, or
mis-interpreted. This left the diagnosis of FM to be made based on symptoms
alone. Also, since 1990, other KEY symptoms of FM have been identified that had
previously been ignored including fatigue, mental fog (“cognitive symptoms”),
and the extent of the body pain complaints (“somatic symptoms”).
As a result, it has been reported
that the original 1990 approach was too strict and inaccurate because too many
patients with FM were missed – 25% to be exact – by using this method. In 2010,
the diagnostic approach was modified by using two different questionnaires: 1)
The “Widespread Pain Index” or (WPI), which measures the number of painful body
regions; and 2) the development of a “Symptom Severity” scale (SS). The MOST
IMPORTANT FM diagnostic variables included the WPI score and scores of
“cognitive symptoms,” which includes the “brain fog” common with FM,
unrefreshed sleep, fatigue, and the
number of “somatic symptoms” (other complaints). The Symptom Severity
scale (SS) incorporates these four categories and is scored by adding the
totals from each category. By using both
the WPI and the SS, they correctly classified 88.1% of FM cases out of a group
of 829 previously diagnosed FM patients and non-FM controls!
What’s important is that this NEW
approach does NOT rely on the “old” physical exam requirement of finding at
least 11 of 18 tender points. Because FM patients traditionally present with
highly variable symptoms, removing the challenge of determining the diagnosis
by physical examination is very important! Plus, now we can TRACK the outcomes
of the FM patient to determine treatment success both during and after care.
Since the 2010 approach has been released, it has been published in multiple
languages and is starting to be used in primary care clinics. Recently, in July
2013, a study reported that the Modified ACR 2010 questionnaire is highly
sensitive and specific for diagnosing FM, and its future use in primary care
was encouraged. What is most exciting about this is that a referral to a
rheumatologist may not be needed since this tool can be easily administered by
primary care physicians, which include chiropractors!
In past health updates, we have
discussed the need for a “team” of health care providers to best manage the FM
patient. This multidisciplinary approach offers the FM patient
multi-dimensional treatment strategies that encompass manual therapies,
physical therapies, nutritional strategies, pharmacology, exercise, and stress
management, cognitive management, and behavioral management. Now, with the
release of the Modified ACR 2010 criteria, we can diagnose FM more accurately,
track progress of the patient, and make timely modifications to the treatment
plan when progress is not occurring. This is a “win-win” for the patient,
providers/health care team, and the insurer!
If you, a friend or family member
requires care for FM, we sincerely appreciate the trust and confidence shown by
choosing our services!
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