Fibromyalgia is a disorder best characterized by the musculoskeletal pain affecting most of the body with accompanying sleep problems, memory issues and fatigue.
Many medical researchers believe the condition causes the brain to change how it processes pain signals, which in turn, magnifies painful sensations around the body.
The case with fibromyalgia diagnoses
No cure for fibromyalgia exists at this time. Instead, doctors assess fibromyalgia treatment by providing patients with the condition appropriate care for their individual case.
Though, no two people really have the same case of fibromyalgia. It’s because fibromyalgia can’t be fully diagnosed at this time. Due to that, it leads to instances where some diagnoses might not be the same as others.
Fibromyalgia diagnosis criteria has significantly changed over the years. Criteria for fibromyalgia mainly helps doctors assign patients with a formal diagnosis of the condition. But, since the condition itself has ‘mysterious’ origins, determining an accurate diagnosis has been a subject of issue for the medical community for years.
In this article, we’re going to take a look at the history behind fibromyalgia diagnosis criteria and the current set of fibromyalgia diagnosis criteria today.
Behind fibromyalgia diagnosis criteria
Most patients with fibromyalgia need multiple tests to determine whether their symptoms originate from the condition. A single test can’t determine a fibromyalgia diagnosis because of the way fibromyalgia affects people and the lack of solid fibromyalgia diagnosis criteria.
How fibromyalgia gets diagnosed
Patients with fibromyalgia may need multiple tests and evaluations before their doctor can settle on a diagnosis. Many patients with the condition often have laboratory and other test results that don’t show any abnormalities. Some symptoms even mimic other rheumatic conditions like arthritis. Due to that, many cases of fibromyalgia may be diagnosed by using what’s known as a differential diagnosis.
That type of diagnosis more or less has doctors narrow down all possible issues associated with a patient, based on their symptoms, age, gender, location, medical history, family history and other factors. The complexity of fibromyalgia makes it a condition that’s often diagnosed through that aforementioned process.
The criteria of fibromyalgia diagnosis
Despite the difficulty of diagnosing fibromyalgia, fibromyalgia diagnosis criteria does exist. The most used set of fibromyalgia diagnosis criteria was first established in 1990 as a set of fibromyalgia criteria for research. The Multicenter Criteria Committee of America established that set of criteria, also informally known as the ‘ACR 1990’ criteria.
The ACR 1990 criteria is defined as:
– Having a history of ‘widespread pain’ that has lasted more than three consecutive months. The pain is defined has having affected all quadrants of the body, including both sides, below and above the waist.
– Feeling pain along or at the designated tender points. This criteria appointed 18 designated tender points where pain from fibromyalgia may radiate. People with fibromyalgia may also feel pain in other areas, as well.
An interesting thing to note is that the aforementioned criteria was originally created for research purposes. It wasn’t intended for use as clinical diagnosis criteria, but the wide adoption by medical practitioners immediately negated that.
The original 1990 criteria also characterized the pain of fibromyalgia as ‘occurring in 11 or more of the 18 specific tender point sites where fibromyalgia pain radiates.’ The widespread pain of the 1990 fibromyalgia diagnosis criteria was defined as pain in ‘3 out of 4’ quadrants, including pain originating from the left and right side.
The 1990 fibromyalgia diagnosis criteria required a tender point site examination, which was actually found to be a ‘barrier’ in clinical settings. The tender point exam also created the assumption that fibromyalgia is a peripheral disease of the musculoskeletal system, as if its main characteristics originate from those tender points.
Due to that, medical practitioners and researchers began developing new fibromyalgia diagnosis criteria to suit the true conditions of fibromyalgia as a disorder.
Redefining fibromyalgia diagnosis criteria
The first steps toward redefining fibromyalgia diagnosis criteria started as early as 2010. During that year, the American College of Rheumatology made their provisional revised fibromyalgia diagnosis criteria public after its approval.
The new 2010 criteria eliminated the 1990 criteria’s requirement for a tender point exam. It also redefined how medical practitioners grade fibromyalgia in patients. The ACR 2010 criteria diagnoses fibromyalgia, as long as the patient meets the following conditions:
– A widespread pain index (WPI) score that’s greater than or equivalent to 7.
– A symptom severity (SS) score that’s greater than or equivalent to 5.
OR
– A WPI score ranging from 3 to 6 and SS scale score greater than or equivalent to 9.
AND
– Symptoms that have been present for at least three months.
– The patient doesn’t have an underlying disorder that may be the actual cause of the aforementioned pain.
The main reason why the American College of Rheumatology changed the fibromyalgia diagnosis criteria has a lot to do with how fibromyalgia diagnosis is handled in a clinical setting.
Most diagnoses of fibromyalgia are handled in a clinical setting. When diagnosed under the 1990 criteria, most people needed a tender point examination. The problem with that was tender point examinations were rarely performed correctly, if they were ever performed at all.
The 2010 criteria essentially simplified the diagnosis process, making the fibromyalgia diagnosis criteria much more useful in a clinical setting without ever performing a tender point examination. The revised criteria also placed a larger emphasis on recognizing the non-physical symptoms of fibromyalgia, including fatigue, sleep problems and cognitive impairment.
Further modifications were made to the new fibromyalgia diagnosis criteria in 2011. The revisions aimed to ‘make fibromyalgia diagnosis criteria more patient driven’ by eliminating doctor-sanctioned estimates of fibromyalgia symptoms and allowing patients to more or less ‘self report’ symptoms.
Besides those changes, the 2011 fibromyalgia diagnosis criteria added what’s known as the fibromygalia (FMS) symptom scale. The FMS symptom scale (FS) is the cumulative score made from the WPI and (now modified) SS scale score, measuring the strength of fibromyalgia in a patient. This scale was found to be the ‘best predictor of fibromyalgia’ in patients who were diagnosed under the new criteria.
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