diagnosis

Diagnosis

Fibromyalgia Fact Sheet

Fibromyalgia (pronounced fy-bro-my-AL-ja) is a complex chronic pain disorder that affects an estimated 10 million Americans. While it occurs most often in women, it can occur in men and children, and all ethnic backgrounds. For those with severe symptoms, fibromyalgia (FM) can be extremely debilitating and interfere with basic daily activities.

Diagnosis:
  • The FM classification criteria, established by the American College of Rheumatology (ACR) in 1990, includes a history of widespread pain in all four quadrants of the body for a minimum duration of three months, and pain in at least 11 of the 18 designated tender points when a specified amount of pressure is applied.

  • New diagnostic criteria were developed by the American College of Rheumatology (ACR) in 2010. These criteria do not use tender points but focus upon pain being widespread and accompanied by allied symptoms such as sleep problems, problems with thinking clearly, and fatigue.

  • Since people with FM tend to look healthy and conventional tests are typically normal, a physician knowledgeable about the disorder is necessary to make a diagnosis.

  • Physicians should rule out other causes of the symptoms before making a diagnosis of fibromyalgia.

Symptoms:
  • Although chronic, widespread body pain is the primary symptom of fibromyalgia, a variety of other symptoms are common in FM patients. Symptoms include: moderate to severe fatigue, sleep disorders, problems with cognitive functioning, IBS, headaches and migraines, anxiety and depression, and environmental sensitivities.

  • Some people may have only 1-2 symptoms while others may have many. Symptoms will often come and go and many people with fibromyalgia report difficulties identifying a pattern to their symptoms

Causes:
  • Recent research has suggested a strong genetic basis for FM.. The disorder is often seen in families, among siblings or mothers and their children.

  • Fibromyalgia can occur following a physical trauma, such as an acute illness or injury, which may act as a “trigger” in the development of the disorder. Other “triggers” can include both physical and psychological forms of stress. While the stress may help trigger FM, the stressor may not be involved in maintaining it once it starts

  • Increasing attention is being devoted to the central nervous system as the underlying mechanism of FM. Recent studies have suggested that FM patients have generalized disturbance in pain processing and an amplified response to stimuli that would not ordinarily be painful in healthy individuals.

Treatment:
  • Since there is no known cure for FM, treatment focuses on relieving symptoms and improving function.

  • A variety of prescription medications are often used to reduce pain levels and improve sleep. On June 21, 2007, the U.S. Food and Drug Administration approved Lyrica (pregabalin) as the first drug to treat fibromyalgia. Cymbalta (duloxetine HCl) was approved in June 2008; and Savella (milnacipran HCl) was approved in January 2009.

  • Non-pharmacological therapies such as aerobic exercise, self-management, and cognitive-behavioral therapy have demonstrated benefits in FM

  • Alternative therapies, such as massage, myofasical release, acupuncture, chiropractic, herbal supplements and yoga, may also be effective tools in managing FM symptoms for some people.

  • Increasing rest, pacing activities, reducing stress, practicing relaxation and improving nutrition can help minimize symptoms and improve quality of life.



newdiag

Understanding the “new” Fibromyalgia (FM) Criteria

Just when you thought you understood the concept of tender points, the criteria for FM changed. Where did the tender points go? The brief article that follows offers clarification and answers questions about the old and new criteria.

One big difference however is that the research criteria can be mailed to people or completed in a research setting without a physician present. The survey is self-report and can help classify someone as likely to have FM but does not provide a formal diagnosis. While developed by many of the same people who developed the 2010 ACR Diagnostic Criteria, the 2011 survey is not formally endorsed by the ACR. The survey criteria also permit the calculation of a Fibromyalgia Score, a score on a 0-31 point scale. Thus, rather than either having FM (yes/no), the FM Score allows an individual to have a lot or a little of FM – consistent with the experience that FM tends to change over time.


The New Criteria are More Consistent with the Science of FM

Both the new Diagnostic Criteria and the FM Research Criteria are more in line with what is being discovered about FM, namely, that FM is a very pure example of a centralized pain condition. What does this mean?

Let us say that you cut your finger. The injury is registered by receptors in your finger and then the message is sent up your spine to be processed and appreciated as pain by your brain. In the case of FM, there may not be any observable injury in any specific location of your body; rather normal sensory messages from all over your body are being processed by your brain as pain. This helps to account for the experience of FM being wide-spread and seeming to move around the body to different locations. Wide spread pain, if persistent, can also be fatiguing and interfere with sleep and thinking (e.g., memory). Thus the new criteria better capture the experience of centralized pain than did the old approach to classification.


Reference List

1. Wolfe F, Smythe HA, Yunus MB, et al. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis & Rheumatism 1990;33:160-72.

2. Wolfe F, Clauw DJ, Fitzcharles MA, et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res 2010;62:600-10.

3.. Wolfe F, Clauw DJ, Fitzcharles MA, et al. Fibromyalgia criteria and severity scales for clinical and epidemiological studies: a modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia. The Journal of Rheumatology 2011;38:1113-22.