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.