Fibromyalgia diagnosis: a review of the past, present and future

Abstract

Diagnosis of fibromyalgia (FM) remains controversial even though diverse diagnostic criteria have been developed. This review looks at the history, evolution of diagnostic criteria, endless controversy, recent trends and future perspectives regarding FM diagnosis. Some have criticized that diagnosis of FM could lead to medicalization, whereas others have raised concerns of under-diagnosing FM. With the evolution of diagnosis criteria from American College of Rheumatology 1990 to modified American College of Rheumatology 2010, diagnosis of FM has become simpler. The recent trend of applying patient-reported questionnaires has also increased a simpler FM diagnosis. Reliable biomarkers will not be available for the foreseeable future, so diverse assessment tools will have to be used more pro-actively. After initial diagnosis, multiple and comprehensive assessment measures are needed during the course of treatment in order to better understand type and severity of FM symptoms. These, in turn, could help classify FM based on symptom domain, symptom severity, and comorbidity which would enable more personalized treatment.

Keywords:

• assessment
• controversy
• diagnosis
• fibromyalgia
• history
• pain

Financial & competing interests disclosure

This study was supported by a grant of the Korean Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (HI12C0003). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• FM, a deliberating disorder, is diagnosed purely on a clinical basis, so the diagnosis was subject to numerous criticisms and controversies.

• The ACR 1990 criteria legitimized FM, enabling recognition of patients, booming of researches and development and approval of drugs for FM, but tender point examination and exclusion of other key symptoms such as fatigue, sleep and cognitive dysfunction were problematic.

• ACR 2010 and modified ACR 2010 were released, but both ACR 2010 and modified ACR 2010 have been criticized for their lack of precision or mechanistic features and complete symptom focus.

• With the evolution of diagnosis criteria from ACR 1990 to ACR 2010 and then to modified version of ACR 2010, most agreed that the FM needs a positive diagnosis rather than a diagnosis of exclusion, so the diagnosis of FM is becoming simpler.

• Acknowledging the fact that diagnosis of FM still remains clinical with no objective biomarkers, recent studies are focused on developing potential screening tools to help evaluate symptom domains, SS and presence of comorbidities.

• We expect that the diagnosis of FM in the future will be ‘simple initial diagnosis with comprehensive examinations during the course of treatment’: the diagnosis of FM will be simple enough for a primary care physician to use in brief clinical settings, but a comprehensive evaluations will be conducted to classify FM patients based on their symptom domain, SS and comorbidity.

Notes

^†The Symptom Severity Score is the sum of the severity of the three symptoms (fatigue, waking unrefreshed, cognitive symptoms) plus the extent (severity) of somatic symptoms in general. The final score is between 0 and 12.