Assessing our approach to diagnosing Fibromyalgia

ABSTRACT

Introduction: Fibromyalgia represents the most prevalent of the group of conditions that are known as central sensitivity syndromes. Approximately 2–5% of the adult population in the United States is affected by Fibromyalgia. This pain amplification syndrome has an enormous economic impact as measured by work absenteeism, decreased work productivity, disability and injury compensation, and over-utilization of healthcare resources. Multiple studies have shown that early diagnosis of this condition can improve patient outlook, and redirect valuable health care resources toward more appropriate targeted therapy. Efforts have been made toward improving diagnostic accuracy through updated criteria.

Areas Covered: Reviewed here are 1) reasons for the need for more accurate diagnosis of Fibromyalgia, (2) a review of the evolution of Fibromyalgia to current times, and (3) the proliferation of currently available diagnostic criteria and problems related to each of them. From initial literature review until October 2020, PubMed, Embase, and Scopus were searched for applicable literature.

Expert Opinion: A discussion of ongoing efforts to obtain a biomarker to enhance diagnostic accuracy concludes this review. A need to include rheumatologists as part of the care team of patients with Fibromyalgia is emphasized.

KEYWORDS:

• Fibromyalgia
• ACR diagnostic criteria
• central sensitivity
• tender point
• chronic widespread pain

Article highlights

• History and evolution of Fibromyalgia.

• Development of American College of Rheumatology diagnostic criteria – 1990

• Retooling of criteria de-emphasizing tender points and emphasizing global symptomatology of fatigue, sleep, and cognitive dysfunction amongst others.

• Development of Fibromyalgia Diagnostic Screens and other assessment tools and their effectiveness.

• Need to ensure that rheumatologists remain an integral part of the care team for the majority of patients with Fibromyalgia.

Declaration of interest

The authors have no 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.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was supported in part by funding from Columbus Medical Research Foundation (2020) and National Institutes of Health grant [R61 NS117211] awarded to KV Hackshaw.