A simple screening test to recognize fibromyalgia in primary care patients with chronic pain

Abstract

These results suggest that 2 tests, taking less than 1 minute, can indicate a probable diagnosis of FM in a chronic pain patient. In the case of a positive screen, a follow-up examination is required for confirmation or refutation.

Which symptoms best distinguish fibromyalgia patients from those with other chronic pain disorders?

“…This symptom was conceived by our group to specifically capture the unique character of the pain that is experienced by FM patients. Its effectiveness was first published in this Journal 12 and subsequently corroborated independently by Salaffi and colleagues. 13 We now compare its diagnostic effectiveness with other symptoms.…”

“…The unpublished data for this study was taken from a larger dataset previously published that assessed digital palpation tenderness in 10 locations and blood pressure cuff evoked pain. 12 In the study, a total of 352 patients enrolled in a convenience series, mean age 50 ± 16.3 years, 70% female. Of these, 158 patients presented with pain that included 50 patients (14.2%) who carried a chart diagnosis of FM and 108 (30.7%) with chronic pain but not FM.…”

“…Ten symptoms are drawn from the FIQR/SIQR that include several symptoms that have distinguished FM from patients with multiple rheumatic disorders. [10][11][12] An additional 16 symptoms are based on our review of major published studies (eg, 1990/2010/2016 criteria) and our accumulated experience in treating FM patients. One such symptom, redolent of the "pain all over" from the 1990 criteria, is the "persistent deep aching over most of my body" reported by FM patients.…”

Secondary Fibromyalgia

“…By contrast, the Symptom Impact Questionnaire (SIQR) 13 contains more symptoms and can discriminate between FM, RA, and systemic lupus erythematosus, using the symptoms of "difficulty sitting for 45 minutes" and "tenderness to touch" 14 . Moreover, in a study to find the best symptoms that distinguish FM from other patients with chronic pain, the symptom of "persistent deep ache over most of the body" was far more discriminatory than a visual analog scale pain rating 15 . These SIQR questions are not used in the PSD.…”

Fibromyalgia

“…One screening tool is conducted with two tests: 1) Reports of pain with application of 4 kg of pressure over 4 seconds (or when the examiner's nail beds blanch) to the Achilles tendons, and 2) Yes/No response to the question: “I have a persistent deep aching over most of my body” (see Screening for FM ). The “deep ache question” is emblematic of FM pain/tenderness phenotype characterized by the pain's persistence, depth, and diffuseness, and demonstrates a sensitivity and specificity of 92% and 80%, respectively 7…”