Improving the Recognition and Diagnosis of Fibromyalgia

Abstract

Fibromyalgia (FM) is a chronic widespread pain disorder often seen in primary care practices. Advances in the understanding of FM pathophysiology and clinical presentation have improved the recognition and diagnosis of FM in clinical practice. Fibromyalgia is a clinical diagnosis based on signs and symptoms and is appropriate for primary care practitioners to make. The hallmark symptoms used to identify FM are chronic widespread pain, fatigue, and sleep disturbances. Awareness of common mimics of FM and comorbid disorders will increase confidence in establishing a diagnosis of FM.

Criteria for the Diagnosis of Fibromyalgia: Validation of the Modified 2010 Preliminary American College of Rheumatology Criteria and the Development of Alternative Criteria

“…However, it has become increasingly apparent over the last 2 decades that the 1990 ACR criteria have limited usefulness regarding the diagnosis of FM in clinical practice and cannot be used in epidemiologic surveys (3)(4)(5). Apart from the fact that the designated 18-location tender point count is seldom used or incorrectly performed (5), it is readily apparent that FM is more than just a pain disorder (6,7).…”

Rethinking chronic pain in a primary care setting

“…It is referred to by many names including centralized, dysfunctional, or idiopathic pain, central sensitization, and central sensitivity syndromes. [32][33][34][35] While no clear consensus presently exists on the terminology, the hallmark of this type of pain appears to be generalized hypersensitivity to a variety of stimuli including mechanical, thermal, olfactory, auditory, and visual cues. [36][37][38][39] Unlike traditional central sensitization triggered by persistent nociceptive and/or neuropathic input, it is often impossible to pinpoint the cause of sensory hypersensitivity.…”

“…[1,35,37,41,[80][81][82][83] In addition, hyperalgesia and allodynia are often found in patients with neuropathic pain or sensory hypersensitivity, but less so with nociceptive pain.…”

A Framework for Fibromyalgia Management for Primary Care Providers

“…Also, many clinicians report difficulty in identifying and diagnosing fibromyalgia. 7,13 Finally, patients with fibromyalgia are sometimes perceived as difficult to treat, 14 especially in the primary care office where time and resources may be limited for complex presenting problems. This review is the third and final installment of a series of concise reviews that addresses challenges in fibromyalgia diagnosis, treatment, and management.…”

“…[1][2][3][4] In addition to widespread pain present for more than 3 months, patients with fibromyalgia often report fatigue, nonrestorative sleep, cognitive dysfunction, stiffness, and mood disturbance. [5][6][7] With growing recognition of fibromyalgia by patients and health care professionals, more people are seeking medical help for chronic pain conditions and making frequent visits to their health care practitioner. 8 This has resulted in fibromyalgia becoming a clinical problem commonly seen in primary care and an economic burden on health care resources.…”