The Problematic Nature of Fibromyalgia Diagnosis in the Community

Abstract

BackgroundRecently, some studies suggested that clinical diagnosis of fibromyalgia is inaccurate and does not reflect current definitions. However, this hypothesis has not been tested. We examined whether fibromyalgia was accurately diagnosed in the community.MethodsWe surveyed 3276 primary care patients to determine current fibromyalgia status by criteria (CritFM). We also determined whether the patients had a physician's diagnosis of fibromyalgia (MDFM) and the level of symptom severity as measured by the polysymptomatic distress scale (PSD).ResultsThe prevalence of MDFM and CritFM was 6.1% (95% confidence interval [CI] 5.3%, 6.9%) and 5.5% (95% CI 4.8%, 6.3%), respectively. However, only 32.2% with MDFM met 2016 criteria (CritFM), and only 35.4% with CritFM also had MDFM. The kappa statistic for diagnostic agreement was 0.296 (minimal agreement). The mean PSD score was 12.4 and 18.4 in MDFM and CritFM, respectively. The odds ratio for being a woman compared with being a man was 3.2 for MDFM versus 1.9 for CritFM, P = 0.023. Of the patients with MDFM, 68.3% received specific fibromyalgia pharmacotherapy.ConclusionsThere is little agreement between MDFM and CritFM. Only one‐third of MDFM satisfy fibromyalgia criteria, and only one‐third of patients who meet the criteria have a clinical diagnosis of fibromyalgia. Physician diagnosis is biased and more likely in women. Fibromyalgia treatment is common in MDFM (70.7%). Overall, MDFM appears subjective and unrelated to fibromyalgia criteria. There appears to be no common definition of fibromyalgia in the community.

The Prevalence of Fibromyalgia Among Medical Students at King Abdulaziz University: A Cross-Sectional Study

“…Many studies have been exploring this discordance between the FM diagnosis and the diagnostic criteria. A recent study conducted by Srinivasan et al [ 28 ] investigated this concordance issue. Thus, several researchers have also started to raise the following question: "Why are patients who do not fulfill the criteria diagnosed clinically with fibromyalgia?"…”

Modified 2016 American College of Rheumatology Fibromyalgia Criteria, the Analgesic, Anesthetic, and Addiction Clinical Trial Translations Innovations Opportunities and Networks–American Pain Society Pain Taxonomy, and the Prevalence of Fibromyalgia

“…There are no clear boundaries between what is and what is not FM (32). A number of studies have found substantial discordance between patient-reported diagnosis of FM and assessment using FM criteria (33)(34)(35). While there are many potential reasons for such discordance, uncertainty related to criteria may be one contributing factor.…”

Comorbidities of Patients with Functional Somatic Syndromes Before, During and After First Diagnosis: A Population-based Study using Bavarian Routine Data

“…With FMS in particular, the comparison of raw and standardised results would suggest that the predominant symptoms are partially an expression of the biological, psychological and social status of an older, mostly female patient group. The prevalence of FMS is considerably lower than that of CFS, which might be explained by a reluctance on the part of physicians to label patients with a diagnosis of FMS, which is controversial in German primary care 31 . Further research is however required to better understand the aetiological relationship between the predominant and secondary symptoms.…”