Perhaps one of the most frustrating things for a person with fibromyalgia syndrome (FMS) to have had to endure is the unreasonably long period of time it took to get a definitive diagnosis. The symptoms may have been going on for years, but because the criteria for diagnosing FMS failed to take into account common symptoms like fatigue and lack of mental clarity, the diagnosis was either incorrect or not forthcoming at all.
1990 Diagnosit Criteria for FMS
The diagnostic criteria doctors have been using were initially established in 1990 as a qualifier for clinical studies, not as a diagnostic tool. It consisted of the following factors:
· All other possible causes of symptoms were to be eliminated
· Diagnosis was based entirely upon pain
· Pain had to be on both sides of the body; above and below the waist; along the axial skeleton (head, throat, chest, spine)
· Pain in 11 of 18 tender points
· Symptoms must be present for a minimum of three months
The tender point exam has been a controversial point in the diagnostic criterion because the information is subjective, relying upon a patient’s self-reported pain. It did not take into consideration the fact that symptoms fluctuate and pain moves around the body. Very few FMS victims have unrelenting 24/7 widespread pain to all four quadrants of their bodies. So, the number of tender points may vary from one visit with the doctor to another. If the number fell below 11, then the patient was disqualified from an FMS diagnosis.
Developing a Simple, Practical Criteria To Diagnose FMS
Finally, in May of 2010, the American College of Rheumatology (ACR) proposed a new set of diagnostic criteria for fibromyalgia that recognizes the condition includes more than pain. According to the Abstract, the doctors and researchers wanted to develop simple, practical criteria for clinical diagnosis of fibromyalgia that are suitable for use in primary and specialty care and that do not require a tender point examination, and to provide a severity scale for characteristic fibromyalgia symptoms. At the end of the day, the new criteria is able to identify FMS 88% of the time accurately while the old criteria had only 75% accuracy.
Assessment Tools For Fibromyalgia Diagnosis
The new criteria consider more symptoms and provide a way to monitor the severity of the symptoms. Since the pain threshold of an individual can vary from day to day, measuring pain levels only does not give an accurate picture. There are some aspects of the old criteria that are found in the new criteria: other possible conditions must be ruled out and symptoms must be present for at least three months. However, there are two new assessment tools that have been added to the diagnostic criteria: the widespread pain index (WPI) and the symptom severity (SS) scale score.
The WPI lists 19 areas of the body in which a person may have had pain in the week prior to the examination. The individual identifies the areas of pain to the doctor and the score is between 0-19.
The SS scale score is established as the person ranks specific symptoms associated with FMS on a scale of 0-3:
· 0 = no problem
· 1 = slight or mild problems, generally mild or intermittent
· 2 = moderate, considerable problems, often present and/or at a moderate level
· 3 = severe: pervasive, continuous, life-disturbing problems
These symptoms include:
· Fatigue
· Cognitive symptoms
· Somatic symptoms in general
The numbers assigned to each are added up, for a total of 0-12.
Somatic symptoms are physical symptoms, not psycho-somatic as in physical manifestations of a psychological illness. The somatic symptoms that might be considered are myriad – 41 in total. Some of them are:
· muscle pain
· irritable bowel syndrome
· fatigue/tiredness
· thinking or remembering problems
· muscle weakness
· headache
· pain/cramps in the abdomen
· numbness/tingling
· dizziness
· insomnia
· depression
· constipation
· Raynaud’s phenomenon
· hives/welts
· seizures
· dry eyes
· loss of appetite
· rash
The Way to Diagnose FMS
For a diagnosis of fibromyalgia symptoms a person needs EITHER:
1. WPI of at least 7 and SS scale score of at least 5 OR
2. WPI of 3-6 and SS scale score of at least 9
The authors of the new diagnostic criteria concluded their Abstract as follows:
“This simple clinical case definition of fibromyalgia correctly classifies 88% of cases classified by the ACR classification criteria, and does not require a physical or tender point examination. The SS scale enables assessment of fibromyalgia symptom severity in persons with current or previous fibromyalgia, and in those to whom the criteria have not been applied. It will be especially useful in the longitudinal evaluation of patients with marked symptom variability.”
And, all those with FMS who have waited endlessly for a diagnosis said, “Thank Goodness!”
For more about fibromyalgia diagnosis, read our articles in this section.