When it comes to identifying fibromyalgia, the objective judgment of a physician appears to be better than any of the current diagnostic scale scores and may be the only reliable method for an accurate and valid diagnosis, a review study suggests.

The review, “Challenges in fibromyalgia diagnosis: from meaning of symptoms to fibromyalgia labeling,” published in The Korean Journal of Pain,” focuses on discussing important but less evident factors that can profoundly affect under- or over-diagnosis of fibromyalgia.

Fibromyalgia (FM) is an extremely complex, multifactorial disease, whose clinical diagnosis has always been a hard-to-solve puzzle for physicians. It is characterized by chronic widespread pain, physical exhaustion, sleep problems, and cognitive issues.

However, most patients diagnosed with the condition often report other symptoms that can occur in various other diseases, including psychological disorders. This confuses the boundaries between what is clinically considered fibromyalgia and what is not, which can lead to an incorrect diagnosis and inappropriate treatment for the patient.

There are other important factors that also contribute to this phenomenon, including patients’ healthcare-seeking behavior and physicians’ ability to define and recognize clear diagnostic criteria for fibromyalgia.

“Due to diversity of symptoms presentation and severity over time, it is possible that an individual with FM seeks medical help and is diagnosed with the FM label at one time, and the same patient, at another time, is given a diagnostic label that merely connotes more local complaints, such as chronic low back pain, headache, or temporomandibular joint disorder, irritable bowel syndrome (IBS), and so on,” the authors wrote.

Psychosocial and cultural factors, albeit less evident, also play a major role in a physician’s ability to diagnose fibromyalgia, even more so than the severe fibromyalgia symptoms seen in patients.

“It was demonstrated that having the severe core symptoms that define FM is not essential to receiving an FM diagnosis. Rather, demographic and social disadvantage appears to be more important than symptom severity in making FM clinical diagnosis by clinicians,” the authors said.

In other words, patients must first be in a position to seek medical care for their symptoms, and physicians, for their part, must then be willing and able to correctly identify those symptoms as fibromyalgia.

“Furthermore, in a clinical setting, physicians’ beliefs and biases influence FM diagnosis. All FM assessments are subjective and there is no clear gold standard for FM diagnosis,” they said.

In the past few decades, physicians have been trying to define clear diagnostic criteria that could be used as a basis to diagnose patients in surveys, research, and clinical settings.

However, there are still some key pieces missing, including invalidation — the perception by a patient that his or her illness and symptoms are not being recognized — the previously mentioned psychosocial factors, and the diverse nature of fibromyalgia.

The authors believe that a physician’s unbiased judgment, obtained in an environment open to communication with patients, beats any of the current diagnosis scale scores based on specific fibromyalgia criteria and is the only reliable method for an accurate and valid FM diagnosis.

“Deciding if the patient labeled as having FM or not, and also evaluation of the FM patient for disease impact require a meticulous and discretionary approach to FM. It is better to see FM as a whole, and not as a medical specialty or constructional scores,” they conclude.