Fibromyalgia Diagnosis May Be Improved by Including 4 Painful Regions, According to German Study

Fibromyalgia Diagnosis May Be Improved by Including 4 Painful Regions, According to German Study

Fibromyalgia (FM) is a chronic pain disease that is difficult to diagnose, and over the years clinicians have tried to improve the dignostic criteria to exclude other diseases.

Fibromyalgia was initially diagnosed using the Widespread Pain Index (WPI) according to criteria established in 1990 by the American College of Rheumatology (ACR). The patient had to experience pain distributed in four quadrants plus axial pain (pain that you can identify in one spot, such as a muscle sprain) over one week.

In 2011 the ACR introduced another scale known as the Symptom Severity Scale (SSS) to evaluate patients’ health status, including depression, anxiety, sleep, fatigue, and cognition. Now, a diagnosis of fibromyalgia is based on the number of painful areas, number of symptoms, and their severity. A person is diagnosed with FM if he or she has a WPI of seven or more and SSS of five or more; or a WPI of three to six, and SSS of nine or more.

In a recent study, German researchers compared the two different criteria and raised some concerns about the current FM diagnostic scales. They analyzed 5,011 patients who satisfied the 2011 criteria and compared them with the WPI according to the 1990 ACR fibromyalgia criteria.

The study, “Widespread Pain and Low Widespread Pain Index Scores among Fibromyalgia-positive Cases Assessed with the 2010/2011 Fibromyalgia Criteria,” was published in The Journal of Rheumatology.

Of the 5,011 patients, 4,700 of them (93.8 patient) satisfied the ACR 1990 widespread pain criterion. But when researchers used a new more stringent definition requiring four of five pain regions based on the WPI sites, they identified 98.8 percent of patients who met that criteria. The rest of the patients had milder fibromyalgia and no evidence of increased psychological or physical distress.

In usual clinical and epidemiological studies, the 2011 criteria will identify fibromyalgia patients, but will not be as effective in patients with asymmetrical or regional pain who do not satisfy a widespread pain criterion.

Using this novel four-pain region for a more widespread pain definition, a small number of regional pain false-positive fibromyalgia patients were excluded, and nearly 99 percent of current 2011 criteria cases were identified.

Future revisions of the 2011 criteria should consider incorporating the four-region requirement to avoid misclassification and to improve fibromyalgia treatment approaches, the researchers wrote.

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Using brain scans in fibromyalgia patients under hypnosis, researchers found the technique produces changes in underlying neural activity related to the effects of suggestion, and the mechanism of response in patients differed from that seen in controls — even though their behavioral response was similar.

The study, “Suggestions to Reduce Clinical Fibromyalgia Pain and Experimentally Induced Pain Produce Parallel Effects on Perceived Pain but Divergent Functional MRI-Based Brain Activity,” is published in the journal Psychosomatic Medicine.