Fibromyalgia (FM), or “fibromyalgia syndrome (FMS)”, is classified as a “chronic disorder characterized by widespread and persistent non-inflammatory musculoskeletal pain.” Common symptoms associated with FM include:

  • Widespread musculoskeletal pain
  • Fatigue
  • Insomnia
  • Morning stiffness
  • Depression
  • Anxiety
  • Mental slowness
  • Memory and attention problems

Is fibromyalgia common?

In 2013, fibromyalgia was diagnosed in 2.7% of the world’s population (4.2% of women and 1.4% of males). In women, the frequency of FM seems to rise continuously with age, peaking in middle age in males.

In the past, FM was thought to be a condition mostly affecting women, and diagnosing a man with the condition was quite rare. However, Galvez-Sanchez et al. in 2020 stated recently that prejudice in clinical practice and research causes (and has caused) healthcare practitioners to overestimate the prevalence of fibromyalgia in women and underestimate it in males. The percentage of women falls to 60% or less with improved diagnostic criteria and a less biased patient screening process.

Why does fibromyalgia occur?

The etiology of FM is still unclear, according to the Canadian Guidelines for the diagnosis and treatment of fibromyalgia syndrome. To the development and severity of fibromyalgia, however, a variety of biological, psychological, and social variables may be involved.

Fitzcharles et al. (2012) said that “the expression of FM may be explained by a biopsychosocial model in which predisposition, triggering, and other factors, such as depression, maladaptive coping, or fear-avoidance behavior, contribute to chronicity.”

Exactly how is fibromyalgia identified?

The American College of Rheumatology and Wolfe et al. set the diagnostic standards for FM in 1990. This criterion comprised both “tenderness” in at least 11 of 18 designated precise places, sometimes known as tender spots, and chronic widespread pain (defined as discomfort on both sides of the body, above and below the waist, and in at least one section of the spine, for at least 3 months). Although the tender point test is still often used and discussed, the new FM diagnostic criteria no longer suggest it.

The misconception linked with the tender point examination, a mostly subjective method that has a solid scientific foundation and has been rife with dispute, is the second issue that is underlined. Therefore, contrary to popular perception, a diagnosis of FM should not be validated or confirmed by examination of sensitive spots. 2012’s Fitzcharles et al

The principal diagnostic criteria now in use are the 2016 Revisions to the 2010/2011 American College of Rheumatology (ACR) Diagnostic Criteria. The Widespread Pain Index (WPI) and the Symptoms Severity Scale (SSS) are the two measures that are used.

  • 19 painful locations are included on the WPI (score range: 0–19).

A checklist of 41 symptoms, including IBS, exhaustion/tiredness, muscular weakness, Raynaud’s, ringing in the ears, etc., is included in Part SS2b of the SSS. Part SS2a assesses the degree of fatigue, waking unrefreshed, and cognitive problems.

According to the 2016 version of the 2010/2011 ACR criteria, a person must satisfy three requirements before being given a fibromyalgia diagnosis

  1. Axial, left and right upper, left and right lower, and generalized pain that is specified in at least 4 of the 5 body areas
  2. During at least three months, symptoms have been present at a comparable degree.
  3. WPI higher than or equal to 7, SSS higher than or equal to 5, OR WPI between 4 and 6, and SSS score higher than or equal to 9

The third and final requirement in the original 2010 American College of Rheumatology Criteria was that “the patient does not have a disorder that would otherwise explain the pain”. Wolf et al., writing in 2016 that this needed to be changed, noted that “a diagnosis of fibromyalgia is legitimate independent of other illnesses. A diagnosis does not rule out the possibility of further, clinically significant disorders.

The WPI and SSS scores are combined to create the fibromyalgia severity (FS) scale, which has a total score range of 0-31. A number of 0 indicates no symptoms, while a score of 31 indicates the worst symptoms. The FS score should always be recorded, according to Wolf et al. in 2016, and “a subsequent score 12 might be used as a measure of improvement or of current status.”

Here are the new fibromyalgia diagnostic standards published by Wolf et al in 2016.

Do We Pathologize the Norm?

The “diagnostic expansion” of fibromyalgia has been a source of worry for researchers, which is just a quick aside but something to be taken into account. In this instance, reducing the threshold for what constitutes fibromyalgia merely implies expanding the diagnostic scope.

When too many patients are needlessly given the clinical diagnosis of fibromyalgia (up to 75%), as described by Walitt et al in 2016, there are increased risks of overdiagnosis, possible overmedicalization, and pathologizing otherwise normal human experiences.

Who Should Make a Fibromyalgia Diagnosis?

According to the 2012 Canadian Guidelines for Fibromyalgia Syndrome Diagnosis and Management, FM should be diagnosed in a primary care environment. According to these recommendations, seeing a professional for FM treatment does not clearly give any benefits or lead to better long-term results.

The primary care setting must be the main focus of treatment since the primary care physician has the greatest understanding of the patient from a biopsychosocial viewpoint and is likely to have been treating the patient over time.  2012’s Fitzcharles et al

According to the recommendation, only straightforward laboratory tests should be carried out to rule out other recognizable conditions such as hypothyroidism, rheumatic conditions, neurological disease, or drug-induced conditions. Excessive clinical investigation should also be minimized.

Is There A Treatment?

Fibromyalgia currently has no recognized cure. Given this, the emphasis must change to creating long-term plans for properly coping with and managing this disease.

“The medical profession should discourage passive health-related behaviors and over-reliance on medical staff. Even while clinic visits could be more frequent when a therapy is first started, it is important to cut down on pointless medical contact after the patient is on a stable trajectory.  2012’s Fitzcharles et al

What Are The Treatment Options?

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