With a better understanding of the syndrome and the willingness to combine treatments to get the right regimen, fibromyalgia treatment has never been better. However, one of the biggest challenges that fibromyalgia poses is the difficulty in diagnosing it in the first place.
Doctors need to be able to identify the syndrome before they can effectively treat for it. Because of the condition’s long history of generating skepticism and the tendency to think it’s “all in your head,” it is especially important to have reliable methods for diagnosis.
However, the syndrome has symptoms that are a part of various conditions. Widespread pain, which is the major symptom of fibromyalgia, is also a symptom of many other things. Since most of fibromyalgia is still a mystery, it’s impossible to test for other things that may indicate that a patient has the condition. There isn’t any simple test for the condition. We wouldn’t know what to test for, and so we’re stuck judging based off symptoms. Since, as we’ve said, fibromyalgia symptoms are also often symptoms a wide variety of other things, doctors will need to rule those other things out in order to make a confident diagnosis of fibromyalgia.
The most pertinent symptom of fibromyalgia is that the syndrome hurts all over. Unfortunately, one person’s “hurts all over,” doesn’t necessarily mean the same thing as another person’s. Diagnosis has focused generally on the “tender points” that come with fibromyalgia. There are 18 tender points associated with the syndrome. If a patient has experienced widespread pain for three months, and they have experienced pain in 11 of those 18 spots, then they will be diagnosed with the syndrome.
However, the counting of tender points has always been a bit of an obstacle. A person might have 11 points counted in one examination, but fewer might be counted on further examinations on subsequent days. This means that practitioners and patients are no closer than they were before to getting a diagnosis.
The tender point criteria were developed as criteria for research studies, and it’s still being used for the purpose of selecting candidates for research. However, for clinical diagnostic purposes, the conditions can be too strict. There are at least some who might be suffering from fibromyalgia, but don’t meet all the criteria. Besides, most general practitioners have never been comfortable doing a tender point count. A more straightforward alternative has been needed for a while.
In a newer approach to diagnosis, the focus on tender points has been abandoned in favour of an inventory of symptoms, and general pain. This approach uses a combination of two scores from different scales to make a diagnosis. It uses the Widespread Pain Index and the Symptom Severity Scale.
Widespread Pain Index
The pain index is a 19 point checklist of different areas of the body where a patient has experienced pain during the previous week. The WPI is scored as simply the total of the areas indicated by the patient, for a possible score of 19. To get an accurate score, it is recommended that the patient how he or she felt in the previous week, how the felt on their current treatments and medications, and what other conditions they know they suffer from that might cause pain. The areas considered for the index are:
- Shoulder girdle (between neck and shoulder), left and right
- Upper arm, left and right
- Lower arm, left and right
- Hips, left and right
- Upper leg, left and right
- Lower leg, left and right
- Jaw, left and right
- Upper and Lower Back
Symptom Severity Scale
The scale measures the patients’ experience of three symptom areas: sleep that fails to refresh, chronic fatigue and problems with cognitive function. The scale assigns a ranking of from 0 to 3 in four areas for a possible total of twelve. The areas are Fatigue, Waking unrefreshed, Cognitive symptoms and finally, other symptoms. Each area is scored from zero to three, zero being “no problem” and three being “severe.” Like the WPI, this takes into account how you’ve felt over the past week. The other symptoms that it considers are:
- Muscle pain
- Irritable Bowel syndrome
- Fatigue or tiredness
- Thinking or remembering problem
- Muscle Weakness
- Abdominal pain or cramps
- Numbness or tingling
- Pain in upper abdomen
- Chest pain
- Blurred Vision
- Dry mouth
- Raynaud’s Syndrome
- Ringing in Ears
- Oral ulcers
- Loss or changes in taste
- Dry eyes
- Shortness of breath
- Loss of Appetite
- Sun sensitivity
- Hearing difficulties
- Easy bruising
- Hair loss
- Frequent urination
- Bladder spasms
The new approach has delivered good results, and it’s thought that it will discover more than 88% of cases. Nonetheless, there has been some reluctance from both practitioners and organizations to eliminating the tender point criteria. Tender points have been a definitive feature of fibromyalgia, and the elimination of them from diagnostic criteria has naturally caused concern.
However, this kind of controversy often indicates that things are moving in the right direction. In any case, a healthy argument is always good for clarifying. However the syndrome will be diagnosed, if you have any suspicions that you have fibromyalgia, it will be a worthwhile measure to begin a pain diary to keep track of the details of your pain. You should record the locations and any circumstances surrounding your pain, the severity and duration. All of these details will make it easier for your doctor to fully understand your symptoms.
Both the index and scale are taken into consideration to come to a diagnosis of fibromyalgia. A patient can be diagnosed with the syndrome when he or she satisfies one of two situations and symptoms have been present for more than three months:
- WPI score greater than 7 and SS score greater than 5
- WPI score between 3 and 6 and SS score greater than 9
Fibromyalgia Impact Questionnaire (Revised)
Unlike the first two, this is not a diagnostic tool, but rather a tool used to figure out how severe your fibromyalgia is. It does this by assigning scores that reflect the difficulty that syndrome sufferers have conducting certain tasks. The questions are divided into three “domains”: the functional domain, the overall domain and the symptom domain. The functional domain focuses on 9 everyday tasks and the patient’s ability to perform them. The overall domain asks 2 questions focussed on whether the syndrome interfered with the patients goals for the week. Finally, the symptom domain asks 10 questions regarding the various symptoms that a patient suffers.
Each question is assigned a value from zero to ten, and then the scores are added together for each domain, and then “normalized” so that the scores can be added together to get one score for the questionnaire. The functional domain is normalized by dividing by three, the symptom domain is divided by two, and the overall domain score is left alone. This makes the final score add up to a maximum of one hundred.
As an example, if your scores in the functional domain added up to 60, your symptom domain added up to 80 and your overall score was 15, then your total score would be 75. 60 divided by three (20), plus 80 divided by two (40), plus 15. And your score would be out of one hundred, which, despite the difficulty in getting there, is actually a very straightforward concept to wind up with.
The original questionnaire was developed in the late ‘80s and published in 1991. It has since become commonly used in the evaluation of fibromyalgia. It was revised in 2009 to update it with further knowledge both of society in general and the disease specifically. The original questionnaire assumed a white, middle class woman as the subject, which the current revision has corrected. It was also even more complex to score properly, so, believe it or not, the current system of scoring is actually a simplified version of the original.
As you can see from all of these scales, they all depend on your own accurate description of your experiences to be effective. Both the diagnostic and severity questionnaire require you to have good information to give to the health care practitioners that use these tools.
“Changes in the FIQR that address issues in the original FIQ.” The Fibromyalgia Information Foundation. http://fiqrinfo.ipage.com/FIQR%20changes.htm.
“A New Way of Diagnosing Fibromyalgia: Pain Index Plus Symptoms, Not Tender Points, Equals Fibromyalgia, New Study Says.” By Denise Mann. WebMD. http://www.webmd.com/fibromyalgia/news/20100526/a-new-way-of-diagnosing-fibromyalgia.
“New Clinical Fibromyalgia Diagnostic Criteria.” http://neuro.memorialhermann.org/uploadedFiles/_Library_Files/MNII/NewFibroCriteriaSurvey.pdf.
“Fibromyalgia Diagnosis.” by Healthline Editorial Team. Healthline.com http://www.healthline.com/health/fibromyalgia-diagnosis.
“Fibromyalgia symptoms or not? Understand the fibromyalgia diagnosis process.” By Mayo Clinic Staff. Mayoclinic.org. http://www.mayoclinic.org/diseases-conditions/fibromyalgia/in-depth/fibromyalgia-symptoms/art-20045401.