Out with the Old in with the New: Not so much. Diagnosing Fibromyalgia

There has been a great deal of criticism regarding the 2010 Preliminary Proposed Criteria for Fibromyalgia, here, and The Modification of the American College of Rheumatology, here. Besides my own concerns reported on in a blog titled A Comprehensive Review on the Proposed and Modified Diagnostics for Fibromyalgia, here, you might be interested in seeing what other clinicians an researchers have to say:

 

• Enhancing the Diagnosis and Assessment of Fibromyalgia by Lesley M. Arnold, MD, here.
• A report and opinion on the preliminary guidelines for the  clinical diagnostic criteria for fibromyalgia by Robert Bennett, MD, here.
• Drs Bennett & Clauw Debate Abandonment of Tender Point Test in Revised FM Diagnostic Criteria, here.
• The Scientific Basis for Understanding Pain in Fibromyalgia by Robert Bennett MD, FRCP, here. 

 

In July of 2012, the SSA ruled to include Fibromyalgia in the listing of impairments, here. As an RN, this expert  was thrilled that the SSA has the good sense to use the 1990 criteria and require a physical exam, something the authors of the new criteria say is not necessary. As always, functional impairment must be documented using tools such the Residual Functional Capacity Questionnaire by Dr. Robert Bennett. The new diagnostic criteria, proposed but in use by some, falls short of assessing patients for clinical trials and in helping them obtain disability benefits. You can read more about pain and disability here. 

 

Many study results are skewed because common comorbid conditions are not ruled out, the number one culprit is myofascial pain syndrome (MPS), which is known as the great imitator. Research suggests it is one of the main peripheral pain generators to the centralization (amplification) of pain in fibromyalgia. It is also prevalent in other overlapping conditions, such as bruxism, restless leg syndrome, migraine, bladder and bowel dysfunction, chronic fatigue syndrome, TMJ and piriformis syndrome. The presence of MPS can also explain some of the unexplained symptoms of swelling and neuropathy. This is exactly the type of comment I submitted to the FDA on the upcoming “Public Meeting on Fibromyalgia Patient-Focused Drug Development” on December 10, 2013, here. 

 

There is no doubt that fibromyalgia may play a role in neuro, endocrine, and immune function because of the upset in the command center of the brain and possibly a broken mechanism in the brain for interpreting pain messages, but to get clear untainted research, we need good diagnostic criteria, which will only come about when all these other things are considered and leaving out a physical exam is no way to go about it.

 

Is it any wonder we seem to be chasing the monkey around the barrel?

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All answers and blogs are based on the author's opinions and writing and are not meant to replace medical advice.  

Celeste Cooper is a retired RN, educator, fibromyalgia patient, and lead author of the Broken Body Wounded Spirit: Balancing the See Saw of Chronic Pain devotional series (coauthor, Jeff Miller PhD), and Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome and Myofascial Pain: The Mind-Body Connection (coauthor, Jeff Miller PhD) She is a fibromyalgia expert for Dr. Oz, et al., at Sharecare.com, here, and she advocates for all chronic pain patients as a participant in the Pain Action Alliance to Implement a National Strategy, here. You can read more educational information and about her books on her website, http://TheseThree.com