Diagnosis of Fibromyalgia
This is the feeling that some people get just after they receive the news that they have fibromyalgia. It is common in patients who have been suffering intensely for an extended period and who have seen many doctors and had many tests, but they have never been told they have fibromyalgia. Often, they have been told that they might, but it seems that few doctors have the confidence to day so so with any degree of certainty.
Since there is no well-established brain test for fibromyalgia, it is possible to be highly certain that a patient has the disorder based on the ACR-2016, but has be administered with care. Language, cognitive, and psychological barriers can make answers incorrect. Some people with multiple causes for pains can be scored too high on the widespread pain index. Also in the opinion of the author there can be a false positive test even if there are none of the aforementioned barriers in a small number of people who have what is known as “somatic symptom disorder with persistent predominant pain”.
When giving a patient the diagnosis of fibromyalgia, it is advisable to say that the diagnosis is based on the ACR-2016, and that it is highly reliable, it is not 100% reliable.
Author’s opinion on methods to clarify the diagnosis in borderline cases
When diagnosis is unclear based on the ACR-2016, it advisable to do the ACR 1990 which includes a tender point exam, but with a mechanical algometer to ensure the pressure applied is less than 4 kg.
In the personal opinion of the author, if a patient does not have at least 9 tender points, they should not be labelled as fibromyalgia. The ACR-1990 cut off was 11, but 9, gives a little flexibility in borderline cases.
Difficult diagnostic cases, in the opinion of the author should be resolved by taking into consideration the vortex scores, the number of fibromyalgia risk factors and the number of known fibromyalgia precipitating factors factors.