Pre-fibromyalgia

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Author's definition[edit]

This is the situation in which a patient does not meet either the old or the new American College of Rheumatology criteria for fibromyalgia, but in the opinion of the health care worker doing the analysis, the patient is borderline because they score just short of the required threshold for fibromyalgia.

Factors to consider when making a diagnosis of “pre-fibromyalgia”[edit]

These include the number of known co-morbidities and the patient's clinical trajectory towards or away from fibromyalgia. Another factor is the duration of chronic widespread unexplained muscular pains. Historically the diagnosis required three months of muscular pains. There may be patients, for example, who are only 2.5 months past an accident who are on a trajectory towards fibromyalgia.

Another factor relates to the symptom severity score which is part of the new ACR criteria. Periodically a patient has a high score and the symptoms are due to known fibromyalgia co-morbidities such as irritable bowel syndrome. At other times these symptoms are not due to a known fibromyalgia comorbidity. And, at still other times it is very hard to say unless the doctor has an inordinate amount of time to delve deeply in to each symptom. All this underscores the fact that the question-based new ACR diagnostic test for fibromyalgia can be very difficult to apply in some patients. Another pitfall in the new ACR method relates to the widespread pain index. Not every pain ticked off by the patient on the score form should be counted. The examining health care professional should remove any pain that has an obvious other organic cause such as a clear-cut injury to a leg in which the pain is confined to the location of the tissue damage.