New guidelines for diagnosing fibromyalgia have dramatically changed the standard recommendations for the diagnosis and treatment of fibromyalgia syndrome (FMS). The guidelines, published in the Canadian Medical Association Journal, codify a number of revelations made in FMS research in recent years that question long-held beliefs about the syndrome.
“From being a condition of suspect validity 2 decades ago, fibromyalgia is now much more widely accepted as a true syndrome,” wrote Marry-Ann Fitzharles MB ChB, of the Division of Rheumatology at McGill University in Montreal, and colleagues.
Fitzharles and colleagues combed through scientific literature to develop the new recommendations which reflect changes made to the 2010 American College of Rheumatology criteria.
The new guidelines for diagnosing fibromyalgia include:
- Tender point counts should no longer be used for diagnosing fibromyalgia. In the past tender point counts were inherent to FMS diagnosis but recent research has questioned the reliability of this subjective measure since tender points can vary over time in one patient and do not always predict symptom severity.
- Excessive testing should be avoided since there are no laboratory or radiographic tests that can confirm FMS. If testing is to be used, experts recommend that simple blood tests including a complete blood counts, C-reactive protein level, thyroid function, creatine kinase level, and erythrocyte sedimentation rate.
- FMS diagnosis can be made by primary care doctors, rather than just rheumatologist and specialists. Referral to rheumatologists can sometimes delay diagnosis and result in extensive, costly tests.
- Diagnosis should focus on the chief symptom of fibromyalgia: chronic widespread pain often accompanied by fatigue, unrefreshing sleep, mood disorders, and depression. Other symptoms include irritable bowel syndrome, migraine, myofascial pain, temporomandiular joint disorders, and dysmenorrhea.
- FMS is form of neuropathic pain rather than a soft-tissue condition. Studies show that FMS results in changes in pain processing, central sensitization, and changes in the brain’s gray matter, demonstrating the neuropathic nature of the condition.
The new guidelines also set recommendations for treating fibromyalgia including:
- Avoid the regular use of non-steroidal anti-inflammatory drugs and opioid pain killers, because of their toxicity and the increased risk of adverse effects in FMS patients.
- A mix of pharmacological and non-pharmacological treatments should be sought.
- Individualized treatments with a multimodal approach should address each patient’s specific symptoms.
- Treatments should focus on managing symptoms and reducing the severity of flare-ups since there is no cure for FMS.
- Exercise and other non-pharmacological treatments like cognitive behavioral therapy, massage, acupuncture, and patient education can improve symptoms.
“Treatment must move away from the simple prescription of a drug, with incorporation of non-pharmacological strategies in a multimodal approach,” argued Fitzcharles and colleagues.
Part of a successful multimodal approach can include chiropractic care. A 2009 study showed that chiropractic can reduce symptoms and enhance the benefits of exercise in fibromyalgia patients. Chiropractic has also been shown to decrease pain sensitivity and sensory dysfunction, which could disrupt the pattern of abnormal pain processing and central sensitization in people with fibromyalgia.
Fitzcharles, MA, et al. Fibroymalgia: evolving concepts over the past 2 decades. Canadaian Medical Association Journal 2013; doi: 10.1503/cmaj.121414. [E-pub ahead of print].