Diagnosis Of Fibromyalgia Syndrome Research Articles

Diagnostic experience of patients with fibromyalgia - A meta-ethnography.

Objective To examine how individuals experience the process and consequences of receiving a diagnosis of fibromyalgia syndrome. Methods A systematic literature search of qualitative studies up to May 2016 was performed. Twenty-eight reports including information on patients' diagnostic experiences were subjected to an interpretive analysis in accordance with the principles of meta-ethnography. Results Years were normally spent consulting specialists in an attempt to confirm the reality of symptoms and make sense of the illness. Great relief was felt at finally achieving the fibromyalgia syndrome diagnosis. However, relief waned when therapies proved ineffective. Health professionals and others questioned whether individuals were genuinely ill, that the illness had a psychological nature, and whether they were doing their best to recover. The diagnosis did not provide a meaningful explanation of individuals' suffering and had limited power to legitimate illness. Patients felt blamed for their failure to recover, threatening their personal credibility and moral identity. Conclusion The fibromyalgia syndrome diagnosis has limitations in validating and making sense of patients' illness experiences and in providing social legitimation of their illness. Social relationships are strained during the diagnostic process and in the course of ineffective therapies.

Prevalence of Axial Spondyloarthritis Among Patients With Fibromyalgia: A Magnetic Resonance Imaging Study With Application of the Assessment of SpondyloArthritis International Society Classification Criteria.

To evaluate the prevalence of sacroiliitis, the radiographic hallmark of inflammatory spondyloarthropathy, among patients diagnosed with fibromyalgia syndrome (FMS), using the current Assessment of SpondyloArthritis International Society (ASAS) criteria and magnetic resonance imaging. Patients experiencing FMS (American College of Rheumatology 1990 criteria) were interviewed regarding the presence of spondyloarthritis (SpA) features and underwent HLA-B27 testing, C-reactive protein (CRP) level measurement, and magnetic resonance imaging examinations of the sacroiliac joints. FMS severity was assessed by the Fibromyalgia Impact Questionnaire and the Short Form 36 health survey. SpA severity was assessed by the Bath Ankylosing Spondylitis Disease Activity Index. Sacroiliitis was demonstrated among 8 patients (8.1%) and ASAS criteria for diagnosis of axial SpA were met in 10 patients (10.2%). Imaging changes suggestive of inflammatory involvement (e.g., erosions and subchondral sclerosis) were demonstrated in 15 patients (17%) and 22 patients (25%), respectively. The diagnosis of axial SpA was positively correlated with increased CRP level and with physical role limitation at recruitment. Imaging changes suggestive of axial SpA were common among patients with a diagnosis of FMS. These findings suggest that FMS may mask an underlying axial SpA, a diagnosis with important therapeutic implications. Physicians involved in the management of FMS should remain vigilant to the possibility of underlying inflammatory disorders and actively search for such comorbidities.

Definition, classification, clinical diagnosis and prognosis of fibromyalgia syndrome : Updated guidelines 2017 and overview of systematic review articles

The regular update of the guidelines on fibromyalgia syndrome, AWMF number 145/004, was scheduled for April 2017. The guidelines were developed by 13 scientific societies and 2 patient self-help organizations coordinated by the German Pain Society. Working groups (n=8) with atotal of 42 members were formed balanced with respect to gender, medical expertise, position in the medical or scientific hierarchy and potential conflicts of interest. Asystematic search of the literature from December 2010 to May 2016 was performed in the Cochrane library, MEDLINE, PsycINFO and Scopus databases. Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine version 2009. The strength of recommendations was achieved by multiple step formalized procedures to reach aconsensus. The guidelines were reviewed and approved by the board of directors of the societies engaged in the development of the guidelines. The clinical diagnosis of fibromyalgia syndrome can be established by the American College of Rheumatology (ACR) 1990 classification criteria (with examination of tender points) or without the examination of tender points by the modified preliminary diagnostic ACR 2010 or 2011 criteria.

Pain extent is associated with pain intensity but not with widespread pressure or thermal pain sensitivity in women with fibromyalgia syndrome.

Widespread pain is considered a sign of central sensitization in people with chronic pain. Our aim was to examine whether pain extent, assessed from the pain drawing, relates to measures from quantitative sensory testing in fibromyalgia syndrome (FMS). Thirty women with FMS and no other co-morbid conditions completed pain drawings (dorsal and ventral views) and clinical and related disability questionnaires. Pain extent and pain frequency maps were obtained from the pain drawings using a novel customized software. Pressure pain thresholds were assessed over the 18 tender points considered by the 1990 American College of Rheumatology criteria for FMS diagnosis and over two additional standardized points. Heat and cold pain thresholds were also assessed on the dorsal aspect of the neck, the dorsal aspect of the wrist, and the tibialis anterior. Spearman's correlation coefficients were used to assess the relationship between pain extent and quantitative sensory testing outcomes as well as clinical symptoms. Larger extent of pain was associated with a higher pain intensity (dorsal area: r s=0.461, P=0.010; total area: r s=0.593, P=0.001), younger age (ventral area: r s=-0.544, P=0.002; total area: r s=-0.409, P=0.025), shorter history of pain (ventral area: r s=-0.367, P=0.046), and higher cold pain thresholds over the tibialis anterior muscle (r s=-0.406, P=0.001). No significant association was observed between pain extent and the remaining outcomes. Pain drawings constitute an easy and accurate approach to quantify widespread pain. Larger pain extent is associated with pain intensity but not with signs of central sensitization in women with FMS.

Memantine for fibromyalgia and Alzheimer's disease: An observational case comparison

Recent research suggests that memantine may have a beneficial role in treating chronic pain in patients with fibromyalgia syndrome (FMS). This study wished to assess whether patients with Alzheimer's disease (AD) and FMS prescribed memantine have improved pain control to those patients not receiving memantine. Nursing home patients with a diagnosis of AD and FMS were identified from one GP practice list in Arbroath, Scotland. Patients with another diagnosis that cause pain were excluded. Cognition was quantified and pain was assessed on a fortnightly basis for 4 months. Baseline cognitive and pain scores prior to treatment were also recorded. Ten patients with AD and FMS were identified. Four patients were excluded as they had other conditions causing pain. Three patients were prescribed memantine and three patients were prescribed donepezil. Baseline cognition and pain were similar between groups (prior to therapy), with lower pain scores and reduction for patients receiving memantine over the study period. This small research project, albeit with caveats, extends the findings to date that memantine may improve pain in patients with FMS, to those residing in nursing homes with diagnosis of AD.

Is having O blood type a risk factor for Fibromyalgia syndrome? The importance of nutrition in Fibromyalgia syndrome

Aim: Fibromyalgia syndrome (FS) is characterized with diffuse pain and sensitivity at specifc anatomical points and occurs together with mood, sleep and cognitive disorders. Life quality of the patients was destroyed and this situation creates an important economical issue in the medical care system. According to different antigens placed on the surface of red blood cells, there are four different blood type groups such as A, B, O and AB. To give nutritional recommendations for different blood types became one of the most popular topics in last decades. In this study, we investigated the link between FS and ABO blood types. Methods: In this study, we included 200 female patients with FS diagnosis (according to American College of Rheumatology, 2010 criteria) who visited our Physical Medicine and Rehabilitation Clinic between July 2015 and December 2015. The patients’ age, blood group, Rh antigen system were saved. Control group was also formed from 185 volunteer healthy female patients. P<0.05 was evaluated as statistically signifcant. Results: In our study, age distribution of FS group (N=200) was 40.6±10.8 and for control group (N=185), it was 43.0±14.8. In the control group, 58 people was A type (%31,4), 29 people was B type (%15.7), 23 people was AB type (%12.4) and 75 people (40.5%) was O type blood group according to ABO classifcation system. In the FS group, 60 people was A type (%30), 21 people was B type (%10.5), 10 people was AB type (%5) and 109 people (54.5%) was O type blood group according to ABO classifcation system. In both groups, a statistically signifcant difference was observed (p=0.03). There were more O type blood group carrying patients were detected in FS group. Conclusion: Most of the treatments used for FS are not effective. In order to decrease oxidative stress, weight management, nutritional condition, diet and nutrition supplement are important in these patients. To see more O type carrying people in FS group will guide us for etiopathogenesis, monitoring, clinical follow and treatment.

Bone mineral density is decreased in fibromyalgia syndrome: a systematic review and meta-analysis.

Previous studies have shown that fibromyalgia syndrome (FMS) is associated with low level of physical activity and exercise, which may lead to an increased risk of osteoporosis. However, studies of bone mineral density (BMD) in fibromyalgia have shown conflicting results. Thus, we conducted a systematic review and meta-analysis to better characterize the association between FMS and BMD. A comprehensive search of the databases MEDLINE and EMBASE was performed from inception through May 2016. The inclusion criterion was the observational studies' assessment of the association between fibromyalgia and bone mineral density in adult subjects. Fibromyalgia was diagnosed in accordance with the American College of Rheumatology criteria for the diagnosis of fibromyalgia syndrome. BMD was measured at the lumbar spine and femoral neck by dual-energy X-ray absorptiometry. Pooled mean difference (MD) of BMD at each site and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method. The between-study heterogeneity of effect size was quantified using the Q statistic and I 2. Data were extracted from four observational studies involving 680 subjects. At lumbar spine (L2-L4), BMD is significantly decreased in patients with FMS compared with controls with pooled MD of -0.02 (95% CI -0.03 to -0.01, P value=0.003,I 2=0%) (Fig.1). At femoral neck, BMD is not significantly decreased in patients with FMS compared with controls with pooled MD of 0.01 (95% CI -0.02 to 0.01, P value=0.23,I 2=0%) (Fig.2). In this meta-analysis, we observe that BMD at lumbar spine is decreased in FMS compared with normal individuals. Patients with FMS should be assessed for risk of osteoporosis. Fig.1 Forest plot of bone mineral density at the lumbar spine, for patients with and without fibromyalgia syndrome. CI-confidence interval Fig.2 Forest plot of bone mineral density at the femoral neck, for patients with and without fibromyalgia syndrome. CI-confidence interval.

Circulating microRNA Profiles as Liquid Biopsies for the Characterization and Diagnosis of Fibromyalgia Syndrome.

This work was aimed at investigating the circulating microRNA (miRNA) profiles in serum and saliva of patients affected by fibromyalgia syndrome (FM), correlating their expression values with clinical and clinimetric parameters and to suggest a mathematical model for the diagnosis of FM. A number of 14 FM patients and sex- and age-matched controls were enrolled in our study. The expression of a panel of 179 miRNAs was evaluated by qPCR. Statistical analyses were performed in order to obtain a mathematical linear model, which could be employed as a supporting tool in the diagnosis of FM. Bioinformatics analysis on miRNA targets were performed to obtain the relevant biological processes related to FM syndrome and to characterize in details the disease. Six miRNAs were found downregulated in FM patients compared to controls. Five of these miRNAs have been included in a linear predictive model that reached a very high sensitivity (100%) and a high specificity (83.3%). Moreover, miR-320b displayed a significant negative correlation (r=-0.608 and p=0.036) with ZSDS score. Finally, several biological processes related to brain function/development and muscular functions were found potentially implicated in FM syndrome. Our study suggests that the study of circulating miRNA profiles coupled to statistical and bioinformatics analyses is a useful tool to better characterize the FM syndrome and to propose a preliminary model for its diagnosis.

Smoking, depression, & stress: predictors of fibromyalgia health status

The purpose of the present study was to examine the effects of smoking, stress, and depression on fibromyalgia health status. Fibromyalgia syndrome (FMS) is a chronic musculoskeletal pain condition that negatively affects health status. Health status is not only affected by the constellation of physical symptoms, but also by mood symptoms, stress levels, and patient behaviors (e.g. smoking). Participants were 491 individuals with a physician’s diagnosis of FMS. They completed self-report measures of their current levels of depression, stress, the number of cigarettes smoked per day, and health status. A linear regression analysis was conducted to determine whether these measures predicted FMS health status. All three measures predicted worse health status, predicting 51.5% of the variance in health status. However, it is important to evaluate and treat more than just the physical symptoms of FMS. Attention should also be paid to mental health status and to engagement in unhealthy behaviors in order to reduce their effects on FMS health status. Future researchers should design and evaluate interventions that target these modifiable risk factors to determine the extent to which they could improve health outcomes.

Rule based fuzzy logic approach for classification of fibromyalgia syndrome.

Fibromyalgia syndrome (FMS) is a chronic muscle and skeletal system disease observed generally in women, manifesting itself with a widespread pain and impairing the individual's quality of life. FMS diagnosis is made based on the American College of Rheumatology (ACR) criteria. However, recently the employability and sufficiency of ACR criteria are under debate. In this context, several evaluation methods, including clinical evaluation methods were proposed by researchers. Accordingly, ACR had to update their criteria announced back in 1990, 2010 and 2011. Proposed rule based fuzzy logic method aims to evaluate FMS at a different angle as well. This method contains a rule base derived from the 1990 ACR criteria and the individual experiences of specialists. The study was conducted using the data collected from 60 inpatient and 30 healthy volunteers. Several tests and physical examination were administered to the participants. The fuzzy logic rule base was structured using the parameters of tender point count, chronic widespread pain period, pain severity, fatigue severity and sleep disturbance level, which were deemed important in FMS diagnosis. It has been observed that generally fuzzy predictor was 95.56% consistent with at least of the specialists, who are not a creator of the fuzzy rule base. Thus, in diagnosis classification where the severity of FMS was classified as well, consistent findings were obtained from the comparison of interpretations and experiences of specialists and the fuzzy logic approach. The study proposes a rule base, which could eliminate the shortcomings of 1990 ACR criteria during the FMS evaluation process. Furthermore, the proposed method presents a classification on the severity of the disease, which was not available with the ACR criteria. The study was not limited to only disease classification but at the same time the probability of occurrence and severity was classified. In addition, those who were not suffering from FMS were evaluated for their conditions in other patient groups.

Determination of New Bio Signal and Tests Alternative to Verbal Pain Scale for Diagnosing Fibromyalgia Syndrome

In this study; values obtained through the analysis of blood samples, taken under laboratory conditions, from patients diagnosed with fibromyalgia syndrome and healthy subjects and the sympathetic skin response parameters were used. With the aim of classifying verbal pain scale, which is one of the psychological test scores used for fibromyalgia syndrome diagnosis; relation between the sympathetic skin response effect on other test data and the verbal pain scale were reviewed by using different conditions of available data. Within this framework, three different algorithms were used for classification with high accuracy rates. These algorithms are: Multi-Layer Feed-Forward Neural Networks, Probabilistic Neural Network and Radial Basis Function Neural Network. For Multi-Layer Feed-Forward Neural Networks classification algorithm, classification was done with three different training algorithms, Levenberg-Marquardt back propagation, Resilient back propagation and the Scaled conjugate gradient back propagation and the results were compared elaborately. Based on the results, by using all variables the following accuracy rates were obtained: 68.2% accuracy with Levenberg-Marquardt training algorithm, 77.3% accuracy with the Resilient back propagation training algorithm, and 68.18% accuracy with the Scaled conjugate gradient training algorithm. These success rates show that there is a relationship between verbal pain scale, sympathetic skin response and other test data.

FIBROMYALGIA OR CHRONIC WIDESPREAD PAIN: DOES IT MATTER?

The question whether Fibromyalgia syndrome (FMS) is a distinct clinical entity in the context of chronic widespread pain (CWP) have remained challenging after decades of research and several diagnostic criteria that have attempted to clarify FMS. A recent study has raised more challenges on the issue, proposing that diagnosis of FMS in patients representing with CWP is not informative or helpful for clinical practice and such a differentiation will provide little or no significance regarding the choice of effective and safe therapies. This proposal will be further discussed here by reviewing the recent advances in the field of pain medicine. These advances have collectively provided compelling evidence that all individuals with chronic pain, even those classically categorized as originating from peripheral/nociceptive origins have common central contributions to their pain and associated comorbidities. The recent understanding of the pain mechanisms has also provided important implications on classification and management of pain. Centrally acting agents have been recommended as first-line treatment options for FMS and potential use of these agents has been expanded to other chronic pain disorders. After having reviewed the recent advances in the pain field, distinction between CWP and FMS still seems not to be useful in clinical practice, as effective treatment in an individual patient might be much guided by dominant underlying mechanisms rather than specific diagnosis the patient is suffering. The conditions representing with CWP in the absence of definitive objective confirmation may then be classified under one heading such as “CWP”, “chronic pain syndrome” or “central pain”, when considering their similar pattern of clinical presentation, commonality of central sensitization to their pathophysiology and their similar response to centrally acting analgesics. Future research should be directed toward classification of CWP based on the validated measurements of different aspects of pain. Such a classification may help clinicians identify the patients who will preferentially respond to peripheral or centrally acting analgesics and may therefore assist in advancing a more individualized and pain mechanism focused treatment in the clinical setting.

Fibromyalgia syndrome care of Iraq- and Afghanistan-deployed Veterans in Veterans Health Administration.

Little is known regarding fibromyalgia syndrome (FMS) care among Operation Iraqi Freedom/Operation Enduring Freedom/Operation New Dawn (OIF/OEF/OND) Veterans. Current recommendations include interdisciplinary, team-based combined care approaches and limited opioid use. In this study of OIF/OEF/OND Veterans who accessed Veterans Health Administration services between 2002 and 2012, we hypothesized that combined care (defined as at least 4 primary care visits/yr with visits to mental health and/or rheumatology) versus <4 primary care visits/yr only would be associated with lower risk of at least 2 opioid prescriptions 12 mo following an FMS diagnosis. Using generalized linear models with a log-link, the Poisson family, and robust standard errors, we estimated risk ratios (RRs) and 95% confidence intervals (CIs). We found that 1% of Veterans had at least 2 FMS diagnoses (International Classification of Diseases-9th Revision-Clinical Modification code 729.1) or at least 1 FMS diagnosis by rheumatology. Veterans with (vs without) FMS were more likely to be female, older, Hispanic, and never/currently married. Combined primary, mental health, and rheumatology care was associated with at least 2 opioid prescriptions (RR [95% CI] for males 2.2 [1.1-4.4] and females 2.8 [0.4-18.6]). Also, combined care was associated with at least 2 nonopioid pain-related prescriptions, a practice supported by evidence-based clinical practice guidelines. In tandem, these results provide mixed evidence of benefit of combined care for FMS. Future studies of healthcare encounter characteristics, care coordination, and benefits for Veterans with FMS are needed.

Physiological parameters as a tool in the diagnosis of fibromyalgia syndrome in females: A preliminary study

AimsAlthough fibromyalgia (FM) syndrome is associated with many symptoms, there is as yet no specific finding or laboratory test diagnostic of this syndrome. The physical examination and laboratory tests may be helpful in figuring out this syndrome. Materials and methodsThe heart rate, respiration rate, body temperature (TEMP), height, body weight, hemoglobin level, erythrocyte sedimentation rate, white blood cell count, platelet count (PLT), rheumatoid factor and C-reactive protein levels and electrocardiograms (ECG) of FM patients were compared with those of control individuals. In addition, the predictive value of these tests was evaluated via receiver operating characteristic (ROC) analysis. Key findingsThe results showed that the TEMP and the PLT were higher in the FM group compared with the control group. Also, ST heights in ECGs which corresponds to a period of ventricle systolic depolarization, showed evidence of a difference between the FM and the control groups. There was no difference observed in terms of the other parameters. According to the ROC analysis, PLT, TEMP and ST height have predictive capacities in FM. SignificanceChanges in hormonal factors, peripheral blood circulation, autonomous system activity disorders, inflammatory incidents, etc., may explain the increased TEMP in the FM patients. The high PLT level may signify a thromboproliferation or a possible compensation caused by a PLT functional disorder. ST depression in FM patients may interrelate with coronary pathology. Elucidating the pathophysiology underlying the increases in TEMP and PLT and the decreases in ST height may help to explain the etiology of FM.

A Study on the Effects of Sympathetic Skin Response Parameters in Diagnosis of Fibromyalgia Using Artificial Neural Networks.

Fibromyalgia syndrome (FMS), usually observed commonly in females over age 30, is a rheumatic disease accompanied by extensive chronic pain. In the diagnosis of the disease non-objective psychological tests and physiological tests and laboratory test results are evaluated and clinical experiences stand out. However, these tests are insufficient in differentiating FMS with similar diseases that demonstrate symptoms of extensive pain. Thus, objective tests that would help the diagnosis are needed. This study analyzes the effect of sympathetic skin response (SSR) parameters on the auxiliary tests used in FMS diagnosis, the laboratory tests and physiological tests. The study was conducted in Suleyman Demirel University, Faculty of Medicine, Physical Medicine and Rehabilitation Clinic in Turkey with 60 patients diagnosed with FMS for the first time and a control group of 30 healthy individuals. In the study all participants underwent laboratory tests (blood tests), certain physiological tests (pulsation, skin temperature, respiration) and SSR measurements. The test data and SSR parameters obtained were classified using artificial neural network (ANN). Finally, in the ANN framework, where only laboratory and physiological test results were used as input, a simulation result of 96.51 % was obtained, which demonstrated diagnostic accuracy. This data, with the addition of SSR parameter values obtained increased to 97.67 %. This result including SSR parameters - meaning a higher diagnostic accuracy - demonstrated that SSR could be a new auxillary diagnostic method that could be used in the diagnosis of FMS.

Can mastalgia be another somatic symptom in fibromyalgia syndrome?

OBJECTIVE:The purposes of this study were to determine the coexistence of mastalgia and fibromyalgia, to investigate the effects of this combination on pain patterns, and to discuss the status of breast pain in the diagnostic algorithm of fibromyalgia syndrome.METHODS:Sixty-one female patients reporting breast pain during the last three months and 53 female patients diagnosed with fibromyalgia syndrome were enrolled in this study. The Breast Pain Questionnaire was administered to all participants in the mastalgia group and to those in the fibromyalgia syndrome group who had experienced mastalgia during the past three months. The patients in the fibromyalgia syndrome group were evaluated using the 2010 preliminary American College of Rheumatology classification criteria. All of the patients in the mastalgia group were evaluated for the diagnosis of fibromyalgia syndrome by a single physiatrist. The coexistence and pain patterns of mastalgia and fibromyalgia were assessed statistically.RESULTS:Approximately half of the patients with fibromyalgia syndrome (47.2%) reported having mastalgia at the time of admission and 37.7% of the patients with mastalgia met the diagnostic criteria for fibromyalgia syndrome. The patients with mastalgia in the fibromyalgia syndrome group had significantly higher total breast pain scores compared with the women in the mastalgia group. In addition, the patients with fibromyalgia syndrome in the mastalgia group had significantly higher Widespread Pain Index and Symptom Severity Scale scores than the patients with fibromyalgia syndrome.CONCLUSIONS:We suggest that mastalgia can be an aspect of the central sensitivity syndrome and can be added to the somatic symptoms of fibromyalgia.

Acquiring a diagnosis of fibromyalgia syndrome: The sociology of diagnosis

Despite past attempts to develop theoretical frameworks to explain diagnostic behaviour, recent work suggests that the sociology of diagnosis needs further development. Accordingly, this article explores the diagnostic search in fibromyalgia syndrome (FMS), a biomedically unexplained disorder. Semi-structured interviews were conducted with 17 people diagnosed with FMS. Analysis was driven by interactionist notions of negotiated order and the self. The diagnosis of FMS is not ascribed, but is achieved through a process of negotiation between patient and doctor, in which power is both wielded and ceded by each party. In the process, individuals with FMS differentiate between the self and the body, where illness is conceptualized as an external force that invades the body and cannot be controlled by the self. It is this meaning of the illness experience, and the emergence of an ‘expert’ self, that guides the individual’s negotiation of an acceptable outcome in the diagnostic search. However, it is also guided by a social discourse that reflects lay understandings of acceptable help-seeking, such as proving one has attempted to cope with the illness, knowing when seeking help is acceptable, as well as cultural expectations regarding access to medical care.

Is it necessary to strictly diagnose fibromyalgia syndrome in patients with chronic widespread pain?

The applicability of the American College of Rheumatology (ACR) 1990 and 2010 criteria for the diagnosis of fibromyalgia syndrome (FMS) was determined in 284 patients with chronic widespread pain (CWP) including those with regional and systemic painful disorders. On the basis of initial evaluation, patients were classified into three groups. Group 1, those without any comorbid disease (N = 105), group 2, those having regional non-inflammatory painful disorders (N = 104), and group 3, those with a diagnosis of an inflammatory rheumatic disease (N = 75). Overall, 65 % of the patients fulfilled the 1990 criteria, while 94 % of them fulfilled the 2010 criteria. Almost all of the patients (97 %) with CWP did meet at least one of the criteria set, regardless of whether they have accompanying painful disorders. Widespread pain index (WPI), symptom severity scale (SS), and fibromyalgia impact questionnaire (FIQ) scores were found to be significantly higher in the patients who satisfied the 1990 criteria than those who did not (P < 0.001). Tender point counts were found to be significantly correlated with WPI, SS, FIQ, and Beck depression inventory (BDI) scores (P < 0.001). The findings of the study support the suggestion that FMS is just a continuum of CWP, rather than a distinct diagnostic entity. As treatment of FMS is usually identical with that of CWP, strict diagnosis of FMS will provide little or no significance from the viewpoint of clinical practice. We suggest that future research should be directed toward classification of CWP to provide guidance to clinicians in selecting effective therapies.

Construct validity and clinical utility of current research criteria of DSM-5 somatic symptom disorder diagnosis in patients with fibromyalgia syndrome

ObjectiveThe validity and clinical utility of current research criteria of the DSM 5 category somatic symptom disorder (SSD) needs to be tested outside the setting of psychiatry. MethodsConsecutive patients with an established diagnosis of fibromyalgia syndrome (FMS) were evaluated by medical examination, psychiatric interview and self-report questionnaires in an outpatient pain medicine center. The diagnosis of SSD was established using published research criteria. The discriminative concurrent criterion validity of SSD was tested by comparing FMS-patients with and without SSD as to the amount of impairment and of health care seeking. Two clinicians blinded as to the purpose of the study, assessed the medical reports of patients after the evaluation for the determination of the need for psychotherapy based on the German FMS — guideline recommendations (clinical utility). Results25.6% of 156 patients met the criteria of SSD. Patients meeting SSD criteria scored significantly higher in a self-report measure of disability. There were no significant differences in the number of patients on sick leave or applying for disability pension and in self-reported doctor visits and physiotherapy in the previous six months. 95.0% of patients with SSD and 71.6% of patients without SSD met the criteria of a current anxiety or depressive disorder as assessed by the psychiatric interview. 80.0% of patients with SSD and 66.7% of patients without SSD received a recommendation for psychotherapy. ConclusionsThe construct validity and clinical utility of current research criteria of DSM 5 category SSD were limited in German patients with FMS.

The Diagnosis and Management of Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) when it is Comorbid in Patients with the Fibromyalgia Syndrome (FMS): A Focused Review

The central neurologic soft tissue pain condition, called fibromyalgia syndrome (FMS), and the autoimmune peripheral nerve injury condition, called chronic inflammatory demyelinating polyneuropathy (CIDP), are both potentially disabling. Either condition can accompany an arthritis condition. The general population prevalence of FMS is about two percent, while CIDP is less common, at less than one percent. On this basis, overlap (being comorbid) of FMS and CIDP by chance would be expected in about two per ten thousand of the general population or in about one percent of persons with FMS. By contrast, these conditions are reported to be comorbid (i.e., FMS/ CIDP overlap) in thirty percent of FMS. This high level of association between FMS and CIDP has not yet been adequately explained. Fortunately, validated diagnostic criteria are available for both conditions so they can be distinguished from each other on the bases of established clinical criteria. A self-report questionnaire, based on the 2010 American College of Rheumatology Fibromyalgia Diagnostic Criteria can be used as support for the clinician's diagnosis of FMS (sensitivity ninety six percent). CIDP can be diagnosed using the electrophysiology-based European Federation of Neurological Societies/Peripheral Nerve Society criteria (sensitivity ninety six percent). Neurologic consultation is key to the diagnosis of CIDP. Lower extremity weakness and/or hyporeflexia in a patient with FMS should prompt consideration of FMS/CIDP. Many or all of the chronic manifestations of FMS/CIDP can improve with a course of intravenous immunoglobulin. There are potential risks associated with intravenous immunoglobulin therapy, but clinicians and patients will often conclude that the severity of the impairment associated with FMS/CIDP justifies some therapeutic risk. The threshold for treatment of FMS/CIDP should be low because the potential for benefit is high.