Proposed New Screening Tool Identifies Likely Fibromyalgia Patients
In recent years, fibromyalgia experts have been trying to develop new and better ways to accurately diagnose fibromyalgia as quickly and easily as possible.
The original diagnostic criteria, established by the ACR in 1990, relied on a single symptom - pain - and required that the diagnosing physician be trained in how to do a manual tender point exam. While many still feel that the tender point exam is the most accurate way to diagnose FM, not all doctors have the time or inclination to learn how to correctly conduct the exam. Too many people were still waiting several years for an accurate diagnosis.
Then in 2010, the American College of Rheumatology (ACR) proposed a new set of diagnostic criteria that eliminated the tender point exam and took into account other common FM symptoms such as fatigue, sleep disturbances, and cognitive problems, in addition to pain. This criteria still requires a physician to ask patients questions about their symptoms and score the results. But since there is no hands-on exam, it doesn't require the training needed to do the tender point exam.
New Screening Tool Proposed
This month, an article in the journal Pain Medicine reported the results of an evaluation to validate a new brief, self-reported fibromyalgia screener that was conducted at the University of Pittsburgh.
Study Design and Results
The screening tool used in this evaluation was a one-page, six-question self-report fibromyalgia screening questionnaire based on the updated 2010 ACR fibromyalgia diagnostic criteria. A total of 337 chronic pain patients filled out the questionnaire. Then each patient underwent a clinical evaluation with their treating clinician on the same day they completed the self assessment screener.
It was found that the diagnosis from the screening tool and the clinician's diagnosis agreed with 76% sensitivity and 82% specificity. The researcher's concluded, "A self-administered, brief fibromyalgia screening questionnaire can effectively identify chronic pain patients who will likely have clinical fibromyalgia."
It's important to note that this screening tool is not intended to provide a definitive diagnosis of FM but rather to identify patients who are likely to have FM as opposed to another chronic pain condition. A clinical evaluation by a physician would still be necessary in order to confirm a fibromyalgia diagnosis and rule out other potential conditions that might have symptoms similar to FM.
You may be wondering what value there is to using a screening tool that doesn't definitively diagnose FM. As I see it, this questionnaire has the potential to significantly speed up the time it takes to diagnose fibromyalgia. When a patient with unexplained chronic pain goes to the doctor, there are dozens of possibilities that doctor has to consider as to possible causes of the pain. After the patient has completed this questionnaire, the doctor will have a good idea as to whether or not FM is a likely cause of the pain. If so, the doctor can do a more thorough exam for fibromyalgia to confirm it. If not, she can start looking for other causes of the pain.
Personally, I'm all for anything that can speed up the process of accurately diagnosing fibromyalgia because the earlier it is diagnosed and treated, the better the prognosis. Two additional pluses: a screening tool like this is extremely inexpensive to use and can save the treating physician much valuable time. I hope using a screening tool like this soon becomes the norm in every doctor's office.
Source: Marcus DA, et al. Brief, self-report fibromyalgia screener evaluated in a sample of chronic pain patients. Pain Medicine. 2013 Apr 11. doi: 10.1111/pme.12114.