Present ACR Criteria for Fibromyalgia May Be Deficient in Cases of Asymmetrical or Regional Pain

The differential diagnosis of fibromyalgia has been a challenge to clinicians, and improvements to diagnostic criteria have been the focus of attention for some time. The American College of Rheumatology initially based diagnosis on the Widespread Pain Index, specifying an experience of pain in 4 quadrants plus axial pain. This was modified later to include the Symptom Severity Scale, evaluating the patient’s status in areas including depression, anxiety, sleep, fatigue, and cognition. A recent study comparing the original and more recent approaches has recommended further refinements to more effectively identify patients with asymmetrical or regional pain. The study was conducted by a research team comprised of participants from the University of Bern, Switzerland; Technische Universität München, Munich, Germany; and University of Kansas School of Medicine, Wichita. The findings appear online ahead of print in Journal of Rheumatology.

The examination of some 5,000 patients concluded that the use of a more stringent definition requiring 4 of 5 pain regions based on the Widespread Pain Index sites could enhance the accuracy of fibromyalgia diagnosis. From the study abstract, “In usual clinical and epidemiological studies, the 2011 and 2010 criteria work well, but are not as effective in patients with asymmetrical or regional pain who do not satisfy a widespread pain criterion. A ≥4-pain region widespread pain definition will eliminate regional pain false-positives and will identify 98.8% of current 2011 cases. Future revisions of the 2010/2011 criteria should consider incorporating the ≥4-region requirement to avoid misclassification.”

Read more about fibromyalgia, here.

A news story about the conclusions and recommendations may be read here.

The journal abstract may be read here.

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