Fibromyalgia syndrome (FMS) is a chronic disorder characterized by widespread and persistent non-inflammatory musculoskeletal pain. In 1990, American College of Rheumatologists published the diagnostic criteria for fibromyalgia symptoms. The criteria required tenderness on pressure (tender points) in at least 11 of 18 specified sites and the presence of widespread pain for diagnosis. This has subsequently been revised in 2010. However, pain is not the only symptom of fibromyalgia.
Some of the common fibromyalgia symptoms include:
- Persistent widespread pain (maybe throughout the body but maybe worse in back and neck)
- Increased sensitivity to stimuli you may normally not react to (hypersensitivity – hyperalgesia or allodynia)
- Fatigue
- Insomnia
- Morning Stiffness
- Depression
- Anxiety
- Cognitive Issues (forgetfulness, concentration difficulties, mental slowness, memory and attention problems, etc.)
- Negative Affect (neuroticism, alexithymia, and catastrophizing and impaired health-related quality of life)
Fibromyalgia also co-exists with other conditions such as
- Irritable bowel syndrome
- Chronic fatigue syndrome
- Migraines and other types of headaches
- Interstitial cystitis or painful bladder syndrome
- Temporomandibular joint disorders
- Postural tachycardia syndrome
Fibromyalgia is considered to be associated with central sensitization which is a state in which the nervous system goes through a process called wind-up and gets up-regulated in a persistent state of high reactivity. This persistent, or regulated, state of reactivity lowers the threshold for what causes pain and other fibromyalgia symptoms and subsequently comes to maintain these fibromyalgia symptoms even after the initial aggravating factor might have healed. A fuller explanation of central sensitization is provided elsewhere in the website.
ACR Criteria for Diagnosis of Fibromyalgia
The updated 2010 ACR criteria for diagnosis of fibromyalgia symptoms is:
| A patient satisfies diagnostic criteria for fibromyalgia if the following 3 conditions are met: |
| 1) Widespread pain index (WPI) ≥7 and symptom severity (SS) scale score ≥5 or WPI 3–6 and SS scale score ≥9. |
| 2) Symptoms have been present at a similar level for at least 3 months. |
| 3) The patient does not have a disorder that would otherwise explain the pain. |
| Ascertainment |
| 1) WPI: note the number areas in which the patient has had pain over the last week. In how many areas has the patient had pain? Score will be between 0 and 19. |
| Shoulder girdle, left Shoulder girdle, right |
| Upper arm, left Upper arm, right |
| Lower arm, left Lower arm, right |
| Hip (buttock, trochanter), left, Hip (buttock, trochanter), right |
| Upper leg, left, Upper leg, right, Lower leg, left, Lower leg, right |
| Upper back, Lower back, Neck, Chest, Abdomen, Jaw left, Jaw right |
| 2) SS scale score: |
| Fatigue |
| Waking unrefreshed |
| Cognitive symptoms |
| For the each of the 3 symptoms above, indicate the level of severity over the past week using the following scale: |
| 0 = no problem |
| 1 = slight or mild problems, generally mild or intermittent |
| 2 = moderate, considerable problems, often present and/or at a moderate level |
| 3 = severe: pervasive, continuous, life-disturbing problems |
| Considering somatic symptoms in general, indicate whether the patient has:* |
| 0 = no symptoms |
| 1 = few symptoms |
| 2 = a moderate number of symptoms |
| 3 = a great deal of symptoms |
| The SS scale score is the sum of the severity of the 3 symptoms (fatigue, waking unrefreshed, cognitive symptoms) plus the extent (severity) of somatic symptoms in general. The final score is between 0 and 12. |