The Korean Journal of Pain

The Korean Pain Society (대한통증학회)
권호 표지
DOI QR코드

DOI QR Code

Challenges in fibromyalgia diagnosis: from meaning of symptoms to fibromyalgia labeling

  • Bidari, Ali (Department of Rheumatology, Iran University of Medical Sciences) ;
  • Parsa, Banafsheh Ghavidel (Rheumatology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences) ;
  • Ghalehbaghi, Babak (Otolaryngology and Head and Neck Surgery Research Center, Iran University of Medical Sciences)
  • Received : 2017.11.29
  • Accepted : 2018.02.19
  • Published : 2018.07.01
Download PDF
⟨ Previous Next ⟩

Abstract

Fibromyalgia (FM) is a contested illness with ill-defined boundaries. There is no clearly defined cut-point that separates FM from non-FM. Diagnosis of FM has been faced with several challenges that occur, including patients' health care-seeking behavior, symptoms recognition, and FM labeling by physicians. This review focuses on important but less visible factors that have a profound influence on under- or over-diagnosis of FM. FM shows different phenotypes and disease expression in patients and even in one patient over time. Psychosocial and cultural factors seem to be a contemporary ferment in FM which play a major role in physician diagnosis even more than having severe symptom levels in FM patients. Although the FM criteria are the only current methods which can be used for classification of FM patients in surveys, research, and clinical settings, there are several key pieces missing in the fibromyalgia diagnostic puzzle, such as invalidation, psychosocial factors, and heterogeneous disease expression. Regarding the complex nature of FM, as well as the arbitrary and illusory constructs of the existing FM criteria, FM diagnosis frequently fails to provide a clinical diagnosis fit to reality. A physicians' judgment, obtained in real communicative environments with patients, beyond the existing constructional scores, seems the only reliable way for more valid diagnoses. It plays a pivotal role in the meaning and conceptualization of symptoms and psychosocial factors, making diagnoses and labeling of FM. It is better to see FM as a whole, not as a medical specialty or constructional scores.

Keywords

References

  1. Wolfe F, Walitt B. Culture, science and the changing nature of fibromyalgia. Nat Rev Rheumatol 2013; 9: 751-5. https://doi.org/10.1038/nrrheum.2013.96
  2. Wolfe F, Walitt B. Fibromyalgia: a short commentary. J Headache Pain Manag 2016; 1: 27.
  3. Schmidt-Wilcke T, Clauw DJ. Fibromyalgia: from pathophysiology to therapy. Nat Rev Rheumatol 2011; 7: 518-27. https://doi.org/10.1038/nrrheum.2011.98
  4. Mease PJ, Arnold LM, Crofford LJ, Williams DA, Russell IJ, Humphrey L, et al. Identifying the clinical domains of fibromyalgia: contributions from clinician and patient Delphi exercises. Arthritis Rheum 2008; 59: 952-60. https://doi.org/10.1002/art.23826
  5. Vincent A, Hoskin TL, Whipple MO, Clauw DJ, Barton DL, Benzo RP, et al. OMERACT-based fibromyalgia symptom subgroups: an exploratory cluster analysis. Arthritis Res Ther 2014; 16: 463. https://doi.org/10.1186/s13075-014-0463-7
  6. Sluka KA, Clauw DJ. Neurobiology of fibromyalgia and chronic widespread pain. Neuroscience 2016; 338: 114-29. https://doi.org/10.1016/j.neuroscience.2016.06.006
  7. Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Häuser W, Katz RS, et al. Fibromyalgia criteria and severity scales for clinical and epidemiological studies: a modification of the ACR preliminary diagnostic criteria for fibromyalgia. J Rheumatol 2011; 38: 1113-22. https://doi.org/10.3899/jrheum.100594
  8. Wolfe F, Brähler E, Hinz A, Häuser W. Fibromyalgia prevalence, somatic symptom reporting, and the dimensionality of polysymptomatic distress: results from a survey of the general population. Arthritis Care Res (Hoboken) 2013; 65: 777-85. https://doi.org/10.1002/acr.21931
  9. Kosek E, Ordeberg G. Lack of pressure pain modulation by heterotopic noxious conditioning stimulation in patients with painful osteoarthritis before, but not following, surgical pain relief. Pain 2000; 88: 69-78. https://doi.org/10.1016/S0304-3959(00)00310-9
  10. Clauw DJ. Fibromyalgia: a clinical review. JAMA 2014; 311: 1547-55. https://doi.org/10.1001/jama.2014.3266
  11. Häuser W, Clauw DJ, Fitzcharles MA. Treat‐to‐target strategy for fibromyalgia: opening the dialogue. Arthritis Care Res (Hoboken) 2017; 69: 462-6. https://doi.org/10.1002/acr.22970
  12. Bidari A, Ghavidel-Parsa B, Ghalehbaghi B. Reliability of ACR criteria over time to differentiate classic fibromyalgia from nonspecific widespread pain syndrome: a 6-month prospective cohort study. Mod Rheumatol 2009; 19: 663-9. https://doi.org/10.3109/s10165-009-0222-9
  13. Egloff N, von Känel R, Müller V, Egle UT, Kokinogenis G, Lederbogen S, et al. Implications of proposed fibromyalgia criteria across other functional pain syndromes. Scand J Rheumatol 2015; 44: 416-24. https://doi.org/10.3109/03009742.2015.1010103
  14. Walitt B, Fitzcharles MA, Hassett AL, Katz RS, Häuser W, Wolfe F. The longitudinal outcome of fibromyalgia: a study of 1555 patients. J Rheumatol 2011; 38: 2238-46. https://doi.org/10.3899/jrheum.110026
  15. Perrot S, Choy E, Petersel D, Ginovker A, Kramer E. Survey of physician experiences and perceptions about the diagnosis and treatment of fibromyalgia. BMC Health Serv Res 2012; 12: 356. https://doi.org/10.1186/1472-6963-12-356
  16. Ghavidel-Parsa B, Bidari A, Amir Maafi A, Ghalebaghi B. The iceberg nature of fibromyalgia burden: the clinical and economic aspects. Korean J Pain 2015; 28: 169-76. https://doi.org/10.3344/kjp.2015.28.3.169
  17. Walitt B, Katz RS, Bergman MJ, Wolfe F. Three-quarters of persons in the US population reporting a clinical diagnosis of fibromyalgia do not satisfy fibromyalgia criteria: the 2012 National Health Interview Survey. PLoS One 2016; 11: e0157235. https://doi.org/10.1371/journal.pone.0157235
  18. Walitt B, Nahin RL, Katz RS, Bergman MJ, Wolfe F. The prevalence and characteristics of fibromyalgia in the 2012 National Health Interview Survey. PLoS One 2015; 10: e0138024. https://doi.org/10.1371/journal.pone.0138024
  19. Häuser W, Ablin J, Fitzcharles MA, Littlejohn G, Luciano JV, Usui C, et al. Fibromyalgia. Nat Rev Dis Primers 2015; 1: 15022.
  20. Wolfe F. Editorial: the status of fibromyalgia criteria. Arthritis Rheumatol 2015; 67: 330-3. https://doi.org/10.1002/art.38908
  21. Wolfe F, Fitzcharles MA, Goldenberg DL, Häuser W, Katz RL, Mease PJ, et al. Comparison of physician-based and patient-based criteria for the diagnosis of fibromyalgia. Arthritis Care Res (Hoboken) 2016; 68: 652-9. https://doi.org/10.1002/acr.22742
  22. Aronowitz RA. When do symptoms become a disease? Ann Intern Med 2001; 134: 803-8. https://doi.org/10.7326/0003-4819-134-9_Part_2-200105011-00002
  23. Marchesoni A, De Marco G, Merashli M, McKenna F, Tinazzi I, Marzo-Ortega H, et al. The problem in differentiation between psoriatic-related polyenthesitis and fibromyalgia. Rheumatology (Oxford) 2018; 57: 32-40. https://doi.org/10.1093/rheumatology/kex079
  24. Kool MB, van Middendorp H, Boeije HR, Geenen R. Understanding the lack of understanding: invalidation from the perspective of the patient with fibromyalgia. Arthritis Rheum 2009; 61: 1650-6. https://doi.org/10.1002/art.24922
  25. Santiago MG, Marques A, Kool M, Geenen R, da Silva JA. Invalidation in patients with rheumatic diseases: clinical and psychological framework. J Rheumatol 2017; 44: 512-8. https://doi.org/10.3899/jrheum.160559
  26. Kool MB, van Middendorp H, Lumley MA, Schenk Y, Jacobs JW, Bijlsma JW, et al. Lack of understanding in fibromyalgia and rheumatoid arthritis: the Illness Invalidation Inventory (3*I). Ann Rheum Dis 2010; 69: 1990-5. https://doi.org/10.1136/ard.2009.123224
  27. Ghavidel-Parsa B, Amir Maafi A, Aarabi Y, Haghdoost A, Khojamli M, Montazeri A, et al. Correlation of invalidation with symptom severity and health status in fibromyalgia. Rheumatology (Oxford) 2015; 54: 482-6. https://doi.org/10.1093/rheumatology/keu355
  28. Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum 1990; 33: 160-72. https://doi.org/10.1002/art.1780330203
  29. Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res (Hoboken) 2010; 62: 600-10. https://doi.org/10.1002/acr.20140
  30. Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Häuser W, Katz RL, et al. 2016 revisions to the 2010/2011 fibromyalgia diagnostic criteria. Semin Arthritis Rheum 2016; 46: 319-29. https://doi.org/10.1016/j.semarthrit.2016.08.012
  31. Bennett RM, Friend R, Marcus D, Bernstein C, Han BK, Yachoui R, et al. Criteria for the diagnosis of fibromyalgia: validation of the modified 2010 preliminary American College of Rheumatology criteria and the development of alternative criteria. Arthritis Care Res (Hoboken) 2014; 66: 1364-73. https://doi.org/10.1002/acr.22301
  32. Fitzcharles MA, Ste-Marie PA, Rampakakis E, Sampalis JS, Shir Y. Disability in fibromyalgia associates with symptom severity and occupation characteristics. J Rheumatol 2016; 43: 931-6. https://doi.org/10.3899/jrheum.151041
  33. Smythe HA. Unhelpful criteria sets for "diagnosis" and "assessment of severity" of fibromyalgia. J Rheumatol 2011; 38: 975-8. https://doi.org/10.3899/jrheum.110142
  34. Ehrlich GE. Pain is real; fibromyalgia isn't. J Rheumatol 2003; 30: 1666-7.
  35. Hadler NM, Greenhalgh S. Labeling woefulness: the social construction of fibromyalgia. Spine (Phila Pa 1976) 2005; 30: 1-4.
  36. Barker KK. Listening to Lyrica: contested illnesses and pharmaceutical determinism. Soc Sci Med 2011; 73: 833-42. https://doi.org/10.1016/j.socscimed.2011.05.055
  37. Desmeules JA, Cedraschi C, Rapiti E, Baumgartner E, Finckh A, Cohen P, et al. Neurophysiologic evidence for a central sensitization in patients with fibromyalgia. Arthritis Rheum 2003; 48: 1420-9. https://doi.org/10.1002/art.10893
  38. Friend R, Bennett RM. A critical examination of the Polysymptomatic Distress Scale construct as a symptom severity questionnaire. J Rheumatol 2015; 42: 1364-7. https://doi.org/10.3899/jrheum.150611
  39. Usui C, Hatta K, Aratani S, Yagishita N, Nishioka K, Kanazawa T, et al. The Japanese version of the modified ACR preliminary diagnostic criteria for fibromyalgia and the fibromyalgia symptom scale: reliability and validity. Mod Rheumatol 2013; 23: 846-50. https://doi.org/10.3109/s10165-012-0759-x
  40. Jones GT, Atzeni F, Beasley M, Fluss E, Sarzi-Puttini P, Macfarlane GJ. The prevalence of fibromyalgia in the general population: a comparison of the American College of Rheumatology 1990, 2010, and modified 2010 classification criteria. Arthritis Rheumatol 2015; 67: 568-75. https://doi.org/10.1002/art.38905
  41. Ferrari R, Russell AS. A questionnaire using the modified 2010 American College of Rheumatology criteria for fibromyalgia: specificity and sensitivity in clinical practice. J Rheumatol 2013; 40: 1590-5. https://doi.org/10.3899/jrheum.130367
  42. Bidari A, Hassanzadeh M, Ghavidel Parsa B, Kianmehr N, Kabir A, Pirhadi S, et al. Validation of the 2010 American College of Rheumatology preliminary diagnostic criteria for fibromyalgia in an Iranian population. Rheumatol Int 2013; 33: 2999-3007. https://doi.org/10.1007/s00296-013-2829-6
  43. Häuser W, Jung E, Erbslöh-Möller B, Gesmann M, Kühn- Becker H, Petermann F, et al. Validation of the Fibromyalgia Survey Questionnaire within a cross-sectional survey. PLoS One 2012; 7: e37504. https://doi.org/10.1371/journal.pone.0037504
  44. Segura-Jimenez V, Aparicio VA, Alvarez-Gallardo IC, Soriano-Maldonado A, Estevez-Lopez F, Delgado-Fernandez M, et al. Validation of the modified 2010 American College of Rheumatology diagnostic criteria for fibromyalgia in a Spanish population. Rheumatology (Oxford) 2014; 53: 1803-11. https://doi.org/10.1093/rheumatology/keu169
  45. Furedi F. The end of professional dominance. Society 2006; 43: 14-8. https://doi.org/10.1007/BF02698479
  46. Wolfe F. Most fibromyalgia research is worthless [Internet]. [place unknown]: The Fibromyalgia Perplex; 2016 [cited 2017 Oct 23]. Available at http://www.fmperplex.com/ 2016/08/30/most-fibromyalgia-research-is-worthless/.

Cited by

  1. Body Reprogramming: Reframing the Fibromyalgia narrative and providing an integrative therapeutic model vol.7, pp.2, 2018, https://doi.org/10.1177/2055102920971494
  2. Fibromyalgia: Recent Advances in Diagnosis, Classification, Pharmacotherapy and Alternative Remedies vol.21, pp.21, 2018, https://doi.org/10.3390/ijms21217877
  3. Psychometric Properties of the Fibromyalgia Survey Questionnaire in Chilean Women With Fibromyalgia vol.27, pp.6, 2018, https://doi.org/10.1097/rhu.0000000000001547
  4. The Work of Workplace Disclosure : Invisible Chronic Conditions and Opportunities for Design vol.5, pp.cscw1, 2018, https://doi.org/10.1145/3449147
  5. High cost of illness in fibromyalgia patients in Iran, irrespective of disease severity: A prospective cost study vol.24, pp.5, 2018, https://doi.org/10.1111/1756-185x.14094
  6. Utilisation of healthcare services and drug consumption in fibromyalgia: A cross‐sectional analysis of the Clalit Health Service database vol.75, pp.11, 2018, https://doi.org/10.1111/ijcp.14729
  7. Interactions between affect, cognition, and information behavior in the context of fibromyalgia vol.73, pp.1, 2018, https://doi.org/10.1002/asi.24538