Earlier this month I posted that a new Fibromyalgia diagnostic criteria has been proposed that will not include tender point examinations. Even though some of the reports I have read are stating that the revisions are “new and improved”, I have been reading mixed emotions by Fibromyalgia patients on the subject. The new diagnostic criteria is for both the United States and Canada.
If the tender point exam is eliminated from the diagnosis inclusions, most people then with headaches, sore joints and fatigue be given a wastebasket diagnosis of Fibromyalgia? Even with the tender points inclusion that have been used up until now, look how many doctors diagnose people with Fibromyalgia and use it as a wastebasket diagnosis? Is this going to cause a lot of problems for culrrently diagnosed Fibromyagia patients?
The American College of Rheumatology proposes the new diagnostic criteria include focusing on common FM symptoms such as sleep disturbances, fatigue, pain and cognitive dysfunction. Robert S. Katz, one of the authors of the new criteria and a rheumatologist at Rush University Medical Center, says in a Medical News Today article:
“These new criteria recognize that fibromyalgia is more than just body pain. This is a big deal for patients who suffer symptoms but have had no diagnosis. A definite diagnosis can lead to more focused and successful treatment and reducing the stress of the unknown.”
“There are numerous shortcomings with the previous criteria, which didn’t take into account the importance of common symptoms including significant fatigue, a lack of mental clarity and forgetfulness, sleep problems and an impaired ability to function doing normal activities. The tender point test also has a gender bias because men may report widespread pain, but they generally aren’t as tender as women. Fibromyalgia may be under-diagnosed in both men and women because of the reliance on 11 tender points, and also due to failing to account for the other central features of the illness.”
The authors of the propsed new criteria also said that most primary care doctors don’t bother to check tender points or they aren’t checking them correctly. They claim that the new criteria will standardize a symptom-based diagnosis so that all doctors are using the same process. But I wonder if this will change will just give the doctors that already didn’t believe in Fibromyalgia just another reason to continue to not believe in it.
The tenderpoint exam will be replaced with a widespread pain index and a symptom severity scale:
The widespread pain index score is determined by counting the number of areas on the body where the patient has felt pain in the last week. The checklist includes 19 specified areas. The symptom severity score is determined by rating on a scale of zero to three, three being the most pervasive, the severity of three common symptoms: fatigue, waking unrefreshed and cognitive symptoms. An additional three points can be added to account for the extent of additional symptoms such as numbness, dizziness, nausea, irritable bowel syndrome or depression. The final score is between 0 and 12.
To meet the criteria for a diagnosis of fibromyalgia a patient would have seven or more pain areas and a symptom severity score of five or more; or three to six pain areas and a symptom severity score of nine or more.
Some criteria will remain unchanged. The symptoms must have been present for at least three months, and the patient does not have a disorder that would otherwise explain the pain.
With the new criteria, will all currently diagnosed Fibromyalgia patients have to go through this in order to continue to be diagnosed with Fibromyalgia? I think there are some good changes coming with the new criteria. Everybody with Fibromyalgia doesn’t suffer the same. I’m sure that for some patients some of the other symptoms are worse for them than the pain. The new criteria will include those other symptoms.
I think one of the things that worries me about the new criteria is that if you are not seeing a rheumatologist, will the new criteria even be used? Rheumatologists will be up to date with the changes but will regular family practitioners? I am hoping for the best, but I’m still questioning the changes. I guess we’ll have to wait and see what comes out of it. What are your thoughts? Do you feel this is a good or bad change?