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This is the second of three short films on the examination of fibromyalgia. If you have not seen the first video, watch it first. Click on the link that appears to get to it. In this film, we will go through the diagnostic criteria for fibromyalgia from 2016.(1)
My name is Andreas Persson and I am a physiotherapist and specialist in pain and pain rehabilitation. What I say in the film can be found in text form together with references to the scientific literature that the things I say are based on. The link is in the description.
As I mentioned in the previous film, the criteria from 2016 have not been fully accepted, partly because they do not contain any physical tests. Another reason for this is that the person with symptoms can test whether she meets the criteria on her own. This means that healthcare professionals may lose some control over the diagnosis. As mentioned in the previous film, however, a doctor must be involved in the step before testing the diagnostic criteria, to exclude other underlying diseases. If you fill in the test form for yourself, you can take it to your doctor or physiotherapist to get it in your medical record.
Now we move on to the criteria themselves. The form we will go through can be printed from my website. The link is in the description.
This is a form that you can use to test the ACR 2016 criteria. At the top of the page is the widespread pain index. There, the sufferer can check the boxes for all areas that have hurt in the past week. The painful areas are divided into different regions and in this form a figure show which surface of the body is included in what area. The figure is shown in a larger version on the back of the document. When you have checked the boxes for all the areas that have hurt in the last week, you add them up and fill in how many they were in the box where it says WPI score.
Then you move on to the next part, the symptom severity scale. In this part you fill in how big problems you have with fatigue, waking unrefreshed and cognitive symptoms according to a scale that goes from no problems to severe / constantly present problems.
In the last part of the symptom severity scale, you check the boxes if you have had headaches, pain, or cramps in the lower abdomen and depressive symptoms in the last 6 months.
The points from the symptom severity scale are added up by adding the points in parentheses for the alternatives filled in for the first three parts together with one point for each of, headache, pain, or cramp in the lower abdomen and depression in the last six months. The total score is filled in the box that says SSS score.
Then you add up the score from the widespread pain index and the symptom severity scale and write it in the box where it says fibromyalgia severity scale. The fibromyalgia severity scale is a measure of how severely a person is suffering from fibromyalgia. The higher the number the more severe fibromyalgia.
The last step is to determine whether the person affected meets the 2016 diagnostic criteria for fibromyalgia.
You can find the criteria at the back of the form. To meet the diagnostic criteria, you must have seven or higher on the widespread pain index (WPI) and five points or higher on the symptom severity scale (SSS) Or 4-6 pain areas on WPI and 9 points or higher on SSS.
In addition to this, you need to have generalized pain to meet the diagnostic criteria. Generalized pain is defined in the criteria, as having had pain in at least 4 of the five regions listed in the pain distribution index. The generalized pain definition does not include pain in the jaw, chest, or abdomen. If you for example have only pain in the jaw in the left upper region, that region does not count.
To meet the criteria, the symptoms must have been present for at least three months.
In the criteria, it is pointed out that the diagnosis of fibromyalgia is valid regardless of other diagnoses. If the sufferer has, for example, the disease rheumatoid arthritis since before and meets the diagnostic criteria for fibromyalgia, the sufferer then has both diagnoses.
The authors of the criteria also point out that if you meet the criteria for fibromyalgia, you can also have other clinically important diseases.
Check out the youtube channel for more videos about fibromyalgia and chronic pain.
In the next video, we will go through the fibromyalgia criteria from 1990.
1. 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(3):319-29