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UPDATE ON FIBROMYALGIA SYNDROME (FMS)

I first got interested in fibromyalgia back in the mid nineties. I was taught that FMS was a multi-faceted pain disorder that could be diagnosed using the criteria designed by the American College of Rheumatology (ACR) in 1990.  The confirmation of FMS included:
  • Pain is the predominant complaint (as opposed to fatigue in chronic fatigue syndrome)
  • Pain for > 3 months duration
  • Pain in 3 out of 4 quadrants of the body
  • Tenderness to palpation in 11 out of 18 predetermined tender points (which are in no way trigger points)
  • The advent is preceded by a traumatic event – physical or mental trauma, disease, illness, accident, fall, surgery, divorce, death of a loved one etc.

At the beginning of my interest I saw many patients with the diagnosis. In the last 5-7 years I’ve noticed a tailing off. Either there were fewer diagnoses being made, or the battle was being won. As a subscriber to the Journal of Musculoskeletal Pain with contributions from all around the world I don’t believe that it’s the latter.

Why then fewer diagnoses? Seems that doctors were having trouble with the 4th and 5thbullet points listed above. In 2010 a bunch of doctors put forward a new set of diagnostic criteria.

Have a look at the scoring table published below in the journal Arthritis Care and Research Vol 62, No.5 May 2010. The authors were F. Wolfe, D. Clauw, M. Fitzcharles, D. Goldenberg, R. Katz, P. Mease, A. Russell, I. Jon Russell, J. M. Winefield and M. Yunus. These people are glitterati.

  • The table above now includes 2 more variables that best define FMS and its symptom spectrum
    • The Widespread Pain Index (WPI – score one point for each area)
      • 19 areas of the body are scored by number of areas in pain

ü  A total of 7 or more is bad

  • The composite Symptom Severity scale (SS)
    • Three symptoms scored by severity (0-3)

v Un-refreshed sleep

v Fatigue

v Cognitive symptoms

ü  A total of 5 or more is bad

  • This new list can be summarized as pain for > 3 months (stet), WPI ≥ 7, SS ≥5 and should include the fact that no other disorder that might explain the pain.
  • Along the way, an educated use of the 11 out of 18 tender points being tender should never be discounted.

So, what does this new confirmation criteria mean?  The experts expect less people will fall through the cracks. They reinforce that this syndrome is real and not going away. The ubiquitous trigger point phenomena also cloud the skies. Many, if not all FMS sufferers also have trigger points.

So, what do we as manual therapists do about it?

A future blog will offer interventions from a neuromuscular point of view that I put together 10-12 years ago, and then compare that with techniques that I’ve developed over the intervening years.

Maybe we’ll find that not much has changed.

Stew