In his post on Cannabis, John Quintner refers to “Too Easy To Diagnose Fibromyalgia.” One might think I would be offended by this offhand categorization, as I have spent much of my professional life working on fibromyalgia diagnosis. (Wolfe, Smythe et al. 1990, Wolfe, Clauw et al. 2010, Wolfe, Clauw et al. 2011, Wolfe, Clauw et al. 2016) Look what he says. A “constellation of symptoms …exists in varying degrees of severity within all communities. These symptoms are non-specific and include widespread pain and tenderness, fatigability, sleep disturbance, cognitive impairment, mood changes etc. When present together in various combinations they are currently understood as reflecting “polysymptomatic distress” (Wolfe, Walitt et al. 2015). Self-diagnosis is not at all uncommon, through the agency of electronic media and support groups.” Worse than that, “…there is no objective marker or test for fibromyalgia, and it has been said that the condition can co-exist with any other painful condition, theoretically the label may be applied to many of the one in five members of the general population who report persistent pain and associated distress.”
And even worse than that, Brian Walitt and I applied surrogate criteria to the US National Health Interview Survey and found that fibromyalgia is often not diagnosed when the symptoms fit, but that most people who are diagnosed with fibromyalgia don’t satisfy criteria for fibromyalgia. (Walitt, Katz et al. 2016)
Last week, I read a new publication from Dan Clauw’s group, the inveterate and ubiquitous promulgators, that stated, “Fibromyalgia (FM) is the current term for chronic widespread musculoskeletal pain for which no alternative cause can be identified.” (Sluka and Clauw 2016) With that characterization Clauw threw out all of the criteria: fibromyalgia is simply “chronic widespread pain.”
And fibromyalgia as chronic widespread pain isn’t something you have to have now. It can come and go. Once fibromyalgia, always fibromyalgia. Using such definitions the prevalence of fibromyalgia can be seen to exceed 20%. I am reminded of Derek Summerfield’s comment, “… If on average 1 in 4 or 6 of the people going about their ordinary business on the street outside my house as I write are diagnosable as ‘cases’ of mental illness, we need to re-examine our models before we examine the people.” (Sluka and Clauw 2016)
So what good are criteria? They keep people a little more honest. When applied, they should prevent people with trivial problems being diagnosed with fibromyalgia. They set obvious limits of validity and reliability that all of us and institutions and courts should be aware of. And they should make us think a diagnosis of fibromyalgia is not always the best or only way of approaching symptoms and distress.
Sluka, K. A. and D. J. Clauw (2016). “Neurobiology of fibromyalgia and chronic widespread pain.” Neuroscience.
Walitt, B., R. S. Katz, M. J. Bergman and F. Wolfe (2016). “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 11(6): e0157235.
Wolfe, F., D. Clauw, M. A. Fitzcharles, D. Goldenberg, W. Häuser, R. S. Katz, P. Mease, A. S. Russell, I. J. Russell and J. B. Winfield (2011). “Fibromyalgia Criteria and Severity Scales for Clinical and Epidemiological Studies: A Modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia.” J Rheumatol. 38: 1113-1122.
Wolfe, F., D. Clauw, M. A. Fitzcharles, D. Goldenberg, R. S. Katz, P. Mease, A. S. Russell, I. J. Russel, J. Winfield and M. B. Yunus (2010). “The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity.” Arthritis Care Res 62(5): 600-610.
Wolfe, F., D. J. Clauw, M.-A. Fitzcharles, D. L. Goldenberg, W. Häuser, R. L. Katz, P. J. Mease, A. S. Russell, I. J. Russell and B. Walitt (2016). “2016 Revisions to the 2010/2011 Fibromyalgia Diagnostic Criteria.” Seminars in Arthritis and Rheumatism.
Wolfe, F., H. A. Smythe, M. B. Yunus, R. M. Bennett, C. Bombardier, D. L. Goldenberg, P. Tugwell, S. M. Campbell, M. Abeles, P. Clark and et al. (1990). “The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee.” Arthritis Rheum 33(2): 160-172.
Wolfe, F., B. T. Walitt, J. J. Rasker, R. S. Katz and W. Häuser (2015). “The Use of Polysymptomatic Distress Categories in the Evaluation of Fibromyalgia (FM) and FM Severity.” The Journal of rheumatology 42(8): 1494-1501.