Section Free - Video Lectures

03. Diagnosing Fibromyalgia

Published on July 1, 2023 Certification expiration date: July 1, 2026

Daniel J. Clauw, M.D.

Professor of anesthesiology & Psychiatry at the University of Michigan - Georgetown University

Key Points

The new criteria for fibromyalgia look for a combination of:
-Widespread pain.
-Sleep, memory, and fatigue problems.
-Irritable bowel, depression, and headache.

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Slides and Transcript

Slide 1 of 11

The current fibromyalgia diagnostic criteria.

Diagnosing Fibromyalgia Slide 1 of 11

Slide 2 of 11

You see on the left side a body map. There are 19 sites on this body map and people are asked to check all the sites they have pain.

References:

Clauw, D. J. (2014). Fibromyalgia. JAMA, 311(15), 1547.
Wolfe, F., Clauw, D. J., Fitzcharles, M. A., Goldenberg, D. L., Häuser, W., Katz, R. S., Mease, P., Russell, A. S., Russell, I. J., & Winfield, J. B. (2011). Fibromyalgia criteria and severity scales for clinical and epidemiological studies: A modification of the ACR preliminary diagnostic criteria for fibromyalgia. The Journal of Rheumatology, 38(6), 1113–1122.

Diagnosing Fibromyalgia Slide 2 of 11

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Slide 3 of 11

And you add up from 0 to 19 how many sites people have pain in. And this measure is called the Widespread Pain Index and it just gives you an extent of how widespread the pain is. And just the body map alone will help predict for example, which individuals with low back pain or osteoarthritis respond to a drug like duloxetine that is working in the amplifier, in the central nervous system.

References:

Clauw, D. J. (2014). Fibromyalgia. JAMA, 311(15), 1547.
Wolfe, F., Clauw, D. J., Fitzcharles, M. A., Goldenberg, D. L., Häuser, W., Katz, R. S., Mease, P., Russell, A. S., Russell, I. J., & Winfield, J. B. (2011). Fibromyalgia criteria and severity scales for clinical and epidemiological studies: A modification of the ACR preliminary diagnostic criteria for fibromyalgia. The Journal of Rheumatology, 38(6), 1113–1122.

Diagnosing Fibromyalgia Slide 3 of 11

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People are asked about central nervous system symptoms that are phenotypic markers of nociplastic pain or fibromyalgia. They’re asked about fatigue, memory problems, and sleep disturbances. Those are scored from 0, 1, 2, or 3 based on whether they’re not there, slight, moderate, or severe.

References:

Clauw, D. J. (2014). Fibromyalgia. JAMA, 311(15), 1547.
Wolfe, F., Clauw, D. J., Fitzcharles, M. A., Goldenberg, D. L., Häuser, W., Katz, R. S., Mease, P., Russell, A. S., Russell, I. J., & Winfield, J. B. (2011). Fibromyalgia criteria and severity scales for clinical and epidemiological studies: A modification of the ACR preliminary diagnostic criteria for fibromyalgia. The Journal of Rheumatology, 38(6), 1113–1122.

Diagnosing Fibromyalgia Slide 4 of 11

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Slide 5 of 11

And then people are asked about irritable bowel, depression, or headache and they get 1 point each for those questions.

References:

Clauw, D. J. (2014). Fibromyalgia. JAMA, 311(15), 1547.
Wolfe, F., Clauw, D. J., Fitzcharles, M. A., Goldenberg, D. L., Häuser, W., Katz, R. S., Mease, P., Russell, A. S., Russell, I. J., & Winfield, J. B. (2011). Fibromyalgia criteria and severity scales for clinical and epidemiological studies: A modification of the ACR preliminary diagnostic criteria for fibromyalgia. The Journal of Rheumatology, 38(6), 1113–1122.

Diagnosing Fibromyalgia Slide 5 of 11

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So a total of 0 to 19 points based on how widespread the pain is on the body map. A score from 0 to 9 points based on whether people have and how severe their fatigue, memory problems, and sleep disturbance are, and then a total of 3 points for just the presence or absence of irritable bowel, depression, or headache.

References:

Clauw, D. J. (2014). Fibromyalgia. JAMA, 311(15), 1547.
Wolfe, F., Clauw, D. J., Fitzcharles, M. A., Goldenberg, D. L., Häuser, W., Katz, R. S., Mease, P., Russell, A. S., Russell, I. J., & Winfield, J. B. (2011). Fibromyalgia criteria and severity scales for clinical and epidemiological studies: A modification of the ACR preliminary diagnostic criteria for fibromyalgia. The Journal of Rheumatology, 38(6), 1113–1122.

Diagnosing Fibromyalgia Slide 6 of 11

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Slide 7 of 11

This score from 0 to 31, if someone has a score of 13 or higher, they are said to be diagnosed with fibromyalgia.

References:

Clauw, D. J. (2014). Fibromyalgia. JAMA, 311(15), 1547.
Wolfe, F., Clauw, D. J., Fitzcharles, M. A., Goldenberg, D. L., Häuser, W., Katz, R. S., Mease, P., Russell, A. S., Russell, I. J., & Winfield, J. B. (2011). Fibromyalgia criteria and severity scales for clinical and epidemiological studies: A modification of the ACR preliminary diagnostic criteria for fibromyalgia. The Journal of Rheumatology, 38(6), 1113–1122.

Diagnosing Fibromyalgia Slide 7 of 11

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But one of the things that I think is really important to realize or understand is that all the data about nociplastic pain or fibromyalgia suggest that this is never just present or absence. Different people have different degrees of this.

References:

Clauw, D. J. (2014). Fibromyalgia. JAMA, 311(15), 1547.
Wolfe, F. (2009). Fibromyalgianess. Arthritis & Rheumatism, 61(6), 715-716.

Diagnosing Fibromyalgia Slide 8 of 11

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Slide 9 of 11

And the term fibromyalgianess was coined by Fred Wolfe many years ago to connote this. And he said that if you basically look at the degree of fibromyalgia that someone with osteoarthritis or rheumatoid arthritis or lupus has, that’s often a stronger predictor of how much pain or disability they have than our more objective measures of that disease like an x-ray or a sedimentation rate or a C-reactive protein. And so what we see is that the higher degree of fibromyalgianess is really just saying the same is that they have more central sensitization, more nociplastic pain.

References:

Clauw, D. J. (2014). Fibromyalgia. JAMA, 311(15), 1547.
Wolfe, F. (2009). Fibromyalgianess. Arthritis & Rheumatism, 61(6), 715-716.

Diagnosing Fibromyalgia Slide 9 of 11

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And so the new criteria for fibromyalgia nociplastic pain, look for a combination of more widespread pain, comorbid sleep, memory, and fatigue issues as well as irritable bowel, depression or headache.

Diagnosing Fibromyalgia Slide 10 of 11

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Slide 11 of 11

Diagnosing Fibromyalgia Slide 11 of 11

Next Section

04. Centralized Pain in Chronic Pain Conditions

Learning Objectives:

After completing this activity, the learner will be able to:

Delve into the pain mechanisms and appreciate their clinical relevance.
Learn the essential steps for recognizing and accurately diagnosing patients with fibromyalgia.
Execute impactful pharmacologic and nonpharmacologic interventions for chronic pain management.

Original Release Date: July 1, 2023

Review and Re-release Date: March 1, 2024

Expiration Date: July 1, 2026

Expert: Daniel Clauw, M.D.

Medical Editor: Paz Badía, M.D.

Relevant Financial Disclosures:

Daniel Clauw declares the following interests:

- Pfizer: Consultant
- Tonix: Consultant, research support
- Virios: Consultant

All of the relevant financial relationships listed above have been mitigated by Medical Academy and the Psychopharmacology Institute.

Contact Information: For questions regarding the content or access to this activity, contact us at support@psychopharmacologyinstitute.com

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