DIAGNOSING FYBROMYALGIA: A NEW ERA
Fybromyalgia is the most common musculoskeletal condition after osteoarthritis. Yet, it is often misdiagnosed and misunderstood. Its characteristics include fatigue, joint and muscle pain, as well as other symptoms. This debilitating condition can cause depression and social isolation. While the majority of people who suffer with this syndrome are women, men are also diagnosed with the syndrome. Most patients are between 25-60 years of age. The impact that fybromyalgia has on lives come from the devastating physical and psychological strains associated with the condition. Those strains can lead to reduced working hours, loss of pay, and even job loss.
Diagnosing the condition is the first step to treating it. But for fybromyalgia patients, diagnosing the condition was difficult. Because of the very nature of this condition and the fact that there are no laboratory tests to diagnose, physicians had to rely on certain tender points in the body. They used a tender point exam or tenderness to the touch of 11 or more of 18 specific tender points and widespread pain in all four quadrants of the body over a period of three months. Many doctors did not know how to do a tender point count and, therefore, were not comfortable to diagnose this condition. Some doctors even dismissed their fybromyalgia patients saying that it was “all in the head”.
Well, change has come. Now there is a new way to diagnose fybromyalgia using a pain index coupled with a key symptoms severity scale. But the new method is not fail-safe yet. Since fybromyalgia is based on symptoms, X-rays cannot help in diagnosis as they can in other rheumatoid diseases. The trick to fybromyalgia is in its diagnosis.
NEW TREATMENT DETAILS
The criteria for this new treatment avoid the tender point exam and, instead, use a widespread pain index along with a severity scale for diagnosis. The pain index is a 19 item list. A person marks the body parts where they have experienced pain within the last week. The severity scale includes the three tell-tale symptoms of fybromyalgia; unrefreshed sleep, fatigue, and cognitive issues. Symptoms are rated on a severity scale of 0-3. The whole diagnosis encompasses the number of painful areas, the number of symptoms, and their severity. This diagnostic treatment received the approval of the American College of Rheumatology.
RESULTS OF THE NEW CRITERIA
By using the new criteria, physicians will be able to diagnose more people because they will be, in a sense, “casting a wider net”. The number of people affected by fybromyalgia is estimated to be over12 million or more in the United States and between 3-6% of the population worldwide. With the new treatment, this estimate may double or triple.
To test their criteria, the researchers used a group of 829 people diagnosed with fybromyalgia and another matched group of individuals suffering from other chronic pain conditions such as osteoarthritis and back pain. They found that the pain index, symptom severity, and number of symptoms were instrumental in the diagnosis for fybromyalgia. The new criteria can diagnose 88% of people with fybromyalgia without a physical or tender point exam. This is a break-through for doctors who otherwise would not deal with patients suspected of having fybromyalgia.
The new criteria adds more credibility to fybromyalgia because more types of doctors, not just rheumatologists, will be able to diagnosis this ailment. Now the diagnosis can be made and reassurance given to patients that this is a real condition and not just something in their head. When the diagnosis is made, then treatment can begin to help these sufferers of this debilitating condition.
One of the doctors that helped bring about the new criteria commented on the older criteria. According to Daniel J. Clauw, MD, a rheumatologist at the University of Michigan, the old criteria were never intended to diagnose fybromyalgia. They were only intended to be used to standardize classification criteria for research into fybromyalgia. They served that purpose well and will continue to be used by researchers in that way.
The new criteria will offer the medical world a clear alternative procedure to use, replacing the tender point exam with a tool that is intended for diagnostic use. This is wonderful news for fybromyalgia patients.