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Innovations in Chronic Pain Therapeutics

diagnosis of chronic pain, widespread pain, tender points, widespread pain index, symptom severity

current practices

Diagnosis of fibromyalgia:

  • Chronic, widespread pain (both above and below the waist, and on the left and right sides) upon digital palpation of at least 11 of 18 tender points (American College of Rheumatology, Wolfe 1990). Or a Widespread Pain Index (WPI) ≥7 and symptom severity (SS) scale score ≥5; or WPI 3-6 and SS scale score ≥9 (American College of Rheumatology,Wolfe 2010).
  • Symptoms have been present for at least 3 months.
  • The patient does not have a disorder that would otherwise explain the pain.
  • The American College of Rheumatology (ACR) fibromyalgia Classification Criteria are used for diagnosis and clinical studies. For additional information on diagnosis and treatment go to: (Wolfe 1990) (Wolfe 2010) (Clauw 2014).

Current clinical practice for diagnosis and treatment of fibromyalgia:

Clauw DJ. Fibromyalgia: a clinical review. JAMA. 2014;311:1547-55.
This journal article is an authoritative and up-to-date clinical review of current clinical practices for the diagnosis and treatment of fibromyalgia.

Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis care & research. 2010;62:600-10.
This paper is the American College of Rheumatology’s (ACR) 2010 recommended diagnostic criteria for the diagnosis of fibromyalgia. It provides the Widespread Pain Index (WPI) and Symptom Severity (SS) scoring systems and an overall simple, validated set of diagnostic criteria for fibromyalgia. Alternatively the ACR’s 1990 criteria, below, can be used. The 2010 diagnostic system allows a clinician to use WPI in place of the tender point exam.

Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, et al. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis & Rheumatism. 1990;33:160-72.
This paper is the American College of Rheumatology’s 1990 recommended diagnostic criteria for the diagnosis of fibromyalgia. It assesses pain using the tender point exam method.


Additional related references:

The low pain thresholds, or high sensitivity to pain, in individuals with fibromyalgia are real.

Although early on there was a lack of good evidence that fibromyalgia was not just in a woman’s imagination, there is now good evidence that the low threshold of pain in these patients is real, as demonstrated for example by brain imaging studies in which there was a significant differential in pain processing in these patients vs normal individuals (Gracely 2002).