New fibromyalgia diagnostic guidelines

As the NHS makes clear:

“Diagnosing fibromyalgia can be difficult, as there’s no specific test to diagnose the condition. The symptoms of fibromyalgia can vary and are similar to those of several other conditions.”

For that reason, fibromyalgia has been treated mainly as a diagnosis of exclusion, ie can other conditions be ruled out as responsible for your symptoms? If so, you may have fibromyalgia. However, a problem with that approach is that the symptoms of fibromyalgia may also be present in other conditions, for example:

• hyperthyroidism (an underactive thyroid gland);
• chronic fatigue syndrome (CFS or Myalgic Encephalomyelitis or ME); and
• rheumatoid arthritis.

To complicate matters further, if you suffer from one of these other conditions, you may concurrently have fibromyalgia.

Fibromyalgia diagnosis UK

If it’s possible to exclude other conditions, or they do not fully explain the presenting symptoms, the NHS says that the most common diagnostic criteria for fibromyalgia are:

• The presence of severe pain in 3 to 6 different areas or milder pain in 7 or more different areas.
• Persisting symptoms at a more or less constant and similar level for at least 3 months.
• No other explanation for the persistence of these symptoms has been identified.

Fibromyalgia tender points

The severity of your pain for the purpose of diagnosing fibromyalgia used to be assessed by applying pressure to certain ‘tender points’ on the body where the pain was likely to be most severe. These days that has largely gone out of fashion.

RCP fibromyalgia guidelines

As a result of this uncertainty, there is a significant risk of being wrongly diagnosed, which then often significantly delays a correct diagnosis. It’s also not unknown for people to be wrongly diagnosed with fibromyalgia.

Therefore, the Royal College of Physicians (RCP) has recently published clinical guidelines entitled, ‘The diagnosis of fibromyalgia syndrome’. These guidelines are the result of a multi-professional working party, which also included input from patients and their carers.

Although these guidelines contain no new information on fibromyalgia and its diagnosis, they draw together a broad spectrum of knowledge and experience and provide some real structure and cohesion to the diagnostic process.

An interesting aspect of the guidelines relates to who can diagnose fibromyalgia. Traditionally, the condition’s diagnosis has tended to fall within the field of rheumatology. But the guidelines say that:

“The diagnosis of FMS should be made by any clinician adequately experienced to make this diagnosis.”

While suitably vague, this nevertheless suggests that clinicians in other disciplines who are regularly involved in the clinical management of the condition may also now diagnose. The most obvious candidates are pain medicine specialists, but the RCP say:

“Any diagnostician (eg a GP or physiotherapist) is well-placed to consider a diagnosis of FMS.” [my emphasis]

User friendly

The guidelines are relatively easy to read – certainly not written solely for clinicians – and if you or a loved one are affected by fibromyalgia, I would recommend them to you. You will find the link above.

So far, there seems to have been minimal feedback from either clinicians or patient groups, but that is likely to change soon.

If you have developed symptoms of fibromyalgia following an accident in the last 3 years, or you currently have an injury claim ongoing where you think you may have developed fibromyalgia, contact us, as we are specialists in maximising damages in such claims.