So it looks like some clinicians have some uncertainty when it comes to diagnosing Fibromyalgia. Remember the criteria for tender points is no longer used.
Data from the U.S., Europe and Asia report that approximately half of providers admit uncertainty in confidently making a diagnosis of [fibromyalgia]. Diagnosing [fibromyalgia] more promptly should reduce unnecessary tests, specialty referrals, health care costs and patient anxiety,” Kim D. Jones, PhD,FNP, FAAN, from Oregon Health and Science University School of Nursing and School of Medicine, and colleagues wrote. “Based on our clinical experience, we surmise that clinicians need a simple screening test that can be performed as part of the routine evaluation in all patients with persistent pain complaints.”
The study recommends adding two things to help with assessments.
- Asking whether they have deep, persistent, aching pain all over their body. Widespread pain criteria.
- And see if there is pain when the Achilles tendon is pinched for 4 seconds.
The study involved 52 patients with FM, 108 with chronic pain but not FM and 192 without pain or FM. They used three measures: BP cuff-evoking pain, digital palpation-evoked pain and a question about persistent deep aching. Patients were looked at for tenderness to digital pressure at 10 spots and BP cuff-evoked pain and then asked to rate their deep persistent aching widespread pain on a 1-10 scale.
More FM patients answered the questions about persistent deep aching compared to the chronic pain subjects. They had higher bilateral digital evoked tenderness and BP cuff-evoked pain. (But the cuff-evoked pain became non-significant when researchers did multivariate logistic regressions).
Analysis demonstrated pinching the Achilles tendon for more than 4 seconds and a positive answer tot the deep aching question did provide a beneficial screening test that indicated a probably diagnosis of fibromyalgia.
“We are recommending two simple assessments to be added to the routine evaluation of any chronic pain patient. We envisage these assessments be used as a screening instrument not a diagnostic test, with a definitive diagnosis of [fibromyalgia] being reserved for later,” Jones and colleagues wrote. “By raising a providers’ index of suspicion, patients may be spared a lengthy cycling through the medical system before receiving a diagnosis of [fibromyalgia] and beginning treatment.”
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