It is very important for the healthcare professional (HCP) to establish rapport with the patient and confirm to them to the very real existence of this condition.
It should no longer be a diagnosis due to all other medical conditions being excluded.
Diagnosis should be accompanied by a comprehensive explanation and it has been noted that patients seem to be most satisfied by explanations that make sense to them, remove blame, integrate psychological and biological factors and which suggest concrete ideas for management.
The quality of explanation offered is likely to be a key determinant on whether patients will seek a second opinion so it is important that a healthcare professional spends a good amount of time getting it right first time.
The American College of Rheumatology published new guidelines for the diagnosis of Fibromyalgia Syndrome in 2010 and these were further revised in 2016.
Wolfe et al conclude that and all 4 of the following need to be present:
1) Widespread pain index (WPI) ≥7 and symptom severity scale (SSS) score ≥5 OR WPI 4–6 and SSS score ≥9.
2) Generalized pain, defined as pain in at least 4 of 5 regions, is present. The 5 regions are Left upper and right upper, left lower and right lower and axial.
3) Symptoms have been present at a similar level for at least 3 months.
4) A diagnosis of fibromyalgia is valid irrespective of other diagnoses. A diagnosis of fibromyalgia does not exclude the presence of other clinically important illnesses.
Wolfe F, Clauw DJ, FitzCharles M, Goldenerberg D, Häuser W, Katz RS, Russell IJ, Mease PJ, Russell A, Walitt B. 2016 Revisions to the 2010/2011 Fibromyalgia Diagnostic Criteria [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/2016-revisions-to-the-20102011-fibromyalgia-diagnostic-criteria/. Accessed October 16, 2018.
Fibromyalgia information leaflet by Dr Deepak Ravindran, Consultant Pain Medicine Royal Berkshire Hospital