It has been a couple of years now since the 1990 criteria for the diagnosis of fibromyalgia were replaced. The new criteria now take into consideration the presence and severity of fatigue, cognitive symptoms, and unrefreshing sleep; the old criteria only discussed widespread pain and tender points. Now, instead of simply saying, I am treating fibromyalgia, a doctor can instead say, I am treating a patient with fatigue, sleep disturbance, and body pain. Some will say we in Rheumatology are now treating the patient, and not a syndrome that for some health care providers carries a socio-political weight that many find difficult to bear.
Unfortunately, the patient often was the loser, casting about from one doctor’s office to the next in search of not just pain relief, but a caring listener.
Of course, there are criticisms of the 2010 criteria. Some health care professionals mistakenly feel that the tender points of fibromyalgia are being ignored; but this is not true—it is just not emphasized so much. Others felt that depression should have been one of the criteria for the diagnosis of fibromyalgia. However, one must remember that the rheumatic diseases do not make for intrinsically happy patients: Many are chronic conditions that have their onset in youth, and in the setting of a previously healthy patient. Depression is to be expected with chronic pain and chronic illness. Specifically discussing fibromyalgia, depression just is not specific enough to be included in a set of diagnostic criteria.
Our colleagues in the psychiatric and psychology disciplines have in general agreed with the exclusion of depression from the 2010 criteria; it does not make the diagnosis of fibromyalgia more accurate. And good luck in concluding if depression caused fibromyalgia, or fibromyalgia caused the depression.
The 2010 criteria should be used as a screening tool for any individual with a chronic condition that can be associated with sleep disturbance and depression, such as lupus or rheumatoid arthritis, or progressive osteoarthritis. Many patients suffering from these conditions also deal with fibromyalgia. It is up to an astute health care provider to tease out pain due to inflammation or autoimmunity versus the more “central pain” due to fibromyalgia—and treat that pain.
Diagnosing fibromyalgia has always involved grasping at a gestalt. Treating fibromyalgia has always involved fingers crossed.
Perhaps the 2010 criteria have allowed us all to fumble a little less.