There have been recent changes to the original guidelines developed in 1990 for diagnosing fibromyalgia. These involved strict criteria regarding history of widespread body pain, and a trigger point exam; where the examiner would push with a predetermined amount of pressure on 18 places on the patient’s body. If the patient had a pain history that fit the criteria, and pain in at least 11 out of 18 trigger points, then a diagnosis of fibromyalgia could be made. This method of diagnosis is now thought to be too restrictive, and excludes people who actually have the disease, and therefore preventing them from getting the treatment they need. In April of 2010, the American College of Rheumatology proposed a new system that was based on a study where patients were asked about their symptoms, symptom severity, number of medications used, and how many of the 56 designated symptoms they experienced. With this system a diagnosis of fibromyalgia can be made if: The pain location and symptom severity score were above a certain level, the symptoms had been present for at least 3 months, and there is no other disorder that would otherwise explain the pain. This is the type of method I use for diagnosis, and believe it is a much better way to accurately diagnose fibromyalgia than the old trigger point system.
Looking without seeing
Everyone who gets a diagnosis of fibromyalgia is inheriting a syndrome with no known cure, which infiltrates every part of their lives, and which they could pass on to their children. But it is also unknown territory—some doctors do not even believe the syndrome exists. In March of 2008, I received a diagnosis of fibromyalgia.
I had been practicing pediatrics for 18 years. I had learned about fibromyalgia in medical school and residency, but like many pediatricians, thought I had never seen a case. I was taught that in order to be diagnosed with fibromyalgia, an adult would need to fulfill established criteria: having long lasting pain in specified areas of the body. I had no idea that a person could have fibromyalgia without intense widespread pain, or that almost every organ system could be effected. I had no idea a toddler could be diagnosed with juvenile fibromyalgia. Looking back, I now know that some of my puzzling pediatric cases had fibromyalgia, and I missed the diagnosis because I didn’t know what I was looking for.