The symptoms that commonly affect patients with fibromyalgia syndrome include pain, sleep problems, stiffness (especially after rest in the morning), fatigue, bowel upset (irritable bowel syndrome), depression, headaches etc. The pain and the symptoms of the condition tend to last a life time in most patients.
Fibromyalgia syndrome is defined by the American College of Rheumatology (ACR) as pain that is widespread and lasts for over 3 months. The pain needs to be present:-
Left or right shoulder and buttock pain is considered to be pain on either side. Low back pain is considered lower segment pain.
Of the 18 defined tender points, the pain should be present in at least 11 points according to this definition on application of manual pressure of approximately 4 kg over the points. These criteria for fibromyalgia was and is still widely used as prescribed by ACR in 1990.
The criteria for diagnosis were revised in 2010. The new criteria were an alternative method of diagnosis in which the tender point criteria was excluded. The latest criteria for diagnosis includes:-
Widespread pain index (WPI) of more than or equal to 7 and Symptom severity (SS) scale score of more than or equal to 5
WPI of 3-6 and SS scale score more than or equal to 9
The symptoms should be present for at least 3 months and other conditions need to be ruled out. In the new criteria the WPI consists of a total of 19 body areas. At each of these points the patient is asked to score his or her pain during the most recent week between 0 and 19.
Similarly for the SS score the patient is asked to report the severity of three features of fatigue, waking un-refreshed and cognitive symptoms in a score of 0 to 12. The level of severity is rated on a Likert scale that ranges from 0 to 3, where 0 is no problem and 3 is severe problem.
The fibromyalgia pain is accompanied by a high degree of impairment in the patients in performing their daily functioning.
If compared with other chronic or long term pain conditions, patients with fibromyalgia report higher levels of pain and disability in performing their daily activities.
Fibromyalgia patients also report a poorer quality of life compared to other chronic pain patients.
The chronic pain makes regular and extensive use of health services a necessity for fibromyalgia patients. This leads to high costs for medical and societal care.
Types of fibromyalgia pain include:-