Korean J Pain.  2018 Jul;31(3):147-154. 10.3344/kjp.2018.31.3.147.

Challenges in fibromyalgia diagnosis: from meaning of symptoms to fibromyalgia labeling

• Bidari A
• Ghavidel Parsa B
• Ghalehbaghi B

• KMID: 2417953
• DOI: http://doi.org/10.3344/kjp.2018.31.3.147

Abstract

Fibromyalgia (FM) is a contested illness with ill-defined boundaries. There is no clearly defined cut-point that separates FM from non-FM. Diagnosis of FM has been faced with several challenges that occur, including patients' health care-seeking behavior, symptoms recognition, and FM labeling by physicians. This review focuses on important but less visible factors that have a profound influence on under- or over-diagnosis of FM. FM shows different phenotypes and disease expression in patients and even in one patient over time. Psychosocial and cultural factors seem to be a contemporary ferment in FM which play a major role in physician diagnosis even more than having severe symptom levels in FM patients. Although the FM criteria are the only current methods which can be used for classification of FM patients in surveys, research, and clinical settings, there are several key pieces missing in the fibromyalgia diagnostic puzzle, such as invalidation, psychosocial factors, and heterogeneous disease expression. Regarding the complex nature of FM, as well as the arbitrary and illusory constructs of the existing FM criteria, FM diagnosis frequently fails to provide a clinical diagnosis fit to reality. A physicians' judgment, obtained in real communicative environments with patients, beyond the existing constructional scores, seems the only reliable way for more valid diagnoses. It plays a pivotal role in the meaning and conceptualization of symptoms and psychosocial factors, making diagnoses and labeling of FM. It is better to see FM as a whole, not as a medical specialty or constructional scores.

Keyword

Chronic fatigue syndrome; Chronic pain; Classification; Diagnosis; Dyssomnia; Fibromyalgia; Headache; Musculoskeletal diseases; Patient selection; Reproducibility of results; Surveys and questionnaires

MeSH Terms

Chronic Pain
Classification
Diagnosis*
Dyssomnias
Fatigue Syndrome, Chronic
Fibromyalgia*
Headache
Humans
Judgment
Musculoskeletal Diseases
Patient Selection
Phenotype
Psychology
Reproducibility of Results
Surveys and Questionnaires

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