Is FIbromyalgia Over-Diagnosed?

In my opinion, fibromyalgia is becoming far too over-diagnosed. General practitioners, who are not qualified to do so, are diagnosing patients with fibro. “You’re sleepy all the time? Pain? You must have fibro.” Not so. This contributes greatly to the widespread belief that anyone with this diagnosis can still live a normal life.

I’ve even seen recommendations from random people online as to how to diagnosis a loved one with fibromyalgia. “Just look up the pressure points, press on them, and if it hurts, they have it.” WHAT? A specified amount of pressure must be applied to confirm the diagnosis. Press too hard and you can practically guarantee anyone would have a diagnosis, press too lightly and those suffering from a mild form of fibromyalgia won’t pass the test.

And guess what? As of 2010, the American College of Rheumatology has developed a new set of guidelines that do NOT include the tender point test, though many Drs. do not necessarily abide by them.  I agree with this as the new set of guidelines is based on the result of one study. Granted, there were over 800 participants, but one study doesn’t convince a scientific mind of anything until it has been replicated- and it hasn’t been! Besides, this new criteria only correctly diagnoses 88% of sufferers- a number I find too small to be reliable.

The new guidelines require widespread pain lasting at least 3 months, fatigue, cognitive symptoms (hello, fibro fog!), and lack of refreshment upon waking . Other potential causes must have been ruled out by relevant tests.

Here’s the thing with these new guidelines. We live in a “go-go-go” society. Anyone living in this mindset will undoubtedly get worn down over time. They will become stressed that they are more tired than usual, which will interfere with sleep. Seeing as how anyone that is sleep-deprived will begin exhibiting symptoms of fibromyalgia, these individuals can be easily diagnosed as having fibromyalgia under the new criteria, particularly if they are not straightforward with their physician or enough relevant questions are not asked. Even under the old criteria, I consider this a problem, but it is all the more so with the new criteria.

One study has indicated that over-diagnosis is indeed a problem. (We need more studies!!)Inthis study, the participants were either referred to a rheumatologist with a preliminary diagnosis of fibromyalgia by the referring physician, OR diagnosed by a rheumatologist at an initial visit. The diagnosis was correct in 34% of patients. That means that a whopping 66% of patients in the study were diagnosed with fibro- and didn’t have it!

Another study has examined the association between stress at work and new diagnoses of fibro. Guess what? It was found to be a contributing factor. Does it provide evidence that the “go-go-go” population is working themselves into a false diagnosis? Maybe. Maybe not. But it is something to think about.

An article in The Journal of Musculoskeletal Medicine also discusses the discrepancies in the diagnosis of fibromyalgia, and is an easier read than an actual study, while offering some excellent points. The authors point out that until a concrete set of diagnostic criteria are agreed upon and utilized, the possibility of a cure is unlikely. This tells me that we as patients need to do something. What is that something? I don’t know yet. I’m very open to ideas, though, so please share!