Two simple assessments — questioning whether a patient has persistent deep aching pain over most of their body and determining if pain is elicited by pinching the Achilles tendon — should be added to routine evaluation in primary care to help physicians diagnose fibromyalgia, according to recent findings.
“Data from the U.S., Europe and Asia report that approximately half of providers admit uncertainty in confidently making a diagnosis of [fibromyalgia]. Diagnosing [fibromyalgia] more promptly should reduce unnecessary tests, specialty referrals, health care costs and patient anxiety,” Kim D. Jones, PhD, FNP, FAAN, from Oregon Health and Science University School of Nursing and School of Medicine, and colleagues wrote. “Based on our clinical experience, we surmise that clinicians need a simple screening test that can be performed as part of the routine evaluation in all patients with persistent pain complaints.”
Researchers evaluated the utility of three simple measures — BP cuff-evoking pain, digital palpation-evoked pain and a single question about persistent deep aching — as a screening assessment for fibromyalgia in patients with chronic pain. They studied 52 patients with a fibromyalgia diagnosis, 108 with chronic pain but without fibromyalgia and 192 without pain or fibromyalgia. Specifically, patients were examined for tenderness to digital pressure at 10 locations and BP cuff-evoked pain, and asked to rate their persistent deep aching over most of their body on a scale of one to 10.
Analysis showed that significantly more fibromyalgia patients answered the question about deep aching compared to patients with chronic pain but without fibromyalgia (7.4 vs. 3.2; P < .0001), and had higher bilateral digital evoked tenderness (6.1 vs. 2.4; P < .0001) and BP cuffevoked pressure pain (P < .0001). However, the BP cuffevoked pain became nonsignificant after the researchers performed multivariate logistic regressions. Additional analyses revealed pain on pinching the Achilles tendon for more than 4 seconds and positive support of the question regarding persistent deep aching over most of a patient’s body provided a useful screening test that indicated a probably diagnosis of fibromyalgia in patients with chronic pain.
“We are recommending two simple assessments to be added to the routine evaluation of any chronic pain patient. We envisage these assessments be used as a screening instrument not a diagnostic test, with a definitive diagnosis of [fibromyalgia] being reserved for later,” Jones and colleagues wrote. “By raising a providers' index of suspicion, patients may be spared a lengthy cycling through the medical system before receiving a diagnosis of [fibromyalgia] and beginning treatment.” – by Savannah Demko
Disclosure: The authors report no relevant financial disclosures.