Using Different Fibromyalgia Criteria Affects Prevalence Estimates

Clinician Takeaway

For practicing clinicians, the paper’s main value is how it highlights the differences between the two instruments for diagnosing fibromyalgia, says Leslie J. Crofford, MD, an AAPT co-author and chief of the Division of Rheumatology and Immunology, Vanderbilt University Medical Center, Nashville, Tenn.

The AAPT criteria set a lower bar for identifying fibromyalgia. That’s by design, she says, noting the goal of the criteria was to help clinicians—especially primary care providers—identify and effectively treat symptoms early. AAPT criteria were not developed to ascertain population prevalence, Dr. Crofford notes.

Primary care physicians commonly lack confidence when diagnosing fibromyalgia and other pain disorders, says Dr. Crofford. “For that reason,” she says, “rheumatologists get lots of referrals not only for fibromyalgia, but also for rheumatoid arthritis and osteoarthrosis and other pain conditions in the AAPT framework.”

The AAPT framework encompasses a wide array of pain disorders and can help primary care providers decide which disorder most likely causes a patient’s pain and start treatment earlier.

A distinct advantage of the 2016 modified criteria, according to Dr. Crofford, is the inclusion of a severity scale “so you can follow patients over time and see if they get better or worse.”

Dr. Crofford

Dr. Crofford stresses the importance of early identification and treatment of core fibro­myalgia symptoms, such as sleep disorders. She urges clinicians to avoid situations in which patients who are suffering get frustrated and feel like clinicians are not listening to them. That’s when they may develop an “oppositional relationship with the healthcare system,” she says.

“The clinician’s role is to carefully listen to the patient, to evaluate their complaints, put them in an understandable framework for patients, and to work with them to address symptoms to the best of your ability,” Dr. Crofford says. “Make sure you work with patients to improve their overall symptoms and function.”

Deborah Levenson is a writer and editor based in College Park, Md.

References

1. Häuser W, Brähler E, Ablin J, Wolfe F. Modified 2016 American College of Rheumatology fibromyalgia criteria, the analgesic, anesthetic, and addiction clinical trial translations innovations opportunities and networks–American Pain Society pain taxonomy, and the prevalence of fibromyalgia. Arthritis Care Res (Hoboken). 2021 May;73(5):617–625.
2. Arnold LM, Bennett RM, Crofford LJ, et al. AAPT diagnostic criteria for fibromyalgia. J Pain. 2019 Jun;20(6):611–628.
3. Wolfe F, Clauw DJ, FitzCharles M, et al. 2016 revisions to the 2010/2011 fibromyalgia diagnostic criteria [abstract]. Arthritis Rheumatol. 2016;68(suppl 10).
4. Boomershine CS. Fibromyalgia clinical presentation. Medscape. 2020 Apr 23.
5. Clauw DJ. Time to stop the fibromyalgia criteria wars and refocus on identifying and treating individuals with this type of pain earlier in their illness. Arthritis Care Res (Hoboken). 2021 May;73(5):613–616.