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Fibromyalgia: How have the diagnostic criteria changed?

If your symptoms are severe, chronic pain and associated problems from fibromyalgia can be disabling. The symptoms can be so disabling that they keep you from working.

Insurance companies, however, often try to claim that they don't have to pay out on disability policies because of a lack of objective evidence of disabling conditions.

In this post, we will use a Q & A format to update you on how diagnostic criteria for fibromyalgia have evolved. Newer criteria have improved doctors' ability to identify fibromyalgia. These new criteria make insurance companies' refusal to pay out on disability policies even more unjust.

What is fibromyalgia exactly?

Fibromyalgia is a chronic pain disorder that is also often accompanied by fatigue, sleep problems and other issues.

The term "fibromyalgia" is a bit of a misnomer because the condition does not relate directly to fibrous tissue. Rather, it involves substantial disruptions in how the brain processes signals of pain.

But fibromyalgia is not merely in a patient's head. It is a real and potentially disabling condition for which there is currently no cure.

How many people does it affect?

Worldwide, fibromyalgia affects an estimated 210 million people. In the U.S., approximately 3 percent of the population suffers from the condition. This is about 10 million people.

Is it true that women are affected more often than men?

Yes. About 80 percent of the people affected by fibromyalgia are women. It is often appears in middle age.

Why is it sometimes difficult to diagnose fibromyalgia?

Doctors don't know what causes fibromyalgia. There may be no triggering event, such as physical trauma or psychological stress. Increasingly, researchers are viewing fibromyalgia as an autoimmune disease.

The doctors who deal with this specialty are called rheumatologists.

"Rheumatology" comes from a Greek word meaning "to flow." It refers to pain or inflammation affecting muscles or joints, as well as fibrous tissues.

When did doctors first use guidelines for diagnosing fibromyalgia?

The American College of Rheumatology (ACR) originally issued diagnostic criteria for fibromyalgia in 1990. These criteria looked to quantify the number of designated "tender points" in the body that were affected over a certain amount of time.

More specifically, the 1990 criteria divided the body into four quadrants. They then tracked how many of 18 "designated tender points" were affected by pain for a minimum duration of three months when a certain amount of pressure was applied. The amount of pressure was 4 kg per cubic centimeters.

If there was pain in all four quadrants in at least 11 tender points for at least three months, the diagnosis was fibromyalgia.

What are the diagnostic criteria now?

In 2010, the ACR recommended new diagnostic criteria for fibromyalgia. The proposal was to replace the 1990 criteria with a more multi-faceted approach that included not only looking at the number of painful regions in the body, but also looked at important related factors including fatigue, sleep disturbance and cognitive symptoms.

The new criteria are still highly quantitative. But they include other symptoms besides widespread pain in designated points.

Will does the future hold?

As research continues, diagnostic criteria for fibromyalgia will continue to evolve and so will treatment options. There is plenty of reason to hope for better diagnosis and treatment.

In the meantime, however, it is important to recognize that fibromyalgia isn't merely a subjective problem about pain perception. It's a common condition with detailed diagnostic criteria. If you have been denied coverage under your disability policy, it makes sense to discuss your legal options with a skilled attorney.

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