Should we use linked chronic widespread pain and fibromyalgia diagnostic criteria?
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Katsuhiro Toda
Dear Editor,
Dr Wolfe et al. reported the revised chronic widespread pain (CWP) criteria [1]. I believe that CWP is an incomplete form or pre-stage of fibromyalgia (FM) [2]. The prevalence of FM is approximately 2% and the prevalence of CWP including FM is approximately 10% [3]. Due to the high prevalence, CWP is easier to be used for epidemiological study than FM. Many diagnostic criteria of FM have been reported after the 1990 classification criteria of FM [4]. Various diagnostic criteria of FM have been used, however, CWP [1] defined by the 1990 classification criteria of FM has been mainly used. This has caused confusion in FM and CWP research. The criteria of CWP should be made based on the criteria of FM actually used.
The revised CWP criteria reported by Dr. Wolfe et al. were made based on the 2016 criteria of FM [1]. The newest diagnostic criteria of FM were reported in 2018 [5]. The newest criteria are simple and easy to use. I think that the newest diagnostic criteria will become a mainstream of diagnostic criteria of FM in the future. The 2018 diagnostic criteria of FM are completely different from the 2016 diagnostic criteria of FM. I am afraid that the coexistence of the 2018 criteria of FM and the revised CWP criteria (based on the 2016 criteria of FM) will cause confusion. Dr. Fitzcharles is an author of the 2018 criteria of FM [5] and the revised CWP criteria [1]. The criteria of CWP based on the 2018 criteria of FM are as follows: Multi-site pain defined as 6 or more pain sites from a total of 9 possible sites for at least 3 months. Which diagnostic criteria of FM should we use? Should we use linked CWP and FM diagnostic criteria?
Many physicians treat patients with incomplete form of FM (CWP and chronic regional pain) using the same treatment as FM [6]. If the treatments of the two diseases are the same, there is no clinical significance in distinguishing between the two diseases [7]. In this case, diagnostic criteria of FM have no clinical value and those have academic value to select uniform patients in conference presentation, writing papers, and/or epidemiological study to investigate prevalence. What is the significance of diagnostic criteria of FM?
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Authors’ statements
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Research funding: Author states no funding involved.
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Conflict of interest: Author states no conflict of interest.
References
[1] Wolfe F, Butler SH, Fitzcharles M, Hauser W, Katz RL, Mease PJ, Rasker JJ, Russell AS, Russell IJ, Walitt B. Revised chronic widespread pain criteria: development from and integration with fibromyalgia criteria. Scand J Pain 2019;20:77–86.10.1515/sjpain-2019-0054Search in Google Scholar PubMed
[2] Toda K. Comparison of symptoms among fibromyalgia syndrome, chronic widespread pain, and an incomplete form of chronic widespread pain. J Musculoskelet Pain 2011;19:52–5.10.3109/10582452.2010.502614Search in Google Scholar
[3] Toda K, Harada T. Prevalence, classification, and etiology of pain in Parkinson’s disease: association between Parkinson’s disease and fibromyalgia or chronic widespread pain. Tohoku J Exp Med 2010;222:1–5.10.1620/tjem.222.1Search in Google Scholar PubMed
[4] Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, Tugwell P, Campbell SM, Abeles M, Clark P, Fam AG, Farber SJ, Fiechtner JJ, Franklin CR, Gatter RA, Hamaty D,Lessard J, Lichtbroun AS, Masi AT, McCain GA, et al. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum 1990;33:160–72.10.1002/art.1780330203Search in Google Scholar PubMed
[5] Arnold LM, Bennett RM, Crofford LJ, Dean LE, Clauw DJ, Goldenberg DL, Fitzcharles MA, Paiva ES, Staud R, Sarzi-Puttini P, Buskila D, Macfarlane GJ. AAPT Diagnostic Criteria for Fibromyalgia. J Pain 2019;20:611–28.10.1016/j.jpain.2018.10.008Search in Google Scholar PubMed
[6] Toda K. Treatment of chronic widespread pain is similar to treatment of fibromyalgia throughout the world. J Musculoskelet Pain 2010;18:317–8.10.3109/10582450903295956Search in Google Scholar
[7] Toda K. What is the significance of diagnostic criteria of fibromyalgia? Int J Rheum Dis 2019;22:1945.10.1111/1756-185X.13691Search in Google Scholar PubMed
©2020 Scandinavian Association for the Study of Pain. Published by Walter de Gruyter GmbH, Berlin/Boston. All rights reserved.
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- Frontmatter
- Systematic review
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- Topical reviews
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