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New tool streamlines fibromyalgia screening.

From a clinical perspective, fibromyalgia is a diagnostic nightmare. The often-debilitating chronic pain condition has no definitive cause, signs, tests, or treatments. Adding to the confusion is the fact that the symptoms--which include but are not limited to muscle tenderness, headaches, stomach aches, depression, and fatigue--overlap with those of many other conditions. And the current diagnostic criteria, which were published by the American College of Rheumatology nearly 20 years ago, were developed by rheumatologists principally for research and classification purposes, and as such are difficult to apply in daily clinical practice, according to Dr. Serge Perrot of Hotel-Dieu Hospital in Paris.


Several assessment tools have been developed to address some of the limitations of the ACR criteria. However, "these tools include only items related to widespread pain and fatigue, with no items focusing on other major dimensions or symptoms" of fibromyalgia syndrome, Dr. Perrot and colleagues in the French Rheumatic Pain Study Group (CEDR) recently wrote in their description of the development and validation of a new fibromyalgia screening measure, called FIRST (Fibromyalgia Rapid Screening Tool). Developed by CEDR, FIRST is a six-item, self-completed questionnaire "with excellent discriminative value" for the detection of fibromyalgia syndrome in individuals with diffuse chronic pain, said the authors (Pain 2010 May 18 [doi: 10.1016/j .pain. 2010.03.034]).

In this column, Dr. Perrot discusses the challenges involved in diagnosing fibromyalgia and how FIRST can help.

FAMILY PRACTICE NEWS: What are the main clinical challenges in the diagnosis of fibromyalgia?

Dr. Perrot: Tender-point examination (called for by the ACR 1990 criteria) is difficult, and it requires physician training. Because general practitioners are usually not trained to perform this examination, they typically do not make the diagnosis of fibromyalgia syndrome (FMS). Patients with suspected FMS must therefore wait for a rheumatologist or pain specialist to confirm the diagnosis. This delay in the diagnosis and management of the condition increases patients' anxiety and confusion, and leaves them without treatment for unnecessarily long periods of time.

FPN: How does FIRST address these concerns?

Dr. Perrot: The FIRST assessment tool is a simple self-questionnaire that aims to detect FMS in patients with chronic pain conditions. Patients are asked to answer yes or no to six items related to the nature, location, and severity of their pain; other physical sensations (such as numbness or tingling associated with their pain); co-occurring digestive problems, urinary problems, headaches, or restless legs; and the impact of the pain on quality of life. The questionnaire can be administered by all physicians and takes only 2 minutes to complete. Clinical examination is not needed. This will allow early FMS diagnosis and management.

FPN: What are some of the advantages of FIRST, compared with existing assessment tools?

Dr. Perrot: FIRST is a screening test, and as such it should not be compared with the ACR 1990 criteria, nor to the newly published 2010 ACR criteria for FMS. Following a positive assessment, existing criteria will still be used to confirm the FMS diagnosis. Importantly, the FIRST questionnaire includes not only pain and fatigue, as previous screening tools have, but also pain descriptors and comorbid conditions that are specific to fibromyalgia. Also, FIRST has been shown to be a very sensitive and specific screening test, with a sensitivity of 90.5% and of specificity of 85.7%.

FPN: What are some of the limitations of FIRST?

Dr. Perrot: Because FIRST is a screening test and not a diagnostic tool, a positive screen for FMS is not a diagnosis. It still requires further confirmation by a specialist, based on current FMS diagnostic criteria.

FPN: What has been the reaction among clinicians to FIRST, and is it likely that it will see widespread clinical adoption?

Dr. Perrot: At this time, several groups of physicians involved in FMS management have adopted the FIRST questionnaire. The tool seems to be well accepted, both by physicians and patients, because it is so easy to administer in daily clinical practice. And because of its discriminative properties, FIRST could be used in the research setting, particularly for epidemiologic studies of FMS, which are very much needed.

DR. PERROT is a professor of medicine and on the staff of the rheumatic pain clinic at Hotel-Dieu Hospital, Paris. He has served as a speaker and consultant for Pierre Fabre Medicament.
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Title Annotation:ASK THE EXPERT
Author:Mahoney, Diana
Publication:Family Practice News
Article Type:Interview
Geographic Code:4EUFR
Date:Jul 1, 2010
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