Canadian Criteria For Diagnosis
Recently the Canadian Pain Society (CPS) and the Canadian Rheumatology Association (CRA) endorsed the 2012 Canadian Guidelines for the Diagnosis and Management of Fibromyalgia Symptoms.
Until the 2012 Canadian Guidelines was endorsed the American College of Rheumatology Criteria of 2010 was the criteria Canada followed, the new criteria offers a new approach.
Diagnosis will now be made mainly by your Primary Care Physician, and no longer need a referral to a Specialst for confirmation ("Patients with Fibromyalgia will first present to a Primary Care Physician, and ideal care should remain in the primary care setting, without any clear advantage for care by a Specialist").
The 2012 Canadian Guidelines offers Practice Recommendations, which are;
Practice Recommendations
Section 1: The diagnosis
The clinical evaluation
1. Fibromyalgia, a condition than can wax and wane over time, should be diagnosed in an individual with diffuse body pain that has been present for at least 3 months, and who may also have symptoms of fatigue, sleep disturbance, cognitive changes, mood disorder, and other somatic symptoms to variable degree, and when symptoms cannot be explained by some other
illness [Level 5 [2, 12, 45, 46], Grade D].
2. All patients with a symptom complaint suggesting a diagnosis of fibromyalgia should undergo a physical examination which should be within normal limits except for tenderness on pressure of soft tissues (ie. hyperalgesia which is increased pain following a painful
stimulus) [Level 4 [2, 3, 66], Grade D].
3. Examination of soft tissues for generalized tenderness should be done by manual palpation with the understanding that the specific tender point examination according to the 1990 ACR diagnostic criteria is not required to confirm a clinical diagnosis of fibromyalgia [Level 5 [1, 2], Grade D].
Testing & confirming the diagnosis
4. Fibromyalgia should be diagnosed as a clinical construct, without any confirmatory laboratory test, and with testing limited to simple blood testing including a full blood count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), creatine kinase, and thyroid stimulating hormone (TSH). Any additional laboratory or radiographic testing should depend on the clinical evaluation in an individual patient that may
suggest some other medical condition [Level 5 [75, 76], Grade D].
5. The primary care physician should establish a diagnosis of fibromyalgia as early as possible, without need for confirmation by a specialist, and communicate this diagnosis to the patient. Repeated investigations after diagnosis should be avoided unless driven by the onset of new symptoms, or signs on physical examination [Level 5[6, 77, 82, 83], Grade D].
6. The ACR 2010 diagnostic criteria for fibromyalgia can be used at initial assessment to validate a clinical diagnosis of fibromyalgia with the understanding that symptoms vary over time [Level 3 [1, 2, 58], Grade B].
Differential diagnosis & coexisting conditions
7. Healthcare professionals should be aware that some medical or psychological conditions may present with body pain similar to fibromyalgia, and patients with other medical illnesses may have an associated fibromyalgia [Level 5 [76, 86, 87, 90, 91], Grade
D].
The healthcare team
8. Management of persons with fibromyalgia should be centered in the primary care setting with knowledgeable healthcare professionals, and ideally, where possible, this care may be augmented by accessto a multidisciplinary team [Level 1 [96, 97], Grade A] or team member to provide support and reassurance [Level 3 [101, 102], Grade C].
9. Specialist consultation, including referral to a sleep specialist or psychologist may be required for selected subjects, but continued care by a specialist is not recommended and should be reserved for those patients who have failed management in primary care or have more complex co morbidities [Level 5 [77], Grade D].
The above mentioned critera, was taken from the 2012 Canadian Guidelines, and should you want a copy of the document please email me.
The 2012 Canadian Guidelines, focuses on Primary Care Setting for diagnosis and management, minimal testing for diagnosis, symptom based treatments with a multimodal approach (non-pharmacologic and pharmacologic), close monitoring, setting, focusing, and re-evaluating goals regarding health status and quality of life.
Until the 2012 Canadian Guidelines was endorsed the American College of Rheumatology Criteria of 2010 was the criteria Canada followed, the new criteria offers a new approach.
Diagnosis will now be made mainly by your Primary Care Physician, and no longer need a referral to a Specialst for confirmation ("Patients with Fibromyalgia will first present to a Primary Care Physician, and ideal care should remain in the primary care setting, without any clear advantage for care by a Specialist").
The 2012 Canadian Guidelines offers Practice Recommendations, which are;
Practice Recommendations
Section 1: The diagnosis
The clinical evaluation
1. Fibromyalgia, a condition than can wax and wane over time, should be diagnosed in an individual with diffuse body pain that has been present for at least 3 months, and who may also have symptoms of fatigue, sleep disturbance, cognitive changes, mood disorder, and other somatic symptoms to variable degree, and when symptoms cannot be explained by some other
illness [Level 5 [2, 12, 45, 46], Grade D].
2. All patients with a symptom complaint suggesting a diagnosis of fibromyalgia should undergo a physical examination which should be within normal limits except for tenderness on pressure of soft tissues (ie. hyperalgesia which is increased pain following a painful
stimulus) [Level 4 [2, 3, 66], Grade D].
3. Examination of soft tissues for generalized tenderness should be done by manual palpation with the understanding that the specific tender point examination according to the 1990 ACR diagnostic criteria is not required to confirm a clinical diagnosis of fibromyalgia [Level 5 [1, 2], Grade D].
Testing & confirming the diagnosis
4. Fibromyalgia should be diagnosed as a clinical construct, without any confirmatory laboratory test, and with testing limited to simple blood testing including a full blood count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), creatine kinase, and thyroid stimulating hormone (TSH). Any additional laboratory or radiographic testing should depend on the clinical evaluation in an individual patient that may
suggest some other medical condition [Level 5 [75, 76], Grade D].
5. The primary care physician should establish a diagnosis of fibromyalgia as early as possible, without need for confirmation by a specialist, and communicate this diagnosis to the patient. Repeated investigations after diagnosis should be avoided unless driven by the onset of new symptoms, or signs on physical examination [Level 5[6, 77, 82, 83], Grade D].
6. The ACR 2010 diagnostic criteria for fibromyalgia can be used at initial assessment to validate a clinical diagnosis of fibromyalgia with the understanding that symptoms vary over time [Level 3 [1, 2, 58], Grade B].
Differential diagnosis & coexisting conditions
7. Healthcare professionals should be aware that some medical or psychological conditions may present with body pain similar to fibromyalgia, and patients with other medical illnesses may have an associated fibromyalgia [Level 5 [76, 86, 87, 90, 91], Grade
D].
The healthcare team
8. Management of persons with fibromyalgia should be centered in the primary care setting with knowledgeable healthcare professionals, and ideally, where possible, this care may be augmented by accessto a multidisciplinary team [Level 1 [96, 97], Grade A] or team member to provide support and reassurance [Level 3 [101, 102], Grade C].
9. Specialist consultation, including referral to a sleep specialist or psychologist may be required for selected subjects, but continued care by a specialist is not recommended and should be reserved for those patients who have failed management in primary care or have more complex co morbidities [Level 5 [77], Grade D].
The above mentioned critera, was taken from the 2012 Canadian Guidelines, and should you want a copy of the document please email me.
The 2012 Canadian Guidelines, focuses on Primary Care Setting for diagnosis and management, minimal testing for diagnosis, symptom based treatments with a multimodal approach (non-pharmacologic and pharmacologic), close monitoring, setting, focusing, and re-evaluating goals regarding health status and quality of life.