Clinical criteria and diagnostic assessment of fibromyalgia: position statement of the Italian Society of Neurology-Neuropathic Pain Study Group

Neurological Sciences · 15 authors, 11 centres

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TL;DR

This is a position statement providing practical guidelines for neurologists on diagnosing and assessing fibromyalgia (FM), emphasizing the application of recent ACR criteria and the investigation of small-fiber involvement.

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This position statement offers a non-structured, expert-based review of recent literature to guide neurologists in the clinical and instrumental assessment of fibromyalgia. The authors recommend applying the 2016 ACR diagnostic criteria and state that a rheumatologic visit is mandatory. For evaluating small-fiber pathology, they suggest using at least two specific diagnostic tests, which may be followed by monitoring for underlying metabolic, immunological, or paraneoplastic conditions. The document highlights that a correct diagnostic approach can help exclude known causes of small-fiber impairment. Limitations noted include the non-systematic review method and a focus only on studies from the last 10 years. The authors conclude that clarifying the underlying mechanisms of FM will ultimately improve treatment.

STUDY TYPE

guidelines

SPECIALTY

neurology

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ORIGINAL PAPER

PMC10257633

Clinical criteria and diagnostic assessment of fibromyalgia: position statement of the Italian Society of Neurology-Neuropathic Pain Study Group

Neurological Sciences

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ABSTRACT

Background The role of central and/or peripheral nervous system dysfunction is basically fundamental in fibromyalgia. Aim The aim of this position statement on behalf of the Neuropathic Pain Study Group of the Italian Society of Neurology is to give practical guidelines for the clinical and instrumental assessment of fibromyalgia (FM) in the neurological clinical practice, taking into consideration recent studies. Methods Criteria for study selection and consideration were original studies, case-controls design, use of standardized methodologies for clinical practice, and FM diagnosis with ACR criteria (2010, 2011, 2016). Results ACR criteria were revised. For diagnostic procedure of small-fiber pathology, 47 studies were totally considered. Recent diagnostic criteria should be applied (ACR, 2016). A rheumatologic visit seems mandatory. The involvement of small fibers should request at least 2 among HRV + SSR and/or laser-evoked responses and/or skin biopsy and/or corneal confocal microscopy, eventually followed by monitoring of metabolic and/or immunological/ and or/paraneoplastic basis, to be repeated at 1-year follow-up. Conclusions The correct diagnostic approach to FM could promote the exclusion of the known causes of small-fiber impairment. The research toward common genetic factors would be useful to promote a more specific therapeutic approach. Supplementary Information The online version contains supplementary material available at 10.1007/s10072-023-06836-3.

CITATION EXPORT

G. Devigili, G. Di Stefano, V. Donadio et al.. Clinical criteria and diagnostic assessment of fibromyalgia: position statement of the Italian Society of Neurology-Neuropathic Pain Study Group. Neurological Sciences. (2023). https://doi.org/10.1007/s10072-023-06836-3

AUTHORS

15 · 11 CENTRES

G. Devigili, G. Di Stefano, V. Donadio, I. Frattale, E. Mantovani, M. Nolano, G. Occhipinti, V. Provitera, S. Quitadamo, S. Tamburin, A. Toscano, S. Tozza, A. Truini, M. Valeriani, M. de Tommaso

1UOC Neurologia IIRCCS Carlo Besta, Milan, Italy
2grid.7841.aDepartment of Human Neuroscience, Sapienza University, Rome, Italy
3grid.414405.00000 0004 1784 5501Clinica Neurologica Bellaria Hospital, Bologna, Italy
4grid.6530.00000 0001 2300 0941Child Neurology and Psychiatric Unit, Tor Vergata University, Rome, Italy
5grid.5611.30000 0004 1763 1124Neurosciences, Biomedicine and Movement Sciences Department, Verona University, Verona, Italy
6Skin Biopsy Laboratory, Department of Neurology, Instituti Clinici Scientifici Maugeri IRCCS, Telese Terme, Italy
7grid.4691.a0000 0001 0790 385XDepartment of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II of Naples, 80100 Naples, Italy
8UOC Neurologia E Malattie Neuromuscolari, AUO Martino Messina, Messina, Italy
9grid.414125.70000 0001 0727 6809Developmental Neurology Unit, Ospedale Pediatrico Bambino Gesù, Rome, Italy
10grid.10438.3e0000 0001 2178 8421EURO-ERN NMD, AOU Martino University of Messina, Messina, Italy
11grid.7644.10000 0001 0120 3326Neurophysiopathology Unit, DiBraiN Department, Policlinico General Hospital, Bari Aldo Moro University, Piazza Giulio Cesare, 11, 70124 Bari, Italy