Diagnosing Fibromyalgia and Educating Patients by Activation Level

The 18 tender point test was dropped in 2010, and Will urges clinicians to stop using it. The 2016 American College of Rheumatology criteria combine a widespread pain index from 19 body areas with a symptom severity score covering fatigue, trouble thinking or remembering, waking unrefreshed, lower abdominal pain or cramps, depression and headache. The total is out of 31; above 20 suggests fibromyalgia, and 15 to 20 needs further clinical differentiation. UK data show that a diagnosis halves healthcare appointments and prescriptions in the following year, and primary care can make it. Treatment rests on four pillars: education, sleep, medication and exercise. Education should match the patient's activation level, from overwhelmed and disengaged at level one to ready for discharge and self-management at level four, and can move from informing to collaborating and empowering, as when patients founded a local support group. The Hospital Anxiety and Depression Scale screens distress early, although about half of their cohort did not have high scores. Offering drugs first, especially opioids, makes non-drug treatment harder to accept.