Rethinking the criteria for fibromyalgia in 2019: the ABC indicators

Julian A Stewart,1 Simone Mailler-Burch,1 Darius Müller,1 Martina Studer,1 Roland von Känel,2,3Martin grosse Holtforth,1,4Kyrill Schwegler,1 Niklaus Egloff1,21Department of Neurology, Bern University Hospital, University of Bern, Bern, Switzerland; 2Department of Clinical Research, Bern University Hospital, University of Bern, Bern, Switzerland; 3Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland; 4Department of Psychology, University of Bern, Bern, SwitzerlandPurpose: Diagnostic criteria for fibromyalgia have been subject to debate and controversy for many years. The preliminary diagnostic criteria introduced in 2010 and 2011 have been criticized for different reasons, including questionable diagnostic specificity and a lack of an etiopathogenetic foundation. The “ABC indicators” presented in this study reflect a further development of the 2011 criteria and refer to (A) algesia, (B) bilateral, axial-symmetric pain distribution, and (C) chronic distress.Patients and methods: We compared the diagnostic performance of the ABC indicators with that of the 2011 criteria by analyzing the data of 409 inpatients with chronic functional pain divided into two subgroups of pain patients: Those with whole-body pain and those with pain not involving the whole body. Under the premise that FM phenotypically represents a whole-body pain disorder, sensitivity, specificity, correct classification and diagnostic odds ratios were calculated.Results: The 2011 criteria demonstrated a specificity of 68.1%, a sensitivity of 75.5%, a correct classification of 71.0% and a diagnostic odds ratio of 6.56 (CI: 4.17–10.31). The ABC indicators achieved a specificity of 88.3%, a sensitivity of 62.3%, a correct classification of 78.6%, and a diagnostic odds ratio of 12.47 (CI: 7.30–21.28).Conclusion: The ABC fibromyalgia indicators demonstrated better specificity, lower sensitivity, and better overall diagnostic effectiveness than the original 2011 criteria.Keywords: chronic pain, diagnostic criteria, widespread pain, hyperalgesia, psychological distress, Complex Generalized Pain Syndrome (CGPS)