Travell and simons criteria
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By omitting the definition of generalized pain, the 2010/2011 ACR criteria provided uncertain discrimination between FM and localized functional pain syndromes. However, these criteria led to misclassification because the included widespread pain index (WPI), which indicates the number of pain locations, does not consider the spatial distribution of these locations. These 2010/2011 ACR criteria for FM excluded the tender point examination and included a systemic symptom-based assessment of conditions including fatigue, sleep problems, and cognitive and somatic symptoms. Therefore, the same authors provided new, presumably improved preliminary FM criteria in 2010/2011. The 1990 ACR criteria had several weak points such as the absence of extra-pain manifestations, subjective attribution of tender point examination, and difficulty of implementation. The American College of Rheumatology (ACR) released the first set of criteria to discriminate FM from other chronic pain disorders in 1990.
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A previous study showed that the diagnosis of FM requires > 2 years and that patients with chronic pain will see a mean of 3.7 different physicians during that period. Although many efforts have been implemented to improve the diagnostic accuracy of FM in recent decades, it remains underdiagnosed or under-recognized. FM has become a considerable problem for patients and healthcare providers that leads to functional impairment, poor quality of life, and socioeconomic burdens. FormalParaįibromyalgia (FM) is a chronic pain disorder characterized by chronic widespread pain and associated symptoms, including fatigue, sleep disorder, depression, and anxiety.
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ConclusionsĪlthough the AAPT criteria and modified FAS criteria have simplified the diagnostic criteria to facilitate patient identification, their poor diagnostic accuracy will limit the adoption and spread of these criteria in routine clinical practice.
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The areas under the receiver-operating characteristic curve were 0.852 (95% confidence interval 0.801–0.903) for the AAPT criteria and 0.903 (95% CI 0.861–0.944) for the modified FAS criteria, which were lower than the existing ACR criteria. For the modified FAS criteria, the sensitivity was 60.0% and the specificity was 92.6%. For the AAPT criteria, the sensitivity was 56.8% and the specificity was 94.4%. In patients with existing FM diagnoses, FM was diagnosed in 56.8% using the AAPT criteria and in 60.0% using the modified FAS criteria. All patients were classified using proposed criteria including the 1990, 2010, 2011, and 2016 versions of the ACR criteria. We enrolled 95 patients with FM and 108 patients who had other rheumatologic disorders, including rheumatoid arthritis, systemic lupus erythematosus, osteoarthritis, and myofascial pain syndrome. Here, we explored the performances of the AAPT criteria and modified FAS criteria for diagnosing FM compared to existing American College of Rheumatology (ACR) criteria. Recently, new sets of diagnostic criteria were proposed, including criteria by the ACTTION-American Pain Society Pain Taxonomy (AAPT) group and Fibromyalgia Assessment Status (FAS) 2019 modified criteria for fibromyalgia (FM).