Advancing the screening and diagnosis of fibromyalgia in late-life

      We evaluated subjects with 4 sets of criteria for fibromyalgia (FM) screening and classification. The first two sets of criteria are intended for FM classification in clinical trials: 1) ACR 1990 Criteria for the Classification of Fibromyalgia (gold standard), 2) Pope and Hudson supplemental interview for FM. The next two are designed as screening tests: 1) “do you often feel like you hurt all over?” simple screening question, and 2) pain map score. Using a 115 community-dwelling adults at least 60 years old with comorbid depression and chronic low back pain, we assessed the kappa coefficient measuring agreement between criteria and the gold standard diagnostic method. Sensitivity and specificity were used to determine appropriate cut-off points for pain map scores and Pope and Hudson symptom requirements. 31 of 115 subjects (27%) met ACR 1990 criteria for FM. Compared to subjects without FM, the FM group had higher pain map scores, greater “yes” answers to the “hurt all over” screening question, and more positive results with respect to the PH criteria. The PH criteria showed moderate to substantial agreement with the ACR 1990 criteria, kappa = 0.59 [95% CI: 0.44-0.73]. The PH criteria showed high sensitivity of 0.94 and specificity of 0.76. There was moderate agreement between the “hurt all over?” question and the ACR 1990 criteria (Kappa = 0.51 [95% CI, 0.35-0.66]) with sensitivity of 0.84 and specificity of 0.75. For the pain map score, 14 or higher painful regions was determined to be the best cut-off weighting sensitivity and specificity equally. Using this cut-off, the pain map showed sensitivity= 0.71 and specificity = 0.74 with kappa demonstrating fair to moderate agreement (0.41 [95% CI: 0.23-0.59]). Our findings suggest the utility of alternative screening and classification methods for fibromyalgia in psychiatric settings, and potentially for broader diagnostic use.