Implication of invalidation concept in fibromyalgia diagnosis.

OBJECTIVES: The invalidation or social pain is an important but neglected issue in polysymptomatology of fibromyalgia (FM). This study sought whether tracing-perceived invalidation could be effective to discriminate between the presence and absence of FM in chronic pain patients with respect to five different sources, including spouses, family, colleagues, health professionals, and social services. METHODS: A total of 207 consecutive chronic pain patients were evaluated for the presence of FM by rheumatologic assessment. Invalidation was measured by the Illness Invalidation Inventory (3*I). Receiver operator characteristic (ROC) analyses were used to evaluate the ability of 3*I dimensions and sources to discriminate having FM among chronic pain patients. Binary logistic regression analyses were performed. RESULTS: The perceived discounting and lack of understanding from spouse and family sources were higher in FM rather than non-FM patients. ROC analyses demonstrated that invalidation dimensions stemming from spouse and family could appropriately discriminate between the presence and absence of FM. The area under the curve (AUC) for other sources showed non-significant values. Adjusted logistic regression analysis by age, education level, and work status showed that discounting by family and lack of understanding by the spouse could be significant predictors of FM (OR 2.30; 95% CI 1.29-4.11, P = 0.005; OR 1.72; 95% CI 1.08-2.74, P = 0.022, respectively). CONCLUSIONS: This study elucidated the discriminatory power of invalidation in identification of FM from non-FM patients, especially when originated from spouse and family. Our results provide a basis to propose the invalidation as a salient component in the FM dictionary parallel to other famous FM symptoms. Key Points • The incorporation of newly highlighted social definition of pain seems warranted in the pain practice. • Despite proposing invalidation in painful conditions, its diagnostic role in FM remains unexplored. • Acknowledging of invalidation or social pain in polysymptomatology of FM could shift the paradigm of diagnosis of FM.

Fibromyalgia diagnostic model derived from combination of American College of Rheumatology 1990 and 2011 criteria.

BACKGROUND: We aimed to explore the American College of Rheumatology (ACR) 1990 and 2011 fibromyalgia (FM) classification criteria's items and the components of Fibromyalgia Impact Questionnaire (FIQ) to identify features best discriminating FM features. Finally, we developed a combined FM diagnostic (C-FM) model using the FM's key features. METHODS: The means and frequency on tender points (TPs), ACR 2011 components and FIQ items were calculated in the FM and non-FM (osteoarthritis [OA] and non-OA) patients. Then, two-step multiple logistic regression analysis was performed to order these variables according to their maximal statistical contribution in predicting group membership. Partial correlations assessed their unique contribution, and two-group discriminant analysis provided a classification table. Using receiver operator characteristic analyses, we determined the sensitivity and specificity of the final model. RESULTS: A total of 172 patients with FM, 75 with OA and 21 with periarthritis or regional pain syndromes were enrolled. Two steps multiple logistic regression analysis identified 8 key features of FM which accounted for 64.8% of variance associated with FM group membership: lateral epicondyle TP with variance percentages (36.9%), neck pain (14.5%), fatigue (4.7%), insomnia (3%), upper back pain (2.2%), shoulder pain (1.5%), gluteal TP (1.2%), and FIQ fatigue (0.9%). The C-FM model demonstrated a 91.4% correct classification rate, 91.9% for sensitivity and 91.7% for specificity. CONCLUSIONS: The C-FM model can accurately detect FM patients among other pain disorders. Re-inclusion of TPs along with saving of FM main symptoms in the C-FM model is a unique feature of this model.