Three Simple Tests to Raise the Index of Suspicion for Fibromyalgia in Primary Care

Amanda W. St. John¹, Jonathan H. Aebischer², Robert M. Bennett³, Madeleine J. Sanford², Kaitlin Z. Haws⁴ and Kim D. Jones³, ¹Anesthesiology and Pain Medicine, Oregon Health & Science University, Portland, OR, ²Department of Family Medicine, Oregon Health & Science University, Portland, OR, ³Schools of Nursing and Medicine, Oregon Health & Science University, Portland, OR, ⁴Department of Internal Medicine and Geriatrics, Oregon Health & Science University, Portland, OR

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: Examination, fibromyalgia, pain and primary care

Session Information

Date: Monday, November 14, 2016

Title: ARHP IV: Clinical Practice, Patient Care and Health Services

Session Type: ARHP Concurrent Abstract Session

Session Time: 4:30PM-6:00PM

Background/Purpose: Fibromyalgia (FM) is a multi-symptomatic pain disorder that affects 10-15 million US adults, including 1 in 20 patients seen in primary care. As such, primary care providers are increasingly expected to recognize and diagnose these patients rather than rely on specialists such as rheumatologists. The purpose of this study was to evaluate the usefulness of 3 simple measures, that when routinely used, will alert the clinician to consider a diagnosis of FM.

Methods: A descriptive cross sectional study assessed adults being seen in 2 academic primary care clinics. Data sources included chart review, history, physical exam and patient-completed surveys.

Results: 356 patients were studied (mean age 50 ± 16.3 years, 70% female). Chart review revealed that 53 (15%) of these patients carried a diagnosis of FM in their medical record. On survey, 159 had pain of which 122 (77%) stated that their pain was present greater than three months. On physical exam, those who had FM were tender at a lower level of sphygmomanometery-evoked pain than those without FM (128 mmHg ± 5.4 vs 181 mmHg ± 6.1, p< 0.0001). Similarly, those with FM exhibited more bilateral skin roll tenderness (upper trapezii, radii, interphalangeal joints, anterior thighs) compared to those without FM (p < 0.0001). Pinching the Achilles tendon with 4 kg over 4 seconds was the most commonly endorsed tender area in FM patients. Similarly, those with FM endorsed the question “I have a persistent deep aching pain over most of my body” more commonly than those without FM (p < 0.0001).

Conclusion: Primary care providers should schedule a visit to fully evaluate a patient for FM if the patient has any of the following: 1) sphygmomanometry-evoked allodynia, 2) pain on the Achilles tendon pinch, or 3) endorses the statement “I have a persistent deep aching over most of my body.” By raising providers’ index of suspicion for FM, patients may be spared years cycling through the medical system before receiving a diagnosis and beginning treatment.

Disclosure: A. W. St. John, None; J. H. Aebischer, None; R. M. Bennett, None; M. J. Sanford, None; K. Z. Haws, None; K. D. Jones, None.

To cite this abstract in AMA style:

W. St. John A, H. Aebischer J, M. Bennett R, J. Sanford M, Z. Haws K, D. Jones K. Three Simple Tests to Raise the Index of Suspicion for Fibromyalgia in Primary Care [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/three-simple-tests-to-raise-the-index-of-suspicion-for-fibromyalgia-in-primary-care/. Accessed .

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