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. 2023 Jul;44(7):2561-2574.
doi: 10.1007/s10072-023-06836-3. Epub 2023 May 24.

Clinical criteria and diagnostic assessment of fibromyalgia: position statement of the Italian Society of Neurology-Neuropathic Pain Study Group

G Devigili #  1 , G Di Stefano #  2 , V Donadio #  3 , I Frattale #  4 , E Mantovani #  5 , M Nolano #  6   7 , G Occhipinti #  8 , V Provitera #  6 , S Quitadamo #  9 , S Tamburin #  5 , A Toscano #  10 , S Tozza  8 , A Truini  2 , M Valeriani  11 , M de Tommaso  12
Affiliations

Clinical criteria and diagnostic assessment of fibromyalgia: position statement of the Italian Society of Neurology-Neuropathic Pain Study Group

G Devigili et al. Neurol Sci. 2023 Jul.

Abstract

Background: The role of central and/or peripheral nervous system dysfunction is basically fundamental in fibromyalgia.

Aim: The aim of this position statement on behalf of the Neuropathic Pain Study Group of the Italian Society of Neurology is to give practical guidelines for the clinical and instrumental assessment of fibromyalgia (FM) in the neurological clinical practice, taking into consideration recent studies.

Methods: Criteria for study selection and consideration were original studies, case-controls design, use of standardized methodologies for clinical practice, and FM diagnosis with ACR criteria (2010, 2011, 2016).

Results: ACR criteria were revised. For diagnostic procedure of small-fiber pathology, 47 studies were totally considered. Recent diagnostic criteria should be applied (ACR, 2016). A rheumatologic visit seems mandatory. The involvement of small fibers should request at least 2 among HRV + SSR and/or laser-evoked responses and/or skin biopsy and/or corneal confocal microscopy, eventually followed by monitoring of metabolic and/or immunological/ and or/paraneoplastic basis, to be repeated at 1-year follow-up.

Conclusions: The correct diagnostic approach to FM could promote the exclusion of the known causes of small-fiber impairment. The research toward common genetic factors would be useful to promote a more specific therapeutic approach.

Keywords: Corneal confocal microscopy; Diagnostic criteria; Fibromyalgia; Heart rate variability; Laser-evoked potentials; Skin biopsy; Small-fiber neuropathy.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart showing the total number of identified, screened, included, and excluded records
Fig. 2
Fig. 2
Flow chart reporting the proposal simplified diagnostic assessment for patients with FM. *Glucose dysmetabolism assessment: renal, thyroid, and liver function tests; B12 vitamin and folate blood levels; erythrocyte sedimentation rate; blood cell count. **For associated neurological conditions, consider the supplementary section. ***For tests useful to consider causes of small-fiber neuropathy, consider Gemignani et al. [66]
See this image and copyright information in PMC

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