Challenges in Fibromyalgia Diagnosis: From Meaning of Symptoms to Fibromyalgia Labeling
Open accessAbstract
Fibromyalgia (FM) is a contested illness with ill-defined boundaries. There is no clearly defined cut-point that separates FM from non-FM. Diagnosis of FM has been faced with several challenges that occur, including patients' health care-seeking behavior, symptoms recognition, and FM labeling by physicians. This review focuses on important but less visible factors that have a profound influence on under- or over-diagnosis of FM. FM shows different phenotypes and disease expression in patients and even in one patient over time. Psychosocial and cultural factors seem to be a contemporary ferment in FM which play a major role in physician diagnosis even more than having severe symptom levels in FM patients. Although the FM criteria are the only current methods which can be used for classification of FM patients in surveys, research, and clinical settings, there are several key pieces missing in the fibromyalgia diagnostic puzzle, such as invalidation, psychosocial factors, and heterogeneous disease expression. Regarding the complex nature of FM, as well as the arbitrary and illusory constructs of the existing FM criteria, FM diagnosis frequently fails to provide a clinical diagnosis fit to reality. A physicians' judgment, obtained in real communicative environments with patients, beyond the existing constructional scores, seems the only reliable way for more valid diagnoses. It plays a pivotal role in the meaning and conceptualization of symptoms and psychosocial factors, making diagnoses and labeling of FM. It is better to see FM as a whole, not as a medical specialty or constructional scores.
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The wide range of symptoms and behaviors, accompanied by different severity and combination levels, complicates diagnosis.
“The wide range of symptoms and behaviors, accompanied by different severity and combination levels, complicates diagnosis [131,132].”
From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [132]
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- Authors
- Bidari, A., Parsa, B. G., & Ghalehbaghi, B.
- Affiliations
- Iran University of Medical Sciences (IR)
- Rheumatology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
- ORCID
- Bidari, Ali
- Venue
- The Korean Journal of Pain
- Publisher
- Korean Pain Society
- Published
- 2018-07-31
- Volume
- 31
- Issue
- 3
- Pages
- 147-154
- ISSN
- 1226-2579 (ISSN-L)
- 2005-9159
- 2093-0569
- PMC
- PMC6037812
- OpenAlex
- W2822205841
- Cited by
- 49
- References
- 47
- Citations by year
- 2026: 6 · 2025: 2 · 2024: 4 · 2023: 8 · 2022: 9 · 2021: 10 · 2020: 6 · 2019: 4
- FWCI
- 0.76
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- Locations
- The Korean journal of pain (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Funders
- Guilan University of Medical Sciences
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Myofascial pain diagnosis and treatment
- Keywords
- fibromyalgia, fibromyalgia diagnosis, diagnostic criteria, psychosocial factors, cultural factors, symptom recognition, health-seeking behavior, underdiagnosis, overdiagnosis, disease heterogeneity, patient-physician communication
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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