By Dr. Javier Rivera | Dec. 15, 2018 | Fibromyalgia

Patients frequently ask me if fibromyalgia has degrees of severity.

Fibromyalgia is like many diseases: it has a wide spectrum that ranges from mild forms to more serious forms, going through all the possibilities that have been and will be. Therefore, it is clear that there are degrees of fibromyalgia. However, we are going to explain this in more detail because it has some peculiarities.

Many of the symptoms of fibromyalgia are common and prevalent in the general population. This characteristic led some doctors to think that fibromyalgia was not a well-defined disease but only a set of common symptoms where some people had more and others less. In other words, they removed the category of disease and reduced it to just a few symptoms that anyone could have and not just people with fibromyalgia. Seen this way: indeed, how serious can this disease be?

We already know that fibromyalgia does not have symptoms that are exclusive to it, and that, moreover, they are common among the general population. However, what really characterizes the disease is that the symptoms appear all together, with an intensity above the usual and with a chronic character and not occasional as they are seen in the rest of the people. As if that were not enough, they respond poorly to the usual therapeutic measures and are not easily controlled by the patient. All these characteristics make fibromyalgia a well-defined disease with a spectrum of severity.

At the beginning, when the first symptoms appear, they can be controlled reasonably well and the progression of the disease can be prevented; for this reason, diagnosis in the early stages is so important. Then, if there is still not good control, more symptoms appear, they become autonomous and respond worse and worse to conventional treatments. When the disease is already established, it is when the negative consequences begin to be seen, which are added to the general situation of the patient. These consequences are what we call the impact of the disease on the patient’s life and it affects all spheres of his life: health, personal, family, social, work, economic situation, etc., and this is what really determines the severity of fibromyalgia.

There are several questionnaires used to measure severity through symptoms. However, as fibromyalgia occurs in outbreaks, the situation detected by the questionnaires also fluctuates and only allows the severity to be established at that precise moment, but they work poorly to measure global severity. It is the frequent case that a patient is well at one visit and unwell at another a few weeks later with no major change in her life or treatment; this makes it difficult to objectively establish the overall severity.

The score points that were previously used for diagnosis were intended to be a kind of thermometer of severity. However, this idea failed because it has been proven that the number of painful points is such a simple measure that it is not capable of reflecting a situation as complex as that of fibromyalgia. Currently the points are not even used to make the diagnosis of the disease.

In conclusion, fibromyalgia does indeed have degrees of severity like other diseases. The best way to measure severity is through the consequences that it produces in the patient’s life. Job loss, separation from a partner, social isolation, economic problems, depression, frequent health visits, etc., that people with fibromyalgia present are objective data that can be measured and quantified to assess severity.