Implication of the Nociplastic Features for Clinical Diagnosis of Fibromyalgia: Development of the Preliminary Nociplastic‐Based Fibromyalgia Features (NFF) Tool

Abstract

Objective. Nociplastic concept incorporates a broad continuum of pain phenotypes shared with clinical peculiarity. This study aimed to develop and validate a diagnostic tool, the preliminary Nociplastic-based Fibromyalgia Features (NFF), to detect fibromyalgia (FM) in patients with chronic pain.Methods. Items requiring yes or no responses and relating to the most relevant clinical nociplastic pain (NP) features of FM were compiled by a group of expert rheumatologists. The provisional list was tested in a prospective study on 185 consecutive patients with chronic pain (126 patients with FM and 59 patients with non-FM noninflammatory chronic pain) diagnosed based on expert decision. Identification of the most discriminant combinations of items for FM and the calculation of their sensitivity and specificity were based on both univariate and multivariate (stepwise logistic regression) analyses. All participants were investigated through the final NFF, the 2011 American College of Rheumatology (ACR) criteria, and the 2016 ACR criteria. NFF performance was assessed with receiver operating characteristic curve analysis.Results. Based on multivariate analyses, we retained only seven items in the final version of the NFF. A cut-off score of 4 (corresponding to the number of positive items) gave the highest rate of correct identification of patients (85%), with a sensitivity of 82% and a specificity of 91%. The NFF showed the highest concordance rate with expert diagnosis (85%) and the lowest value (77%) with the ACR 2016 criteria.Conclusion. The preliminary NFF with respect to the various aspects of NP showed good performance for detection of the FM in the clinical setting. This tool may provide a more pragmatic approach to the timely diagnosis of FM.

Myofascial Pain Syndrome: A Nociceptive Condition Comorbid with Neuropathic or Nociplastic Pain

“…A nociplastic pain pattern is more generalized or widespread [ 14 ] than is nociceptive pain, but yet can be found in certain musculoskeletal pain syndromes. Fibromyalgia is a pain condition which fulfills several criteria for nociplastic pain [ 63 , 64 ]. In fact, widespread pain experienced by these patients is a cardinal sign of fibromyalgia, although other symptoms are always present.…”

Fibromyalgia syndrome: epidemiology, diagnosis and treatment

“…This diagnostic tool is based on nociplastic pain characteristics rather than documenting and quantifying FMS-related symptoms and pain sites and differs from existing symptom-focused criteria. With all these features, it is claimed that early diagnosis is achievable before the symptom spectrum arises [33].…”

Fibromyalgia criteria and anomalous results: comment on the article by Ghavidel‐Parsa et al

“…We read with interest the paper by Ghavidel-Parsa et al on the Preliminary Nociplastic-Based Fibromyalgia Features (NFF) tool (1) in which the authors describe a new tool for the diagnosis of fibromyalgia (FM) and then compare the tool's performance with the American College of Rheumatology (ACR) modified 2011 and 2016 criteria in accurately identifying patients with FM (2,3). The performance results for the respective groups (NFF, ACR modified 2011, and ACR modified 2016) were concordance 0.85, 0.80, and 0.77; kappa, 0.68, 0.58, and 0.51; and AUC 0.87, 0.79, and 0.76, as shown in their Table 4.…”