Only 1 Out of 10 of Clinicians Adhere to ACR Criteria for Fibromyalgia

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Most healthcare professionals surveyed do not follow the American College of Rheumatology (ACR) criteria for fibromyalgia, including treatment advice, and many were unaware of the causes of fibromyalgia, according to a study published in Pain Practice.1

Since its introduction 50 years ago, fibromyalgia has increased in prevalence and the clinical criteria for understanding chronic pain has changed. The current ACR criteria for fibromyalgia are defined as: 1) generalized pain, 2) present symptoms for ≥3 months without another disorder to otherwise explain pain symptoms, and 3) a widespread pain index (WPI) score of ≥7, a symptom severity scale (SSS) score of ≥5, or a WPI score between 4 — 6 and a SSS score of ≥9.2

“Despite all the progress that has been made in the last decades, debates on the causes of pain in fibromyalgia remain,” wrote C. Paul Van Wilgen, PhD, associated with the Transcare Transdisciplinary Pain Management Center, Groningen, the Netherlands, and Pain in Motion International Research Group, Brussels, Belgium, and colleagues. “The lack of clear explanation for pain or a biomedical cause not only leads to misdiagnosis or unnecessary treatments but also undermines the doctor-patient relationship and negatively influence therapeutic alliance.”

The international survey was conducted to evaluate whether healthcare professionals are familiar with the ACR criteria for diagnosing fibromyalgia, the causes of the condition, and whether they adhere to clinical guidelines when treating their patients. Clinicians were invited to participate via email and social media advertising. Eligible participants were required to have an active patient practice and reside in one of the countries included in the study.

286 clinicians from 43 countries completed the survey, of which 189 (66%) were male, the median experience was 12 years, and the median age was 38 years. Of these participants, only 10% followed the ACR criteria. The most commonly used diagnostic ACR criteria were widespread pain (44%), unrefreshed sleep (24%), fatigue (20%), and cognitive problems (8%). Only 5% of clinicians surveyed reported pain duration of ≥3 months as a diagnostic criterion. Approximately half (55%, n = 157) of participants did not mention other symptoms related to fibromyalgia.

One out of 3 (32%, n = 94) providers believed the cause of fibromyalgia is unknown or idiopathic. A total of 70 different treatment options were reported, with 24% of responses categorized as recommended by clinical guidelines and 43% were deemed incorrect. These treatment strategies were subcategorized as either pain relief (medication, dry needling, scraping therapy, nerve stimulations, osteopathy, acupuncture, and ultrasound) or pain management (exercise, behavioral, psychological, cognitive, and social approaches). In addition to this, respondents also recommended “no medication,” “drink lots of water,” “mother’s house chores,” and “pleasant tactile stimuli.”

Investigators noted limitations including the underrepresentation of certain geographic areas. Additionally, data were collected over a long period of time due to the variety of investigators and countries included in the study.

“Our results should be interpreted with caution since they might reflect respondents’ personal view rather than the current knowledge or practice in their countries,” investigators concluded. “On the other hand, the answers presented in the current study may reflect that fibromyalgia is a clinical condition that is not clearly understood by non-specialized doctors.”


  1. Van Wilgen CP, Ucles-Juarez R, Krutko D, et al. Knowledge on cause, clinical manifestation and treatment for fibromyalgia among medical doctors: A worldwide survey. Pain Pract. Published online December 29, 2023. doi:10.1111/papr.13339
  2. Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Hauser W, Katz RS, et al. Fibromyalgia criteria and severity scales for clinical and epidemiological studies: a modification of the ACR preliminary diagnostic criteria for fibromyalgia. J Rheumatol. 2011;38(6):1113–22.