Diagnosis of fibromyalgia: diagnostic feasibility and accuracy of thermography

Main Article Content

Claudia Kumpel
Anselmo Cordeiro de Souza
José Sávio Ribeiro
Hildemar Minoru Shirata
Júlia de Oliveira
Cesário Bianchi Filho


Introduction: Studies have suggested using thermography as a resource to diagnose fibromyalgia, although there has been no evidence confirming this hypothesis so far. Objective: To evaluate the sensitivity and specificity of computerized infrared thermography as an auxiliary method for diagnosing fibromyalgia. Methods: It is a diagnostic accuracy studywith cross-sectional design. One hundred and three individuals were evaluated for global pain using the Visual Analogue Scale. The measurement of pain at tender points was assessed by algometry, and skin temperature was assessed by thermography. To evaluate sensitivity and specificity, the analysis was performed using the Receiver Operating Characteristic Curve, measured by the area under the curve with their respective confidence intervals. Results: Thermography has not been very sensitive or specific for pain (tender points) and diagnosis of fibromyalgia, according to the evaluation of the Receiver Operating Characteristic Curve, with an area under the curve equal to or lower than 0.75. Conclusion: In this study the thermography was not sensitive and specific as a tool for diagnosing the fibromyalgia syndrome. This study highlights important clinical implications concerning the current methods for diagnosing it, which, despite all efforts, are still subjective and poorly reproducible.


Download data is not yet available.

Article Details

How to Cite
Kumpel, C., Souza, A. C. de, Ribeiro, J. S., Shirata, H. M., Oliveira, J. de, & Bianchi Filho, C. (2022). Diagnosis of fibromyalgia: diagnostic feasibility and accuracy of thermography. ABCS Health Sciences, 48, e023225. https://doi.org/10.7322/abcshs.2021113.2146
Original Articles


Häuser W, Sarzi-Puttini P, Fitzcharles MA. Fibromyalgia syndrome: under-, over- and misdiagnosis. Clin Exp Rheumatol. 2019;37 Suppl 116(1):90-7.

Ceko M, Bushnell MC, Gracely RH. Neurobiology underlying fibromyalgia symptoms. Pain Res Treat. 2012;2012:585419. https://doi.org/10.1155/2012/585419

Bair MJ, Krebs EE. Fibromyalgia. Ann Intern Med. 2020;172(5):ITC33-ITC48. https://doi.org/10.7326/AITC202003030

Galvez-Sánchez CM, Del Paso GAR. Diagnostic criteria for fibromyalgia: critical review and future perspectives. J Clin Med. 2020;9(4):1219. https://doi.org/10.3390/jcm9041219

Bernardy K, Klose P, Welsch P, Häuser W. Efficacy, acceptability and safety of Internet-delivered psychological therapies for fibromyalgia syndrome: A systematic review and meta-analysis of randomized controlled trials. Eur J Pain. 2019;23(7):1397. https://doi.org/10.1002/ejp.1430

Bazzichi L, Giacomelli C, Consensi A, Giorgi V, Batticciotto A, Di Franco M, et al. One year in review 2020: fibromyalgia. Clin Exp Rheumatol. 2020;38Suppl 123(1):3-8.

Neumeister MW, Neumeister EL. Fibromyalgia. Clin Plast Surg. 2020;47(2):203-13. https://doi.org/10.1016/j.cps.2019.12.007

Häuser W, Ablin J, Fitzcharles MA, Littlejohn G, Luciano JV, Usui C, et al. Fibromyalgia. Nat Rev Dis Primers. 2015;1:15022. https://doi.org/10.1038/nrdp.2015.22

Chopra A, Abdel-Nasser A. Epidemiology of rheumatic musculoskeletal disorders in the developing world. Best Pract Res Clin Rheumatol. 2008;22(4):583-604. https://doi.org/10.1016/j.berh.2008.07.001

Wolfe F, Walitt B, Rasker JJ, Häuser W. Primary and Secondary Fibromyalgia Are The Same: The Universality of Polysymptomatic Distress. J Rheumatol. 2019;46(2):204-12. https://doi.org/10.3899/jrheum.180083

Theoharides TC, Tsilioni I, Bawazeer M. Mast Cells, Neuroinflammation and Pain in Fibromyalgia Syndrome. Front Cell Neurosci. 2019;13:353. https://doi.org/10.3389/fncel.2019.00353

Bradley LA. Pathophysiology of fibromyalgia. Am J Med. 2009;122(12 Suppl):S22-30. https://doi.org/10.1016/j.amjmed.2009.09.008

Jackson T, Thomas S, Stabile V, Han X, Shotwell M, McQueen KA. Chronic Pain Without Clear Etiology in Low- and Middle-Income Countries: a narrative review. Anesth Analg. 2016;122(6):2028-39. https://doi.org/10.1213/ANE.0000000000001287

Wortman MSH, Lokkerbol J, van der Wouden JC, Visser B, van der Horst HE, Hartman TCO. Cost-effectiveness of interventions for medically unexplained symptoms: A systematic review. PLoS One. 2018;13(10):e0205278. https://doi.org/10.1371/journal.pone.0205278

Häuser W, Perrot S, Sommer C, Shir Y, Fitzcharles MA. Diagnostic confounders of chronic widespread pain: not always fibromyalgia. Pain Rep. 2017;2(3):e598. https://doi.org/10.1097/PR9.0000000000000598

Oaklander AL, Nolano M. Scientific advances in and clinical approaches to small-fiber polyneuropathy: A Review. JAMA Neurol. 2019;76(10):1240-51. https://doi.org/10.1001/jamaneurol.2019.2917

Clauw DJ, Arnold LM, McCarberg BH, FibroCollaborative. The science of fibromyalgia. Mayo Clin Proc. 2011;86(9):907-11. https://doi.org/10.4065/mcp.2011.0206

White KP, Nielson WR, Harth M, Ostbye T, Speechley M. Chronic widespread musculoskeletal pain with or without fibromyalgia: psychological distress in a representative community adult sample. J Rheumatol. 2002;29(3):588-94.

Devulder J, Duprez D, Buyzere M, Simoens J, Michielsen W, van Duyse A. Identifying subgroups in the chronic fatigue syndrome. Pain Clin. 2001;13(2):145-52. https://doi.org/10.1163/156856901753421007

Hau HPY, Scudds RA, Harth M. An evaluation of mechanically induced neurogenic flare by infrared thermography in fibromyalgia. J Musculoskeletal Pain. 1996;4(3);3-20. https://doi.org/10.1300/J094v04n03_02

Ammer K. The Glamorgan Protocol for recording and evaluation of thermal images of the human body. Thermol Int. 2008;18(4):125-44.

Ammer K, Engelbert B. Reproducibility of the hot spot count in patients with fibromyalgia, an intra-and inter-observer comparison. Thermol Int. 2009;19:47-51.

Brusselmans G, Nogueira H, Schamphelaere E, Devulder J, Crombez G. Skin Temperature during Cold Pressor Test in Fibromyalgia: an Evaluation of the Autonomic Nervous System? Acta Anaesthesiol Belg. 2015;66(1):19-27.

Oliveira KP, Kagawa LAC, Kumpel C, Souza AC, Kumpel C, Lima PO, et al. The use of myofasial release in fibromyalgia: scope analysis. Int J Adv Eng Res Sci. 2021;8(11):161-70. https://doi.org/10.22161/ijaers.811.17

Eusebi P. Diagnostic accuracy measures. Cerebrovasc Dis. 2013;36(4):267-72.

Porto EF, Kumpel C, Larchert DMS, Palacio PRC, Souza AC. Sensibilidade e especificidade de testes para avaliar o equilíbrio corporal em diabéticos. Saude Pesq. 2018;11(3):413-22.

Souza AC, Miguel AS, Oliveira IM, Acevedo MCL, Portes LA, Porto EF. Perfil da composição corporal e densidade mineral óssea de tabagistas em um centro de referência em reabilitação e assistência à saúde. Life Style. 2018;5(1):77-107. https://doi.org/10.19141/2237-3756.lifestyle.v5.n1.p77-107

Cheatham SW, Kolber MJ, Mokha M, Hanney WJ. Concurrent validity of pain scales in individuals with myofascial pain and fibromyalgia. J Bodyw Mov Ther. 2018;22(2):355-60. https://doi.org/10.1016/j.jbmt.2017.04.009

Brioschi ML, Yeng LT, Pastor EM, Teixeira MJ. Infrared imaging use in rheumatology. Rev Bras Reumatol. 2007;47(1):42-51. https://doi.org/10.1590/S0482-50042007000100008

Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Häuser W, Katz RL, et al. 2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria. Semin Arthritis Rheum. 2016;46(3):319-29. https://doi.org/10.1016/j.semarthrit.2016.08.012

American Academy of Thermology (AAT). Guidelines for neuromusculoskeletal infrared thermography sympathetic skin response (SSR) studies. Pan Am J Med Thermol. 2015;2(1):35-43. http://dx.doi.org/10.18073/2358-4696/pajmt.v2n1p35-43

Brioschi ML, Yeng LT, Araujo JO, Pezzucchi MZ, Teixeira MJ. Modulação da Dor na Síndrome Fibromiálgica: um Distúrbio Termorregulatório?. Pan Am J Med Thermol. 2015;1(2):71-80. http://dx.doi.org/10.18073/2358-4696/pajmt.v1n2p71-80

Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res (Hoboken). 2010;62(5):600-10. https://doi.org/10.1002/acr.20140

Aggarwal R, Ringold S, Khanna D, Neogi T, Johnson SR, Miller A, et al. Distinctions between diagnostic and classification criteria?. Arthritis Care Res. 2015;67(7):891-7. https://doi.org/10.1002/acr.22583

Schamphelaere E, Brusselmans G, Devulder J. Thermographic evaluation and analysis of a cold-water test: a comparative study between patients with the fibromyalgia syndrome and healthy controls. [dissertation]. Belgium, Universiteit Gent. Belgium: 2013.

Lima RP, Brioschi ML, Teixeira MJ, Neves EB. Análise termográfica de corpo inteiro: indicações para investigação de dores crônicas e diagnóstico complementar de disfunções secundárias. Pan Am J Med Thermol. 2015;2(2):70-7. http://dx.doi.org/10.18073/2358-4696/pajmt.v2n2p70-77

Devulder J, Laat M. Lamotrigine in the treatment of chronic refractory neuropathic pain. J Pain Symptom Manage. 2000;19(5):398-403. https://doi.org/10.1016/s0885-3924(00)00131-7

Gomes MJ, Brioschi ML, Hanna JM, Gomes ZS. Correlação entre os métodos de imagem infravermelho e ultra-sonografia na identificação topográfica das lesões músculo-esqueléticas. Rev Bras Ultra-Sonografia. 2015;9:21-6.