Neurological Scienceshttp5/doi.org/10.1007/s10072-023-06836-3CONSENSUS PAPERS AND GUIDELINESClinical criteria and diagnostic assessment of fibromyalgia:positionstatement of the Italian Society of Neurology-Neuropathic Pain StudyGroupG.Devigili'.G.Di Stefano2.V.Donadio3.I.Frattale4.E.Mantovani5.M.Nolano57.G.Occhipinti.V.Proviteras.S.Quitadamo11.S.Tamburin5.A.Toscano10.S.Tozza8.A.Truini2.M.Valeriani.M.de Tommaso11Received:2 March 2023 Accepted:25 April 2023The Author(s)2023AbstractBackground The role of central and/or peripheral nervous system dysfunction is basically fundamental in fibromyalgia.Aim The aim of this position statement on behalf of the Neuropathic Pain Study Group of the Italian Society of Neurologyis to give practical guidelines for the clinical and instrumental assessment of fibromyalgia(FM)in the neurological clinicalpractice,taking into consideration recent studies.Methods Criteria for study selection and consideration were original studies,case-controls design,use of standardizedmethodologies for clinical practice,and FM diagnosis with ACR criteria (2010.2011.2016).Results ACR criteria were revised.For diagnostic procedure of small-fiber pathology,47 studies were totally considered.Recent diagnostic criteria should be applied(ACR,2016).A rheumatologic visit seems mandatory.The involvement ofsmall fibers should request at least 2 among HRV+SSR and/or laser-evoked responses and/or skin biopsy and/or cornealconfocal microscopy,eventually followed by monitoring of metabolic and/or immunological/and or/paraneoplastic basis,to be repeated at 1-year follow-up.Conclusions The correct diagnostic approach to FM could promote the exclusion of the known causes of small-fiber impair-ment.The research toward common genetic factors would be useful to promote a more specific therapeutic approach.Keywords Fibromyalgia.Diagnostic criteria.Small-fiber neuropathy.Laser-evoked potentials.Skin biopsy.Cornealconfocal microscopy.Heart rate variabilityG.Devigili,G.Di Stefano,V.Donadio,I.Frattale,E.Mantovani,M.Nolano.G.Occhipinti.V.Provitera.S.Quitadamo.S.Tamburin andA.Toscano equally contributed to this work.☒M.de TommasoDepartment of Neurosciences,Reproductive Sciencesmarina.detommaso@uniba.itand Odontostomatology,University Federico II of Naples,80100 Naples,ItalyUOC Neurologia IIRCCS Carlo Besta,Milan,Italy8UOC Neurologia E Malattie Neuromuscolari.AUO Martino2Department of Human Neuroscience,Sapienza University,Messina,Messina,ItalyRome.ItalyDevelopmental Neurology Unit,Ospedale PediatricoClinica Neurologica Bellaria Hospital,Bologna,ItalyBambino Gesu,Rome,Italy4Child Neurology and Psychiatric Unit,Tor Vergata10EURO-ERN NMD.AOU Martino University of Messina,University.Rome,ItalyMessina,Italy5 Neurosciences,Biomedicine and Movement Sciences1 Neurophysiopathology Unit,DiBraiN Department,Department,Verona University.Verona,ItalyPoliclinico General Hospital,Bari Aldo Moro University.Skin Biopsy Laboratory,Department of Neurology,InstitutiPiazza Giulio Ce
