In the past, the American College of Rheumatology relied on an examination of certain points on the body -- known as trigger points or tender points -- to diagnose fibromyalgia. Tenderness upon pressure at 11 of the 18 points were considered evidence of fibromyalgia. In 2010, the American College of Rheumatology (ACR) changed the criteria.
Now, according to the ACR, a patient satisfies the diagnostic criteria for fibromyalgia if the following three conditions are met:
- Fibromyalgia pain, as evidenced by a “widespread pain index (WPI)” score of 7 and “symptom severity (SS)” scale score of 5 OR WPI of 3 to 6 and SS scale score of 9.
- Symptoms present at at a similar level of intensity for at least three months.
- No other disorders that would explain the pain.
The Widespread Pain Index
The Widespread Pain Index (WPI) rating looks at the areas where you’ve had pain over the last week. The score will be 0 to 19. Here are the 19 areas evaluated:
- Shoulder girdle, left
- Shoulder girdle, right
- Upper arm, left
- Upper arm, right
- Lower arm, left
- Lower arm, right
- Hip (buttock), left
- Hip (buttock), right
- Upper leg, left
- Upper leg, right
- Lower leg, left
- Lower leg, right
- Jaw, left
- Jaw, right
- Upper back
- Lower back
Symptom Severity (SS) Scale
The SS scale identifies the level of severity of three symptoms over the past week, using the following scale:
0 = no problem
1 = slight or mild problems, generally mild or intermittent
2 = moderate, considerable problems, often present and/or at a moderate level
3 = severe: pervasive, continuous, life-disturbing problems
The three symptoms evaluated include:
- Waking unrefreshed
- Cognitive symptoms
Considering somatic symptoms* in general, indicate whether the patient has:
0 = no symptoms
1 = few symptoms
2 = a moderate number of symptoms
3 = a great deal of symptoms
The SS scale score is the sum of the severity of the 3 symptoms plus the severity of somatic symptoms in general. The final score is between 0 and 12.
* By the ACR’s definition, “somatic symptoms” include muscle pain, irritable bowel syndrome, fatigue/tiredness, thinking or remembering problem, muscle weakness, headache, pain/cramps in the abdomen, numbness/tingling, dizziness, insomnia, depression, constipation, pain in the upper abdomen, nausea, nervousness, chest pain, blurred vision, fever, diarrhea, dry mouth, itching, wheezing, Raynaud’s phenomenon, hives/welts, ringing in ears, vomiting, heartburn, oral ulcers, loss of/change in taste, seizures, dry eyes, shortness of breath, loss of appetite, rash, sun sensitivity, hearing difficulties, easy bruising, hair loss, frequent urination, painful urination, and bladder spasms.
Source: ACR Fibromyalgia Criteria
Download The Fibromyalgia Criteria Checklist
Download a scorable checklist that outlines the NCR fibromyalgia criteria now (PDF format).