How to Diagnose FMS?
Old Diagnostic Criteria

Diagnosis of FMS is difficult. It is believed in the USA that from first symptoms to the final diagnosis takes several years. Widespread pain and tender points are the main symptoms according to the American College of Rheumatology, who formed the following diagnostic criteria of FMS in 1990:

I. History of widespread pain

The pain is regarded as disseminated if it is localized in all quadrants of the body; left and right and upper and lower parts of the body and also in body axis (cervical, thoracic, lumbar part of spinal column or breastbone region of the chest). Pain duration: minimum three months. According to this the criteria are fulfilled if the patient has e.g. pain in the left shoulder region, right hip and the neck.

II. Pain in 11 of 18 points specified below:

Pain, on digital palpation, must be present in at least 11 of the following 9 pairs of tender point sites:

  • Occipital - at the suboccipital muscle insertions;
  • Low cervical - at the anterior aspects of the intertransverse spaces at C5-C7;
  • Trapezius - at the midpoint of the upper border;
  • Supraspinatus - at origins, above the scapula spine near the medial border;
  • Second rib - upper lateral to the second costochondral junction;
  • Lateral epicondyle - 2 cm distal to the epicondyles;
  • Gluteal - in upper outer quadrants of buttocks in anterior fold of muscle;
  • Greater trochanter - posterior to the trochanteric prominence;
  • Knee - at the medial fat pad proximal to the joint line.
New Diagnostic Criteria

In the May 2010 issue of Arthritis Care & Research (ACR) The American College of Rheumatology published a new set of diagnostic criteria they are proposing for fibromyalgia. The new diagnostic criteria, as proposed, will still require the first part of the old criteria - a history of widespread pain in all four quadrants of the body for a minimum duration of three months - but will replace the second part, the tender point exam, with:

A widespread pain index score which will be determined by counting the number of areas on the body where the patient has felt pain in the last week. The checklist includes the 18 areas specified above.

A symptom severity score which will be determined by rating on a scale of zero to three (three being the most pervasive) the severity of three common symptoms: fatigue, waking unrefreshed and cognitive symptoms. An additional three points can be added to account for the extent of additional symptoms such as numbness, dizziness, nausea, irritable bowel syndrome or depression. The final score is between 0 and 12.

To meet the criteria for a diagnosis of fibromyalgia a patient would have:

Seven or more pain areas and a symptom severity score of five or more, or

Three to six pain areas and a symptom severity score of nine or more.

If you think you may have fibromyalgia?

These questions can help you find out. Keep in mind that fibromyalgia must be diagnosed by a doctor, so even if you think you have symptoms see a medical professional to be sure.

  1. If you have widespread pain located in seven or more of the following areas: shoulders, upper arms, lower arms, hips, upper legs, lower legs, jaw, chest, neck, or abdomen. Please note that if you have pain on both sides of the body, e.g. in both your left and right upper arms, each arm would count separately.
  2. If you experience any other fibromyalgia symptoms, such as irritable bowel syndrome, fatigue, problems thinking or remembering, muscle weakness, abdominal pain or cramping, numbness or tingling, dizziness, insomnia, depression, constipation, nausea, nervousness, chest pain, fever, dry mouth, itching, frequent or painful urination, or wheezing.
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