What are the diagnosis criteria for fibromyalgia?

Jennifer N. Caudle, DO
Family Medicine
There is a specific diagnostic criteria for fibromyalgia; chronic, widespread pain in combination with other classic symptoms. Watch as family medicine specialist Jennifer Caudle, DO, shares the symptoms doctors look for when diagnosing fibromyalgia.
Dawn Marcus

The American College of Rheumatology gives the following as diagnosis criteria for fibromyalgia:

Widespread Pain Index

Where do you have pain? Give yourself 1 point for each of the following regions where you feel pain. Possible total score of 0 to 19.

  • Shoulder girdle, left
  • Shoulder girdle, right
  • Upper arm, left
  • Upper arm, right
  • Lower arm, left
  • Lower arm, right
  • Hip or butt, left
  • Hip or butt, right
  • Upper leg, left
  • Upper leg, right
  • Lower leg, left
  • Lower leg, right
  • Jaw, left
  • Jaw, right
  • Chest
  • Abdomen
  • Upper back
  • Lower back
  • Neck

Symptom Severity Scale

Rate how severe each of the following symptoms has been over the previous week on a scale from 0 to 3, with 0 = no symptoms, 1 = mild or intermittent symptoms; 2 = moderate or often troublesome symptoms; 3 = severe, continuous, or disabling symptoms. Possible total score of 0 to 9.

  • Fatigue
  • Waking not feeling refreshed
  • Problems with concentration, memory, or thinking

Symptom Severity Scale Supplement

Have you had the following symptoms in the past six months? Give yourself one point for each symptom for a possible total score of 0 to 3. Add this number to the Symptom Severity Score for a Total Symptom Severity score.

  • Pain or cramps in the lower abdomen
  • Depression
  • Headache

Fibromyalgia-ness score = pain score + total symptom severity score = possible total score of 0 to 31.

You may have to see multiple doctors before getting diagnosed with fibromyalgia because its main symptoms -- fatigue and pain -- are very common in other conditions as well. Your doctor will have to rule out other possible causes. There aren't any laboratory tests to diagnose this condition. As a result, some doctors may think a patient's pain isn't real.

Doctors use criteria developed by the American College of Rheumatology (ACR) to diagnose fibromyalgia. The checklist includes:
  • having widespread pain (pain on both sides of your body as well as below and above the waist) for at least three months
  • fatigue
  • feeling tired when you wake up
  • problems with thinking or remembering
In addition, the ACR has identified 18 sites on the body as tender points -- spots that feel painful or tender when your doctor applies pressure. The diagnostic criteria includes feeling pain or tenderness at 11 or more of these tender points when your doctor applies pressure. However, a newer set of criteria from the ACR doesn't require feeling discomfort at a specific number of tender points, so you may be diagnosed with fibromyalgia even if your experience is different.
Dr. Mehmet Oz, MD
Cardiology (Cardiovascular Disease)
Diagnosing fibromyalgia can be tricky. There is no specific lab test for the condition and symptoms may overlap those of other disorders, such as rheumatoid arthritis or lupus. To help doctors make an accurate diagnosis of fibromyalgia, the American College of Rheumatology recommends doctors consider three criteria:
  • How widespread and severe your symptoms are. Your doctor will ask you to describe your pain, and ask if you have pain in various different places on your body. Your doctor may also do a physical exam to check for painful or tender areas. Your doctor will also consider the severity of other symptoms, including fatigue, waking unrefreshed, memory problems or difficulty thinking clearly. 
  • How long you have had symptoms. To be diagnosed with fibromyalgia you need to have had symptoms for at least three months without improvement.
  • Whether your symptoms could be caused by another condition. Your doctor may order blood tests and look for certain physical signs to rule out other health problems that could be causing your symptoms. 
According to established criteria, a doctor should consider a diagnosis of fibromyalgia in a patient who has the following symptoms that aren't explained by another illness:
  • widespread muscle pain that has lasted for longer than three months
  • pain that occurs on both sides of the body and above and below the waist
A person with fibromyalgia will usually have a pattern of “tender points” on the body. These tender points occur at up to 18 specific sites, from the neck to the knees, in people with fibromyalgia.

Other signs and symptoms a doctor will look for when diagnosing fibromyalgia include fatigue, insomnia, morning stiffness, headaches, tingling or numbness in hands and feet, memory loss or difficulty concentrating (sometimes called “fibro fog”), and anxiety or other mood problems.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.