Table of ContentsView AllTable of ContentsDiagnostic CriteriaExclusionary DiagnosisWidespread Pain IndexSymptom Severity ScaleConfirming the DiagnosisFrequently Asked QuestionsNext in Fibromyalgia GuideHow Fibromyalgia Is Treated
Table of ContentsView All
View All
Table of Contents
Diagnostic Criteria
Exclusionary Diagnosis
Widespread Pain Index
Symptom Severity Scale
Confirming the Diagnosis
Frequently Asked Questions
Next in Fibromyalgia Guide
Fibromyalgiais a difficult disorder to diagnose. Because it is so poorly understood, there is no clear consensus as to what measures could or should be used to confirm it. Moreover, even if you have signs of the disorder—includingchronic widespread painand fatigue—available lab and imaging tests will often appear perfectly normal.
The only way to get a fibromyalgia diagnosis is to embark on a “diagnosis of exclusion.”
This can be a painstaking process in which your healthcare provider reviews and weeds out many other possible causes of your symptoms. Only when these causes are excluded can a diagnosis of fibromyalgia be made.
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The score-basedACR Fibromyalgia Diagnostic Criteriasystem includes an evaluation called the widespread pain index (WPI) and another called the symptom severity (SS) scale.
While the ACR system is commonly used, it does have its detractors who believe that fibromyalgia should not be evaluated as a purely somatic (physical) disorder but one in which psychological factors and psychosocial stresses are also assessed.
Before closely evaluating your currentsymptoms, your healthcare provider needs to exclude other diseases or disorders with similar symptoms and characteristics. Depending on the range of symptoms you have (digestive, urinary, psychological, etc.), the list can become quite extensive.
Among the possibilities:
The challenge in diagnosing fibromyalgia is that other conditions can often co-exist with fibromyalgia and have similar or overlapping symptoms.For instance, if arthritis or sleep apnea is diagnosed, the diagnosis might explain some of the key symptoms you are experiencing, but not others.
That’s why it can really help to have a healthcare provider experienced with fibromyalgia, so they can make the subtle distinctions.
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The widespread pain index (WPI) breaks the body down into 19 sections, each of which is considered a characteristic area of involvement.Your healthcare provider will ask if you experienced pain in each area in the past week. A score of 1 is registered for every “yes” you give.
You may also be asked to characterize thetype of pain you have(such as severe or diffuse) or considertender points(pain trigger points) that used to be central to the diagnosis.
The 19 pain sites included in the evaluation are (from top to bottom):
The maximum score for the WPI is 19.
The symptom severity (SS) scale evaluates four symptoms considered defining in a fibromyalgia diagnosis.Each symptom is scored on a scale of 0 to 3, with 0 meaning no symptoms; 1 meaning mild symptoms; 2 meaning moderate symptoms; and 3 meaning serious symptoms. The score is based purely on the severity of symptoms that have occurred within the past week.
The four symptoms evaluated in the criteria are:
The maximum score on the SS scale is 12.
If no other explanation for your symptoms can be found, your healthcare provider will look to see if your combined WPI and SS scores meet either one of two ACR criteria for possible fibromyalgia diagnosis:
Thereafter, if the healthcare provider can establish that your symptoms have been present at the same or similar level for at least three months, you would be officially diagnosed as having fibromyalgia.
Once the diagnosis is confirmed, you and your healthcare provider can then begin exploringtreatment options. This can be another long and protracted process, but one that can put you on the road to better health and sustainedremission.
Frequently Asked QuestionsFibromyalgia is diagnosed based on the widespread pain index (WPI) and the symptom severity scale (SS). WPI identifies pain locations while SS evaluates other symptoms including fatigue, sleep quality, cognitive difficulties, and somatic symptoms including dizziness, fainting, nausea, and bowel disorders.The old diagnostic criteria for fibromyalgia were based on having at least 11 of 18 specific tender points found in the front of the neck, below the collarbone, back of the neck, back of shoulders, shoulder blades, outsides of the elbows, upper-outer buttocks, outsides of the hips, and inner knees.Learn MoreThe Role of Tender Points in Diagnosing FibromyalgiaUnfortunately, there are no blood tests that confirm a fibromyalgia diagnosis. Imaging studies also typically appear normal in fibromyalgia. Fibromyalgia is diagnosed based on symptoms and history, and after other conditions have been ruled out.
Fibromyalgia is diagnosed based on the widespread pain index (WPI) and the symptom severity scale (SS). WPI identifies pain locations while SS evaluates other symptoms including fatigue, sleep quality, cognitive difficulties, and somatic symptoms including dizziness, fainting, nausea, and bowel disorders.
The old diagnostic criteria for fibromyalgia were based on having at least 11 of 18 specific tender points found in the front of the neck, below the collarbone, back of the neck, back of shoulders, shoulder blades, outsides of the elbows, upper-outer buttocks, outsides of the hips, and inner knees.Learn MoreThe Role of Tender Points in Diagnosing Fibromyalgia
The old diagnostic criteria for fibromyalgia were based on having at least 11 of 18 specific tender points found in the front of the neck, below the collarbone, back of the neck, back of shoulders, shoulder blades, outsides of the elbows, upper-outer buttocks, outsides of the hips, and inner knees.
Learn MoreThe Role of Tender Points in Diagnosing Fibromyalgia
Unfortunately, there are no blood tests that confirm a fibromyalgia diagnosis. Imaging studies also typically appear normal in fibromyalgia. Fibromyalgia is diagnosed based on symptoms and history, and after other conditions have been ruled out.
How Fibromyalgia Is Treated
4 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Fibromyalgia.Rheumatology.org.Wolfe F, Walitt B, Katz R, Häuser W.Symptoms, the Nature of Fibromyalgia, and Diagnostic and Statistical Manual 5 (DSM-5) Defined Mental Illness in Patients with Rheumatoid Arthritis and Fibromyalgia.PLoS ONE. 2014;9(2):e88740. doi:10.1371/journal.pone.0088740Fitzcharles MA, Perrot S, Häuser W.Comorbid fibromyalgia: A qualitative review of prevalence and importance.Eur J Pain. 2018;22(9):1565-1576. doi:10.1002/ejp.1252Namcp.org.Additional ReadingBellato, E.; Marini, E.; Castoldi, F. et al.Fibromyalgia Syndrome: Etiology, Pathogenesis, Diagnosis, and Treatment.Pain Res Treat. 2012; 2012: 426130. DOI: 10.1155/2012/426130.Wolfe, F.; Clauw, D.; Fitzcharles, M.; et al.The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity.Arthritis Care Res.2010; 62(5):600-10. DOI: 10.1002/acr.20140.
4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Fibromyalgia.Rheumatology.org.Wolfe F, Walitt B, Katz R, Häuser W.Symptoms, the Nature of Fibromyalgia, and Diagnostic and Statistical Manual 5 (DSM-5) Defined Mental Illness in Patients with Rheumatoid Arthritis and Fibromyalgia.PLoS ONE. 2014;9(2):e88740. doi:10.1371/journal.pone.0088740Fitzcharles MA, Perrot S, Häuser W.Comorbid fibromyalgia: A qualitative review of prevalence and importance.Eur J Pain. 2018;22(9):1565-1576. doi:10.1002/ejp.1252Namcp.org.Additional ReadingBellato, E.; Marini, E.; Castoldi, F. et al.Fibromyalgia Syndrome: Etiology, Pathogenesis, Diagnosis, and Treatment.Pain Res Treat. 2012; 2012: 426130. DOI: 10.1155/2012/426130.Wolfe, F.; Clauw, D.; Fitzcharles, M.; et al.The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity.Arthritis Care Res.2010; 62(5):600-10. DOI: 10.1002/acr.20140.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Fibromyalgia.Rheumatology.org.Wolfe F, Walitt B, Katz R, Häuser W.Symptoms, the Nature of Fibromyalgia, and Diagnostic and Statistical Manual 5 (DSM-5) Defined Mental Illness in Patients with Rheumatoid Arthritis and Fibromyalgia.PLoS ONE. 2014;9(2):e88740. doi:10.1371/journal.pone.0088740Fitzcharles MA, Perrot S, Häuser W.Comorbid fibromyalgia: A qualitative review of prevalence and importance.Eur J Pain. 2018;22(9):1565-1576. doi:10.1002/ejp.1252Namcp.org.
Fibromyalgia.Rheumatology.org.
Wolfe F, Walitt B, Katz R, Häuser W.Symptoms, the Nature of Fibromyalgia, and Diagnostic and Statistical Manual 5 (DSM-5) Defined Mental Illness in Patients with Rheumatoid Arthritis and Fibromyalgia.PLoS ONE. 2014;9(2):e88740. doi:10.1371/journal.pone.0088740
Fitzcharles MA, Perrot S, Häuser W.Comorbid fibromyalgia: A qualitative review of prevalence and importance.Eur J Pain. 2018;22(9):1565-1576. doi:10.1002/ejp.1252
Namcp.org.
Bellato, E.; Marini, E.; Castoldi, F. et al.Fibromyalgia Syndrome: Etiology, Pathogenesis, Diagnosis, and Treatment.Pain Res Treat. 2012; 2012: 426130. DOI: 10.1155/2012/426130.Wolfe, F.; Clauw, D.; Fitzcharles, M.; et al.The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity.Arthritis Care Res.2010; 62(5):600-10. DOI: 10.1002/acr.20140.
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