Widespread pain
Pain in the left/right side of the body, pain above/below the waist. In addition, axial skeleton pain (cervical spine or anterior chest or thoracic spine or low back) must be present.
Tender points
Pain, on digital palpation (4 Kg/cm² applied over 4 seconds), must be present in at least 11 of the following 18 specified tender-point bilateral sites: occiput, low cervical, trapezius, supraspinatus, second rib, lateral epicondyle, gluteal, greater trochanter, and knee.
Diagnosis
Both criteria must be satisfied. Widespread pain must be present for at least 3 months. The presence of a second clinical disorder does not exclude the diagnosis of fibromyalgia.
| Widespread pain index (WPI)
Note the number of areas in which the patient has had pain over the past week (0–19 points). The following are the areas to be considered: shoulder girdle, hip (buttock, trochanter), jaw, upper back, lower back, upper arm, upper leg, chest, neck, abdomen, lower arm, and lower leg (all these areas should be considered bilaterally).
SS scale score
Fatigue, waking unrefreshed, cognitive symptoms (e.g., working memory capacity, recognition memory, verbal knowledge, anxiety, and depression) [211]. For each of these 3 symptoms, indicate the level of severity 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
Considering somatic symptoms in general, indicate wheter the patient has the following:
0 = no symptoms
1 = few symptoms
2 = a moderate number of symptoms
3 = a great deal of symptoms
Final score between 0 and 12
Criteria
A patient satisfies diagnostic criteria for fibromyalgia if the following 3 conditions are met:
(i) WPI ≥ 7/19 and SS scale score ≥ 5 or WPI 3–6 and SS scale score ≥ 9
(ii) symptoms have been present as a similar level for at least 3 months
(iii) the patient does not have a disorder that would otherwise explain the pain
Modified criteria
(i) WPI (as above)
(ii) SS scale score (as above, but without extent of somatic symptoms)
(iii) presence of abdominal pain, depression, headaches (yes = 1, no = 0)
The number of pain sites (WPI), the SS scale score, and the presence of associated symptoms are summed to give a final score between 0 and 31 |
