Fibromyalgia Criteria Calculator
2016 ACR Revised Diagnostic Criteria for Fibromyalgia
Assessment
Widespread Pain Index (WPI): 0 / 19
Check areas where you have had pain over the last week:
Symptom Severity Scale (SSS): 0 / 12
Rate the severity of the following symptoms over the past week (0-3):
e.g., muscle pain, IBS, headache, numbness/tingling, dizziness, nausea
Diagnostic Result
Diagnostic Criteria
Fibromyalgia is diagnosed when EITHER:
Plus: Symptoms present at similar level for ≥3 months, no other disorder that would explain the pain
Treatment Approach
- • Education: Explain diagnosis, set expectations
- • Exercise: Graded aerobic program (walking, swimming)
- • CBT: Cognitive behavioral therapy
- • Medications: Pregabalin, duloxetine, milnacipran
Must Exclude
- • Hypothyroidism, vitamin D deficiency
- • Inflammatory arthritis (RA, PMR)
- • Myopathy, neuropathy
- • Sleep apnea, depression
💡 Clinical Pearl
Fibromyalgia often coexists with other conditions. Treat comorbid conditions (depression, sleep disorders) aggressively.
Understanding Fibromyalgia
Fibromyalgia is a chronic pain syndrome characterized by widespread musculoskeletal pain, fatigue, sleep disturbances, and cognitive difficulties. The 2016 revised ACR criteria provide a validated method for diagnosis without requiring the previous tender point examination.
Evolution of Diagnostic Criteria
- 1990 ACR Criteria: Required 11 of 18 tender points - difficult to perform, poor reliability
- 2010 Preliminary Criteria: Introduced WPI and SSS, eliminated tender point exam
- 2011 Modified Criteria: Self-report version for survey research
- 2016 Revised Criteria: Current standard, combines WPI and SSS with duration requirement
Widespread Pain Index (WPI)
The WPI assesses pain in 19 body regions over the past week. Patients indicate areas where they have experienced pain, with scores ranging from 0-19. Higher scores indicate more widespread pain distribution.
Symptom Severity Scale (SSS)
The SSS evaluates four domains, each scored 0-3:
- Fatigue: Overwhelming tiredness, lack of energy
- Waking unrefreshed: Non-restorative sleep
- Cognitive symptoms: "Fibro fog" - memory and concentration problems
- Somatic symptoms: Headaches, IBS, numbness, dizziness, etc.
Pathophysiology
Fibromyalgia involves central sensitization - amplified pain processing in the central nervous system. Contributing factors include:
- Altered neurotransmitter levels (serotonin, norepinephrine, substance P)
- Increased glutamate in brain regions processing pain
- Dysfunctional descending pain inhibition pathways
- Sleep disturbances affecting pain perception
- Psychological stress and mood disorders
Multimodal Treatment Approach
Effective fibromyalgia management requires addressing multiple domains:
Non-Pharmacologic Interventions
- Patient Education: Explain the diagnosis, validate symptoms, set realistic expectations
- Aerobic Exercise: Graded program starting low and going slow - most effective intervention
- Cognitive Behavioral Therapy: Address catastrophizing, improve coping strategies
- Sleep Hygiene: Regular schedule, sleep environment optimization
- Stress Management: Relaxation techniques, mindfulness, yoga
Pharmacologic Interventions
- Pregabalin: Alpha-2-delta ligand, FDA-approved for fibromyalgia
- Duloxetine: SNRI, FDA-approved, helps pain and mood
- Milnacipran: SNRI, FDA-approved specifically for fibromyalgia
- Cyclobenzaprine: Muscle relaxant for sleep and pain (low dose at bedtime)
- Amitriptyline: Tricyclic antidepressant, helps sleep and pain
- Gabapentin: Similar to pregabalin, not FDA-approved but commonly used
What Doesn't Work
- Opioids: Ineffective for fibromyalgia, risk of dependence
- NSAIDs alone: Limited efficacy as monotherapy
- Corticosteroids: No role in fibromyalgia treatment
- Complete rest: Deconditioning worsens symptoms
Conditions to Exclude Before Diagnosing Fibromyalgia
| Condition | Key Features | Screening Tests |
|---|---|---|
| Hypothyroidism | Fatigue, myalgias, cold intolerance, weight gain | TSH, free T4 |
| Vitamin D Deficiency | Myalgias, bone pain, weakness | 25-OH vitamin D |
| Polymyalgia Rheumatica | Age >50, shoulder/hip girdle pain, morning stiffness | ESR, CRP (markedly elevated) |
| Rheumatoid Arthritis | Joint swelling, morning stiffness, symmetric small joints | RF, anti-CCP, ESR, CRP |
| Myopathy | Proximal weakness, elevated muscle enzymes, statin use | CK, aldolase, consider EMG |
| Sleep Apnea | Snoring, witnessed apneas, daytime sleepiness, obesity | Sleep study (polysomnography) |
| Depression | Anhedonia, depressed mood, sleep/appetite changes | PHQ-9, clinical assessment |
| Cervical Stenosis | Neck pain, radicular symptoms, neurologic deficits | MRI cervical spine |
Frequently Asked Questions
Is fibromyalgia a "real" disease?
Yes, absolutely. Fibromyalgia is a recognized medical condition with validated diagnostic criteria and demonstrated pathophysiologic abnormalities in pain processing. Brain imaging studies show altered pain perception and processing in fibromyalgia patients. The suffering is real, and effective treatments exist.
Why are my lab tests and imaging studies normal?
Fibromyalgia is a clinical diagnosis based on symptoms and examination. There are no specific blood tests or imaging findings that diagnose fibromyalgia. Lab work and imaging are used to exclude other conditions (hypothyroidism, inflammatory arthritis, etc.). Normal results support rather than contradict the diagnosis of fibromyalgia.
What is the most effective treatment for fibromyalgia?
Aerobic exercise is the single most effective intervention, supported by the strongest evidence. Start with low-impact activities (walking, water aerobics, cycling) at low intensity and gradually increase. Combining exercise with patient education and cognitive behavioral therapy provides the best outcomes. Medications can help but work best as part of a comprehensive, multimodal approach.
Should I avoid activity when I'm having a flare?
No - complete rest often worsens symptoms through deconditioning. During flares, reduce intensity but maintain some activity. The concept of "pacing" is important: alternate activity with rest, avoid overexertion on good days (which leads to crashes), and maintain a consistent baseline activity level. Gradual, consistent exercise is more effective than boom-bust cycles.
Can fibromyalgia coexist with other conditions?
Yes, fibromyalgia commonly coexists with other conditions including rheumatoid arthritis, lupus, osteoarthritis, irritable bowel syndrome, migraine, depression, and anxiety. Having fibromyalgia doesn't exclude other diagnoses. Each condition should be appropriately treated. Studies show 20-30% of patients with inflammatory arthritis also have fibromyalgia.
Why don't opioids work for fibromyalgia?
Fibromyalgia involves central pain amplification and altered neurotransmitter function, not peripheral tissue damage or inflammation. Opioids primarily work on peripheral pain and are ineffective for central sensitization. Multiple studies show opioids don't improve fibromyalgia pain and carry significant risks of dependence, hyperalgesia (increased pain sensitivity), and other side effects. They are not recommended.
What is the prognosis for fibromyalgia?
Fibromyalgia is chronic but not progressive or degenerative - it doesn't cause joint damage or organ failure. With appropriate treatment, many patients experience significant symptom improvement and better quality of life. About 50% of patients show substantial improvement with comprehensive treatment. Complete remission is less common but possible. The key is realistic expectations, active patient engagement in treatment, and a long-term management perspective.
How long do I need to take medications for fibromyalgia?
Treatment duration varies by individual. Many patients benefit from medications for months to years. Once symptoms are well-controlled with a combination of medications and lifestyle modifications, you can work with your doctor to attempt gradual dose reductions. Some patients eventually discontinue medications while maintaining benefits through exercise, sleep hygiene, and stress management. Others require long-term medication. Treatment should be individualized and reassessed periodically.