Fibromyalgia Diagnosis
With no lab tests to prove you have fibromyalgia, the diagnosis is a challenge. Currently, a survey-driven method is used to diagnose fibromyalgia, but it used to be detected by the presence of pain-sensitive areas on the body called tender points. The tender point exam is still used in research, and it’s also helpful to locate tender areas that can be treated, so a brief description is below.
The Tender Point Criteria
Doctors conducted the tender point exam by applying pressure to 18 specified areas.1 If 11 or more elicited pain, a fibromyalgia diagnosis was given, providing the pain persisted for more than three months. By pressing on the tender points, doctors documented reduced pain thresholds in patients. In addition, the exam was deemed to be 90 percent accurate, if done correctly.
The 18 points or nine pairs used for diagnosis are in the neck (4), shoulders (4), upper chest (2), buttocks/hip region (4), inner area of the knee (2), and upper forearm close to the elbow (2). The nine pairs are shown as black dots on the body diagram below, along with two additional points commonly found in patients (red dots).
Identifying tender areas in patients is important because two studies funded by AFSA show that they are treatable myofascial trigger points or MTPs. Active MTPs radiate pain to other body regions, magnify the number of areas that hurt, and restrict range of motion. Research shows that treating just one troublesome MTP leads to a measurable reduction in fibromyalgia pain.
Pitfalls & Benefits of Tender Points
The tender point diagnosis was abandoned due to pitfalls. Many doctors weren’t trained in how to perform the exam and even those who did the evaluation tended to use a variety of techniques. Worse yet, men often went undiagnosed because the criteria were tested in women. Men have higher pain thresholds, so doctors needed to apply more pressure in their male patients (but they didn’t). This led to the misnomer that fibromyalgia was a woman’s disease, yet close to 35 percent of patients are men.
On a positive note, an AFSA-funded study asked people with fibromyalgia to mark on a body diagram their most painful areas. The results are shown for one side of the body (i.e., 11 pairs or 22 total) in the diagram above. As you will read in the section on Muscle Pain Relief, all are treatable MTPs. Plus, patients can identify most of these tender MTP areas … so you may be able to treat them yourself with a little help.
Current Survey-Driven Diagnosis
Today’s criteria for fibromyalgia are simple.2 There is only one prerequisite: symptoms must have persisted for at least three months. Curious if you meet the fibromyalgia diagnosis? Fill out the two-part survey using the diagram below.
Part 1 – Determine Your Widespread Pain Index (WPI)
The WPI is a value between 0 and 19. It’s used to assess your pain in five different body regions as shown in the diagnostic diagram for fibromyalgia. While taking your current medications and using ongoing therapies, circle each area you have felt pain in over the past week.
Red Region 1 (upper left)
jaw *
shoulder girdle
upper arm
lower arm
Orange Region 2 (upper right)
jaw *
shoulder girdle
upper arm
lower arm
Blue Region 3 (lower left)
hip/buttock
upper leg
lower leg
Green Region 4 (lower right)
hip/buttock
upper leg
lower leg
Yellow Region 5 (axial or center of body)
neck
upper back
lower back
chest *
abdomen *
Do you have pain in at least four of the five regions, even when the areas with asterisks are excluded (left and right jaw, chest, and abdomen)? If not, you don’t have the widespread pain required for meeting the fibromyalgia diagnosis. Otherwise, count the number of areas circled and write it down. This is your Widespread Pain Index or WPI score.
Part 2 – Determine Your Symptom Severity Score (SSS)
Grade your level of symptom severity over the past week for four categories below using the specified scales.
Fatigue
0 = No problem
1 = Slight or mild problem; generally mild or intermittent
2 = Moderate; considerable problem; often present and/or at a moderate level
3 = Severe; pervasive, continuous, life disrupting problem
Waking Unrefreshed
0 = No problem
1 = Slight or mild problem; generally mild or intermittent
2 = Moderate; considerable problem; often present and/or at a moderate level
3 = Severe; pervasive, continuous, life disrupting problem
Cognitive Symptoms
0 = No problem
1 = Slight or mild problem; generally mild or intermittent
2 = Moderate; considerable problem; often present and/or at a moderate level
3 = Severe; pervasive, continuous, life disrupting problem
Other Symptoms
Headaches (1 point if circled)
Pain or cramps in lower abdomen (1 point if circled)
Depression (1 point if circled)
Tally your score for Part 2 by adding up the points corresponding to each of the four categories. This is your Symptom Severity Score or SSS, and it can range from 0 to 12.
A person meets the fibromyalgia diagnostic criteria if one of the two following is true:
- your WPI is equal to or greater than 7 and your SSS is equal to or greater than 5
- your WPI is 4, 5 or 6 and your SSS is equal to or greater than 9
Examples:
If your WPI (Part 1) was 9 and your SSS (Part 2) was 6, you would meet the fibromyalgia diagnosis.
If your WPI (Part 1) was 5 and your SSS (Part 2) was 8, you would NOT meet the fibromyalgia diagnostic criteria.
Advancing Your Care
Use your knowledge about the diagnostic criteria to advance your care. For example, the sum of your WPI and SSS is known as your fibromyalgia severity score or FS score. Both you and your doctor might assess your FS score over time to determine if your treatment is working.
If you meet the criteria, bring it to your doctor’s attention. Maybe he or she will work with you or refer you to a healthcare provider who can help ease your symptoms. NEVER assume that fulfilling these criteria means that you only have fibromyalgia; you could have other medical conditions that require treatment. If you need assistance with finding a skilled physician, see our section on Finding Support and Help.
The above survey-type criteria have drawbacks that differ from the tender point diagnosis. A physical exam is not required, so your MTPs will likely be overlooked. But you can rectify this situation by asking your doctor for a referral to a skilled provider who is adept at relieving MTPs. Usually this will be a physical therapist or other hands-on provider in your area. Although the survey-driven diagnosis skips the physical assessment of tender points, the diagram of areas that hurt helps locate regions with MTPs. In addition, check out our Muscle Pain Relief section to learn self-help techniques for easing the discomfort caused by MTPs.
When over 10,000 fibromyalgia patients filled out the survey-driven criteria, they commented on two problems with the current diagnostic method:
- Many people with a prior diagnosis of fibromyalgia did not meet the new criteria (their symptoms were not gone but were effectively treated).
- The criteria do not say how severe the pain in each area must be to endorse it … so if the pain is present in an area, you should checkmark it.
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If you meet the diagnosis for fibromyalgia, check out the list of common symptoms, frequently prescribed medications, and nondrug treatments.