Fibromyalgia Criteria 2010

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Date of Birth*

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A patient satisfies diagnostic criteria for fibromyalgia if the following 3 conditions are met:

Widespread pain index (WPI) ≥ 7 & symptom severity (SS) score ≥ 5 OR WPI 3–6 & SS score ≥ 9.
Symptoms have been present at a similar level for at least 3 months.
The patient does not have a disorder that would otherwise explain the pain.

1. Check all of the options (letters corresponding to areas on the diagram) related to pain over the LAST WEEK?

Widespread Pain Inventory (WPI)

Over the PAST WEEK, how SEVERE the patient’s FATIGUE?

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

0
1
2
3

Hidden

Over the PAST WEEK, how SEVERE the patient’s FATIGUE?

Over the PAST WEEK, how SEVERE was the patient’s WAKING FEELING UNREFRESHED?

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

0
1
2
3

Hidden

Over the PAST WEEK, how SEVERE was the patient’s WAKING FEELING UNREFRESHED?

Over the PAST WEEK, how SEVERE was the patient’s COGNITIVE SYMPTOMS?

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

0
1
2
3

Hidden

Over the PAST WEEK, how SEVERE was the patient’s COGNITIVE SYMPTOMS?

Considering SOMATIC SYMPTOMS in general, indicate whether the patient has:*

0 = no problem
1 = few symptoms
2 = a moderate number of symptoms
3 = a great deal of symptoms

0
1
2
3

Hidden

Considering SOMATIC SYMPTOMS in general, indicate whether the patient has:*

* Somatic symptoms that might be considered: muscle pain, irritable bowel syndrome, fatigue/tiredness, thinking or remembering problem, muscle weakness, headache, pain/cramps in the abdomen, numbness/tingling, dizziness, insomnia, depression, constipation, pain in the upper abdomen, nausea, nervousness, chest pain, blurred vision, fever, diarrhea, dry mouth, itching, wheezing, Raynaud’s phenomenon, hives/welts, ringing in ears, vomiting, heartburn, oral ulcers, loss of/change in taste, seizures, dry eyes, shortness of breath, loss of appetite, rash, sun sensitivity, hearing difficulties, easy bruising, hair loss, frequent urination, painful urination, and bladder spasms.

Adapted from: Arthritis Care & Research, Vol. 62, No. 5, May 2010, pp 600–610 Fibromyalgia Criteria 2010

Symptom Severity (SS) Scale

Phone

This field is for validation purposes and should be left unchanged.