Fibromyalgia Diagnosis

Hi Friends,

Hope you have had a great weekend so far. As you may have seen from my most recent posts, it has become apparent to me that people are still getting diagnosed using the old criteria. This is wrong and the guidelines changed way back in 2016!! I have below detailed the new criteria that is used for diagnosis and comparison to the old criteria which relied solely on trigger point assessment which was and still is very flawed.

To diagnose fibromyalgia using the 2016 ACR criteria, we use two scoring tools:

1. Widespread Pain Index (WPI) – measures the number of painful body regions.

2. Symptom Severity Scale (SSS) – assesses fatigue, sleep issues, and cognitive problems.

1. Widespread Pain Index (WPI) – Score: 0 to 19

The WPI counts how many of 19 body areas have had pain in the past week.

Body Regions Checked for Pain (19 total):

Upper Body (8 points)

✅ Left upper arm
✅ Right upper arm
✅ Left lower arm
✅ Right lower arm
✅ Left shoulder
✅ Right shoulder
✅ Upper back
✅ Lower back

Lower Body (6 points)

✅ Left upper leg
✅ Right upper leg
✅ Left lower leg
✅ Right lower leg
✅ Left hip/buttock
✅ Right hip/buttock

Head and Front of Body (5 points)

✅ Neck
✅ Chest
✅ Abdomen
✅ Jaw (left)
✅ Jaw (right)

👉 Scoring: Each painful area = 1 point. Max score = 19.

2. Symptom Severity Scale (SSS) – Score: 0 to 12

The SSS has two parts:

(A) Core Symptoms (Scored 0-9)

Three symptoms are rated from 0 to 3 based on severity over the past week:
✅ Fatigue
✅ Waking unrefreshed (poor sleep)
✅ Cognitive difficulties (brain fog, memory issues)

🔹 Scoring for each symptom:

• 0 = No problem

• 1 = Slight/mild (occasional, not too bad)

• 2 = Moderate (often present, distressing)

• 3 = Severe (persistent, life-affecting)

👉 Max score for this section = 9

(B) Additional Symptoms (Scored 0-3)

The second part scores other symptoms like headaches, depression, irritable bowel syndrome, numbness, dizziness, and sensitivity issues.

🔹 Scoring:

• 0 = No symptoms

• 1 = Few symptoms

• 2 = Moderate number of symptoms

• 3 = Many symptoms affecting daily life

👉 Max score for this section = 3

Final Diagnosis Criteria

✅ Fibromyalgia is diagnosed if:

• WPI ≥7 and SSS ≥5

• OR

• WPI 4-6 and SSS ≥9

• AND symptoms persist for at least 3 months

• AND no other condition fully explains the symptoms

Key Differences from Older ACR Criteria (1990 vs. 2010/2011 vs. 2016)

This revision makes diagnosis more flexible and does not require a tender point examination, making it a clearer way for GPs and rheumatologists to diagnose fibromyalgia.

I hope this helps and if any questions I will be doing another webinar soon and we can discuss it all then.

In my next email I will discuss other conditions we need to rule out and the tests we use.

Best Wishes

Dr Ahmed