- Last Updated: 11 November 2015 11 November 2015
The 2010 ACR criteria for FM diagnosis
The new criteria for FM diagnosis were developed during a 2010 study intended to create a simple, efficient and uniform standard that would be used in the clinical diagnosis of FM, and that would also be easy to use in primary and specialty care settings.
The new standards were designed to:
- eliminate the use of a tender point examination
- include a severity scale by which to identify and measure characteristic FM symptoms
- utilize an index by which to rate pain
In short, the study concluded that the most significant diagnostic variables were the “widespread pain index” (WPI) and the categorical scales for cognitive symptoms, unrefreshing sleep, fatigue, and other somatic symptoms. These categorical scales were added up to create the “symptom severity score” (SS) scale.
Computing the Widespread Pain Index and Severity Scale Symptoms Scores
The new criteria recommend that the tender point examination be replaced with a combination of a widespread pain index (WPI) and severity scale of symptoms (SS) as the revised standards for the diagnosis of FM.
The Widespread Pain Index is scored by asking the patient about whether pain was experienced in the last week in 19 different areas of the body. Score one point for each area (total WPI score is from 0 – 19).
The Symptom Severity Scale rates the severity in the last week of the following symptoms from 0 (no problems) to 3 (severe, life-disturbing):
- waking unrefreshed
- cognitive symptoms.
In addition to these three, the severity of any/all other symptoms is rated from 0 to 3. This results in a total SS score of from 0 – 12.
For more detail, see this chart [2010_diagnostic_criteria_graphic.pdf]
Making the diagnosis based on the scores
Using these new criteria, a diagnosis of Fibromyalgia will be made on the following basis:
- The values and ranges allowed for the WPI and the SS scales should meet one of the combinations: WPI >7 AND SS >5 or WPI 3–6 AND SS >9.
- Symptoms have persisted at this level for the past 3 months.
- The patient does not have any other disorder or cause to explain the pain.