At Al-Bayrouni Pharmacy, we understand that the journey to an accurate fibromyalgia diagnosis can be long, frustrating, and filled with uncertainty. That's why we've dedicated this article to be a practical tool in your hands. This article is not intended for self-diagnosis, but to empower you by providing the same tools doctors use—the 2016 American College of Rheumatology (ACR) criteria. By systematically organizing your symptoms using this guide, you can go to your next doctor's appointment prepared for a clear and productive conversation, speeding up the path to diagnosis and treatment.
Diagnostic Algorithm
A common misconception is that fibromyalgia is a "diagnosis of exclusion," meaning it's only diagnosed after everything else has been ruled out. Modern diagnosis of fibromyalgia is a positive one, made based on a specific set of symptoms that meet clear criteria. The diagnostic process typically follows a logical and structured path to ensure accuracy.
Step 1: Initial Assessment
Prerequisite: The patient must have experienced widespread body pain and accompanying symptoms (such as fatigue and sleep problems) for at least three months. If the symptoms are recent, it is unlikely to be fibromyalgia.
Step 2: Medical History and Clinical Examination
Procedure: The doctor will take a detailed medical history, listening carefully to your description of the pain's characteristics, location, and severity, as well as other symptoms and the overall impact on your life. They will also perform a physical examination to assess the extent of the pain.
Step 3: Ruling Out Conditions that Mimic Symptoms
Procedure: The doctor will typically order a limited set of basic laboratory tests not to diagnose fibromyalgia, but to rule out other conditions that can cause similar symptoms, such as:
- Complete Blood Count (CBC).
- Inflammatory markers (ESR and CRP).
- Thyroid function tests (TSH).
Decision: If these tests are normal, it strengthens the likelihood of fibromyalgia.
Step 4: Applying the 2016 ACR Diagnostic Criteria
Procedure: The doctor (and you can use the questionnaire below to prepare) uses two main tools: the Widespread Pain Index (WPI) and the Symptom Severity Scale (SSS).
Step 5: Final Diagnosis
Decision: If you meet the required scores in Step 4, the symptoms have persisted for 3 months, and the lab tests do not indicate another condition, a diagnosis of fibromyalgia can be confirmed.
Self-Assessment Questionnaire
You can take the completed version with you when you visit your doctor to discuss your results.
Part 1: Symptom Duration (Essential Question)
Have you experienced widespread body pain and other accompanying symptoms (like fatigue or sleep problems) continuously for at least 3 months? ☐ Yes ☐ No (If your answer is "No," it is unlikely to be fibromyalgia, but it is still important to discuss your symptoms with your doctor.)
Part 2: Widespread Pain Index (WPI)
Instructions: In the past week, have you had pain in any of the following 19 areas? Please place a checkmark (✔) next to each area where you felt pain. (Each checkmark = 1 point).
| Area | Check (✔) here | Area | Check (✔) here |
|---|---|---|---|
| Upper Body | Lower Body | ||
| Left Jaw | ☐ | Left Hip / Buttock | ☐ |
| Right Jaw | ☐ | Right Hip / Buttock | ☐ |
| Left Shoulder | ☐ | Left Thigh | ☐ |
| Right Shoulder | ☐ | Right Thigh | ☐ |
| Left Upper Arm | ☐ | Left Lower Leg | ☐ |
| Right Upper Arm | ☐ | Right Lower Leg | ☐ |
| Left Lower Arm | ☐ | ||
| Right Lower Arm | ☐ | ||
| Trunk | |||
| Neck | ☐ | ||
| Chest | ☐ | ||
| Abdomen | ☐ | ||
| Upper Back | ☐ | ||
| Lower Back | ☐ | ||
Total Widespread Pain Index (WPI) Score: ________ / 19
Part 3: Symptom Severity Scale (SSS)
Part (a): Core Symptoms
Instructions: Over the past week, how severe have the following symptoms been? (Choose one number for each symptom).
| Symptom | 0 (No problem) | 1 (Slight/intermittent problem) | 2 (Moderate/considerable problem) | 3 (Severe/continuous problem) |
|---|---|---|---|---|
| Severe Fatigue | ☐ | ☐ | ☐ | ☐ |
| Waking up unrefreshed | ☐ | ☐ | ☐ | ☐ |
| Cognitive symptoms (brain fog) | ☐ | ☐ | ☐ | ☐ |
Sum the points (0-3) for each of the three symptoms above. Part (a) Total: ________ / 9
Part (b): Additional Symptoms
Instructions: Over the past six months, have you experienced any of the following symptoms? (Place a checkmark (✔) next to each symptom you have experienced. Each checkmark = 1 point).
| Symptom | Check (✔) here |
|---|---|
| Headaches (including migraines) | ☐ |
| Pain or cramps in the lower abdomen | ☐ |
| Depression | ☐ |
Count the number of checkmarks. Part (b) Total: ________ / 3
Calculate the total Symptom Severity Scale (SSS) score = Part (a) Total + Part (b) Total
Total Symptom Severity Scale (SSS) Score: ________ / 12
Calculating and Interpreting Your Results for a Productive Doctor's Visit
Now, use the numbers you have obtained to determine if your symptoms align with the diagnostic criteria for fibromyalgia.
Diagnostic Equation: To meet the criteria, you must satisfy the symptom duration condition (3 months) from Part 1, in addition to one of the following two conditions:
- Condition 1: WPI ≥ 7 and SSS ≥ 5
- or Condition 2: WPI between 4 and 6 and SSS ≥ 9
How to use this information: If your results meet these criteria, it does not mean you are diagnosing yourself, but rather that you have a strong reason to discuss the possibility of fibromyalgia with your doctor. Bring this completed questionnaire with you. This will allow your doctor to see a clear and organized picture of your symptoms, saving valuable time and leading to a more focused conversation.
Warning and Disclaimer
The purpose of this article is purely educational and is not a substitute for professional medical advice. This questionnaire is a screening tool to help you organize your symptoms before visiting a doctor, and it is not a self-diagnosis tool. The results should always be discussed with a qualified healthcare provider to confirm a diagnosis and rule out other conditions.
Getting a clear diagnosis is the first step toward effective management. We hope this toolkit has provided you with the confidence and information needed to embark on this journey with your doctor.
The Al-Bayrouni Pharmacy team strives to spread health awareness in the community, so do not hesitate to contact us through the available communication channels. We wish you health and wellness.
Read the next article: Your 40-Day Plan to a Better Life, Free from Fibromyalgia Pain. In our final article, we will bring together everything we've learned. We will present a comprehensive and integrated 40-day wellness plan to help you start living well with fibromyalgia, incorporating strategies for movement, sleep, and relaxation into your daily life.
Frequently Asked Questions
- Q1: My score meets the criteria. Does this mean I definitely have fibromyalgia?
- A: Not necessarily. This is a powerful screening tool, but a final diagnosis must be made by a qualified doctor who can also rule out other conditions that may cause similar symptoms and conduct a comprehensive evaluation.
- Q2: What if my score is slightly below the minimum threshold?
- A: Your symptoms are still real and deserve attention. Discuss them with your doctor. Fibromyalgia symptoms can fluctuate, and you may meet the criteria at other times. You might also have a related condition like "chronic widespread pain."
- Q3: Why do the diagnostic criteria no longer use the old "tender points"?
- A: Research showed that the tender point exam was subjective and unreliable, and it ignored other key symptoms like fatigue and cognitive fog. The new criteria, based on patient-reported symptoms, are considered more comprehensive and accurate.