Diagnostic Criteria
Rosner Rebuttal
Central Nervous System

Compare Symptoms
Chiari I Malformation
Cervical Spinal Stenosis
Low Blood Pressure
MRI Requirements
Patient Testimonials

Dr. Heffez Information
Introduction to NFRA
NFRA Symposiums

Subgroups in FM
New Dimensions in FM
Other Abstracts

Awareness Pin
Gifts and Memorials
Calendar of Events
Resources & Web Links
Patient Organizations

www.fmaware.org
www.fmpartnership.org

Fibromyalgia is a distinctive syndrome which can be diagnosed with clinical precision. It may occur in the absence (primary fibromyalgia) or presence of other conditions such as rheumatoid arthritis or systemic lupus erythematosus (concomitant fibromyalgia). It is rarely secondary to another disease, in the sense that alleviation of the associated disease also cures the fibromyalgia. It may be confidently diagnosed in patients with widespread musculo-skeletal pain and multiple tender points.

The American College of Rheumatology 1990
Criteria for the Classification of Fibromyalgia

History of widespread pain has been present for at least three months

Definition: Pain is considered widespread when all of the following are present:
 Pain in both sides of the body
 Pain above and below the waist
In addition, axial skeletal pain (cervical spine, anterior chest, thoracic spine or low back pain) must be present. Low back pain is considered lower segment pain.

Pain in 11 of 18 tender point sites on digital palpation

Definition: Pain, on digital palpation, must be present in at least 11 of the following 18 tender point sites:
 Occiput (2) - at the suboccipital muscle insertions.
 Low cervical (2) - at the anterior aspects of the intertransverse spaces at C5-C7.
 Trapezius (2) - at the midpoint of the upper border.
 Supraspinatus (2) - at origins, above the scapula spine near the medial border.
 Second rib (2) - upper lateral to the second costochondral junction.
 Lateral epicondyle (2) - 2 cm distal to the epicondyles.
 Gluteal (2) - in upper outer quadrants of buttocks in anterior fold of muscle.
 Greater trochanter (2) - posterior to the trochanteric prominence.
 Knee (2) - at the medial fat pad proximal to the joint line.

Digital palpation should be performed with an approximate force of 4 kg. A tender point has to be painful at palpation, not just "tender."

Illustration of Tender Points

Fibromyalgia Syndrome Symptoms

Arthritis and Rheumatism, Vol. 33, No. 2, Feb 1990, F. Wolfe, et al.