Diagnosis
There is no unequivocal objective method for diagnosing fibromyalgia. The criteria used for studying fibromyalgia are very helpful, particularly if the patient does not have any accompanying disorder, such as depression or arthritis, which could complicate the diagnosis. Failure to meet the criteria, however, does not rule out fibromyalgia. Fibromyalgia should be suspected in any patient with muscle and joint pain when no identifiable cause has been found.
Criteria for Classifying Fibromyalgia
In 1990, the American College of Rheumatology (ACR) established the following criteria for the classification of fibromyalgia.
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A. Widespread pain must persist for at least three months. This pain must appear in all of the following locations:
- Pain on both sides of the body
- Pain above and below the waist
- Pain along the length of the spine
B. Pain in at least 11 of 18 specific areas called tender points on the body. The pain experienced when pressing on a tender point is very localized and intensely painful (not just tender). Tender points are located in the following areas:
- The left or right side of the back of the neck, directly below the hairline
- The left or right side of the front of the neck, above the collar bone (clavicle)
- The left or right side of the chest, right below the collar bone
- The left or right side of the upper back, near where the neck and shoulder join
- The left or right side of the spine in the upper back between the shoulder blades (scapula)
- The inside of either arm, where it bends at the elbow
- The left or right side of the lower back, right below the waist
- Either side of the buttocks below the hip bones
- Either knee cap
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