New American College of Rheumatology Criteria for Fibromyalgia

Three Graces

Twenty years have passed since the first diagnostic criteria were presented for the
condition of Fibromyalgia.

The new criteria:

  • removes tender point from the diagnostic criteria as the central element in its definition
  • recognizes the importance of a quantitative measure of widespread pain, the widespread pain index (WPI)
  • incorporate key Fibromyalgia symptoms into the criteria
  • provide severity scales to measure the extent of widespread pain and symptom severity; the symptom severity scale (SS)

Fibromyalgia Diagnostic Criteria


A patient satisfies diagnostic criteria for fibromyalgia if the following 3 conditions are met:

  1. Widespread pain indes (WPI) > 7 and symptom severity (SS) scale score > 5 or WPI 3-6 and SS scale score > 9.
  2. Symptoms have been present at a similar level for at least 3 months.
  3. The patient does not have a disorder that would otherwise explain the pain.


  1. WPI (widespread pain index): note the number of areas in which the patient has had pain over the last week. In how many areas has the patient had pain?

Score will be between 0 and 19

Shoulder girdle, left Hip (buttoci, trochanter), left Jaw, left Upper back
Shoulder girdle, right Hip (buttock, trochanter), right Jaw, right Lower back
Upper arm left Upper leg, left Chest Neck
Upper arm right Upper leg, right   Abdomen
Lower arm, left Lower leg, left    
Lower arm, right Lower leg, right    
  1. SS (symptom severity) scale score:
    • Fatigue
    • Walking unrefreshed
    • Cognitive symptoms

For each of the 3 symptoms above, indicate the level of severity over the past week using the following scale:

  1. no problem
  2. slight or mild problems, generally mild or intermittent
  3. moderate, considerable problems, often present and/or at a moderate level
  4. severe: pervasive, continuous, life-disturbing problems

Considering somatic symptoms in general, indicate whether the patient has:

  1. no symptoms
  2. few symptoms
  3. a moderate number of symptoms
  4. a great deal of symptoms

The SS scale score is the sum of the severity of the 3 symptoms (fatigue, walking unrefreshed, cognitive symptoms) plus the extent (severity) of somatic symptoms in general. The final score is between 0 and 12.

Somatic symptoms that might be considered: muscle pain, irritable bowel syndrome, fatigue/tiredness, thinking or remembering problem, muscle weakness, headache, pain/crambe in the abdomen, numbness/tingling, insomnia, depression, constipation, pain in the upper abdomen, nausea, nervousness, chest pain, blurred vision, fever, dry eyes, ringing in the ears, heartburn, oral ulcers, loss of/change in taste, seizures, shortness of breath, loss of appetite, rash, easy bruising, hair loss, frequent urination, painful urination, and bladder spasms.

Reference: Arthritis Care & Research: Vol.62, No.5, May 2010, pp. 600-610

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