Is there a quiz to diagnose fibromyalgia? Although there have been many recent changes to the way fibromyalgia is diagnosed over the last 50 years, the current recommendations for diagnosing fibromyalgia involve a self-report assessment or quiz to help both doctors and patients determine whether or not they meet the diagnostic criteria.
Learn more about the self-report survey, how fibromyalgia diagnosis has changed over time, and how you can work with a provider or a Swing Care physician toward a diagnosis.
The History of Fibromyalgia Diagnosis
The process of defining a diagnosis of fibromyalgia has been ongoing for the better part of the past half-century. The first modern criteria were described in 1977, based on observations from two physicians who first proposed that the best way to diagnose the condition was through a “tender point count” and a requirement of “widespread aching.”1 Another group of physicians and researchers proposed that a fibromyalgia diagnosis required tender points and the presence of generalized aches and pains involving three or more anatomic sites.2
It wasn’t until 1990 that the American College of Rheumatology (ACR) first approved a set of diagnostic criteria for fibromyalgia, in a paper entitled “The American College of Rheumatology 1990 criteria for the classification of fibromyalgia.”3 This set of diagnostic criteria was developed by clinicians seeing patients in rheumatology practices, and were developed to be physician-based (meaning that the physician evaluated the patient in-person, and used physical medical examinations to consider additional diagnostic possibilities other than fibromyalgia).
If you’ve heard of a tender point examination, this is also where that was popularized; the 1990 criteria required the clinician to perform a tender point examination, where the clinician used manual palpation to provide pressure (defined as the amount of pressure used to exert a force that would blanche the thumbnail) to a set of fixed 18 tender points. To meet the diagnosis of fibromyalgia using these diagnostic criteria set, a person must have had pain at 11 out of a possible 18 tender points on both sides of the body and at points above and below the waist.
Changes to the Criteria: Beyond Tender Points
Researchers in fibromyalgia have since recognized that the body of knowledge surrounding how fibromyalgia develops has changed since the original criteria was published. The 1990 criteria were widely accepted by the medical research community, but they were generally ignored by most physicians in clinical practice; although little data exists about why they weren’t used more frequently, physicians most likely used a patient’s subjective symptoms rather than the tender point examination to make the formal diagnosis.
Since that time, the diagnostic criteria for fibromyalgia has morphed from a tender point examination into a set of self-report diagnostic criteria. These revised diagnostic criteria were published in 2010/2011 and then revised further in 2016.4 The 2010 ACR criteria dropped the tender point examination as a requirement to meet criteria for diagnosis; it now required no specific physical examination by a clinician.
Instead, diagnosing fibromyalgia depended on the number of reported painful body regions (assessed by the widespread pain index or WPI) and the severity of associated symptoms (as measured by the symptom severity scale, or SSS) which includes things such as fatigue, cognitive difficulties, and the presence of headaches, pelvic pain, and depressive symptoms. In 2011, the original authors of the 2010 criteria made a revision that allowed the diagnosis of FM to be accomplished entirely by self-report.
The Latest Updates to the Fibromyalgia Diagnostic Criteria
Finally, the authors in 2016 made another revision that introduced several changes based on experience in clinical and research settings with the previously published 2010 and 2011 criteria. These changes:
- included the use of a generalized pain criterion to insure that regional pain syndromes are not captured by the criteria for fibromyalgia.
- returned to the original 1990 recommendation that “fibromyalgia remains a valid construct irrespective of other diagnoses.” Many doctors tended to use fibromyalgia as a “jack of all trades” diagnosis, which may potentially lead to doctors not considering other conditions that patients may be experiencing alongside fibromyalgia. This revision emphasized that people with fibromyalgia may be experiencing other conditions as well as fibromyalgia.
- recommendation for the use the fibromyalgia symptom scale (FS scale) which is the total score from the entire survey (WPI + SSI).
The 2016 revisions represent the latest fibromyalgia diagnostic criteria, and serve as the basis for fibromyalgia quizzes and self-assessments today.
Other Factors to Consider with a Fibromyalgia Quiz
A fibromyalgia diagnosis, or the medical confirmation of a diagnosis, can occur in a variety of different clinical settings. It can also occur along different points along a patient’s care journey and along a spectrum of illnesses. The currently published criteria are recommended to be used alongside or after diagnostic possibilities have been narrowed through medical evaluations with the patient’s care team. A diagnosis also should not be given without the gathering of additional information by medical professionals, where essential medical, family, surgical, and social information can provide a full picture to the clinician.
Fibromyalgia occurs frequently among people with musculoskeletal and other medical/psychological disorders, and it is understood that fibromyalgia may coexist with almost any other medical condition. A diagnosis of fibromyalgia does not mean it is the patient’s only diagnosis or even the most important diagnosis. It is only an acknowledgement that the patient has symptoms of fibromyalgia and satisfies fibromyalgia criteria for diagnosis.
While the self-report survey or quiz can be done at home by patients to assess if they may possibly have the diagnosis of fibromyalgia, it is very important that this survey be used in the context of a consultation with a provider who feels confident in diagnosing and educating on fibromyalgia. A person’s pain journey and history is essential in understanding whether or not fibromyalgia is present and whether or not there are other factors that may be at play that need additional workup, evaluation, and medical attention.
If you’ve taken a fibromyalgia quiz or self-assessment, be sure to talk with your doctor in order to confirm a diagnosis and discuss other potential contributions to your symptoms. A Swing Care physician can meet with you 1:1 virtually to review your history and symptoms, as well as rule out other conditions to move you closer to a diagnosis. Visit www.swing.care to learn more or to check your insurance benefits.
What is a Fibromyalgia Assessment?
Pain Regions and Duration
Answer the following questions about your pain:
- Have you had symptoms for at least 3 months?
- Have you had pain in at least four of these regions?
- Left upper region (shoulder, arm)
- Right upper region (shoulder, arm)
- Axial region (neck, back)
- Left lower region (left hip, leg)
- Right lower region (right hip, leg)
If you’ve answered yes to both, move on to the next sections.
Widespread Pain Index
Note the number of areas in which you have had pain over the last week. Your score will be between 0 and 19.
- Jaw, left
- Jaw, right
- Neck
- Shoulder girdle, left
- Shoulder girdle, right
- Upper back
- Lower back
- Upper arm, left
- Upper arm, right
- Lower arm, left
- Lower arm, right
- Abdomen
- Hip, left
- Hip, right
- Upper leg, left
- Upper leg, right
- Lower leg, left
- Lower leg, right
Symptom Severity Scale
For each of the following symptoms, indicate the level of severity over the past week. Your score will be between 0 and 9.
Fatigue
- 0 – No problem
- 1 – Slight or mild problems, generally mild or intermittent
- 2 – Moderate, considerable problems, often present
- 3 – Severe, pervasive, life disturbing problems
Waking unrefreshed
- 0 – No problem
- 1 – Slight or mild problems, generally mild or intermittent
- 2 – Moderate, considerable problems, often present
- 3 – Severe, pervasive, life disturbing problems
Cognitive symptoms
- 0 – No problem
- 1 – Slight or mild problems, generally mild or intermittent
- 2 – Moderate, considerable problems, often present
- 3 – Severe, pervasive, life disturbing problems
Now add the number of the following symptoms that have bothered you in the last 6 months:
- Headaches – 1
- Pain or cramps in lower abdomen – 1
- Depression – 1
Your total SSS score will be between 0 and 12.
Your Score
A patient satisfies the 2016 fibromyalgia criteria if the following conditions are met:
- WPI is greater than or equal to 7 and SSS is greater than or equal to 5
- WPI is between 4-6 and SSS is greater than or equal to 9
- Symptoms have been generally present for at least 3 months
- Patient is experiencing generalized pain (in at least 4 of 5 regions of the body)
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