Fibromyalgia Scoring System

Used to diagnose Fibromyalgia. It’s complicated, but gives a general idea of how the diagnosis is made, since there’s no biopsy or any other types of test that can show anything. This system is mainly used in research, to tell if a medication works or not, for example. But in general, we diagnose and treat Fibromyalgia even if not every criterion is exactly met.

Per the Scoring System, diagnose Fibromyalgia if the following 3 Criteria are met:

1.  Widespread Pain Index (WPI) โ‰ฅ 7 and Symptom Severity Scale (SSS) score โ‰ฅ 5; OR has the WPI of 4โ€“6 and SSS score โ‰ฅ 9.

2.  Generalized pain, defined as pain in at least 4 of 5 regions, must be present. Jaw, chest, and abdominal pain are not included in generalized pain definition.

3.  Symptoms have been generally present for at least 3 months.


A.  For WPI: 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

Region 1 (Left Upper)
Jaw (left)
Shoulder Area (left)
Upper Arm (left)
Lower Arm (left)
Region 2 (Right Upper)
Jaw (right)
Shoulder area (right)
Upper Arm (right)
Lower Arm (right)
Region 3 (Axial)
Upper Back
Lower Back
Region 4 (Left Lower)
Hip / Buttock (left)
Upper Leg (left)
Lower Leg (left)
Region 5 (Right Lower)
Hip / Buttock (right)
Upper Leg (right)
Lower Leg (right)

B.  For Symptom severity scale (SSS) score, symptoms to consider are:

  • Fatigue
  • Waking up unrefreshed
  • Cognitive symptoms (poor concentration, forgetfulness, unable to multitask, etc.)

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

  • 0 = No problem
  • 1 = Slight or mild problems, generally mild or intermittent
  • 2 = Moderate, considerable problems, often present and/or at a moderate level
  • 3 = Severe: pervasive, continuous, life-disturbing problems

The symptom severity scale (SSS) score: is the sum of the:

  • severity scores of the 3 symptoms (fatigue, waking unrefreshed, cognitive symptoms) (0โ€“9) PLUS
  • sum (0โ€“3) of the number of the following bothersome symptoms during the previous 6 months:
    • Headaches (0โ€“1)
    • Pain or cramps in lower abdomen (0โ€“1)
    • Depression (0โ€“1)

The final symptom severity score (SSS) is between 0 and 12

(Adapted from the American College of Rheumatology as published in Seminars in Arthritis and Rheumatism, Dec. 2016, Vol.46, pages 319-329).

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