Clinical Fibromyalgia Diagnostic Chart (Page 2 of 2) in pdf

Symptom Severity Score (SS score)- Part 2b

Check each of the following OTHER SYMPTOMS that you have experienced over the past week?

Muscle pain

Nervousness

Loss/change in taste

Irritable bowel syndrome

Chest pain

Seizures

Fatigue/tiredness

Blurred vision

Dry eyes

Thinking or remembering problem

Fever

Shortness of breath

Muscle Weakness

Diarrhea

Loss of appetite

Headache

Dry mouth

Rash

Pain/cramps in abdomen

Itching

Sun sensitivity

Numbness/tingling

Wheezing

Hearing difficulties

Dizziness

Raynauld’s

Easy bruising

Insomnia

Hives/welts

Hair loss

Depression

Ringing in ears

Frequent urination

Constipation

Vomiting

Painful urination

Pain in upper abdomen

Heartburn

Bladder spasms

Nausea

Oral ulcers

Count up the number of symptoms checked above.

Enter your score for Part 2b here _____.

*If you tallied:

0 symptoms

Give yourself a score of 0

Now add Part 2a AND 2b scores, and enter ____.

1 to 10

Give yourself a score of 1

This is your Symptom Severity Score (SS score), which

11 to 24

Give yourself a score of 2

can range from 0 to 12.

25 or more

Give yourself a score of 3

What Your Scores Mean

A patient meets the diagnostic criteria for fibromyalgia

*The new FM diagnostic criteria did not specify the

if the following 3 conditions are met:

number of “Other Symptoms” required to score the point

rankings from 0 to 3. Therefore, we estimated the number

1a. The WPI score (Part 1) is greater than or equal to 7

of symptoms needed to meet the authors’ descriptive

AND the SS score (Part 2a & b) is greater than or

categories of:

equal to 5

0 = No symptoms

1 = Few symptoms

2 = A moderate number

3 = A great deal of symptoms

1b. The WPI score (Part 1) is from 3 to 6 AND the SS

score (Part 2a & b) is greater than or equal to 9.

* Wolfe F, et al. Arthritis Care Res 62(5):600-610, 2010.

2. Symptoms have been present at a similar level for at

least 3 months.

For information about Fibromyalgia Network, call our

3. You do not have a disorder that would otherwise

office Monday through Friday, 9:00 a.m. to 5:00 p.m.

explain the pain.

(PST) at (800) 853-2929 or visit us online at

For example:

If your WPI (Part 1) was 9 and your SS score (Parts 2a &

This survey is not meant to substitute for a diagnosis by a

b) was 6, then you would meet the new FM diagnostic

medical professional. Patients should not diagnose

criteria.

themselves. Patients should always consult their medical

professional for advice and treatment. This survey is

intended to give you insight into research on the diagnos-

If your WPI (Part 1) was 5 and your SS score (Parts 2a &

tic criteria and measurement of symptom severity for

b) was 7, then you would NOT meet the new FM diagnos-

fibromyalgia.

tic criteria.

Fibromyalgia Network | | (800) 853-2929

Clinical Fibromyalgia Diagnostic Chart Page 2

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