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Fahmida's diagnosis

The pattern of pain and tenderness without signs of inflammation, the symptoms of poor sleep and fatigue and the history of IBS and depression are all commonly associated with fibromyalgia.

Diagnostic criteria for fibromyalgia

The 2010 American College of Rheumatology (ACR) diagnostic criteria for fibromyalgia suggest a scoring system based on:

  • the widespread pain index (WPI) – the number of areas in which the patient has had pain over the last week
  • the symptom severity (SS) score over the last week –
    • the level of severity of fatigue
    • waking unrefreshed
    • cognitive symptoms
    • the extent of somatic symptoms in general.

The benefit of using the ACR criteria is that they can help to add certainty – for both you and the patient – to the clinical diagnosis.

There may be some other key pointers in the history. It's worth going back through the patient's notes if you suspect fibromyalgia, as there may be other features in their history associated with increased risk of fibromyalgia.


Note that there's no objective swelling in fibromyalgia. This is key, as many patients will report subjective swelling.

It's sometimes helpful to ask patients to take a photo of any swollen joints to try to help with objective assessment in the surgery.

Further reading and resources

Download a score sheet (PDF, 124KB) based on the ACR diagnostic criteria for fibromyalgia.

Download our Hands On guide Fibromyalgia syndrome: management in primary care (PDF, 313 KB). 

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GP talking to patient

Weighing up the likely causes of a patient's pain is key to deciding on an initial management plan and in considering whether to refer for specialist opinion.

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