[ Back to Index ]

American College of Rheumatology

1990 Criteria for the Classification of Fibromyalgia

1. History of widespread pain.
Definition. Pain is considered widespread when all of the following are present: pain in the left side of the body, pain in the right side of the body, pain above the waist, and pain below the waist. In addition, axial skeletal pain (cervical spine or anterior chest or thoracic spine or low back) must be present. In this definition, shoulder and buttock pain is considered as pain for each involved side. "Low back" pain is considered lower segment pain.

[ Image of woman with tender points marked. ]

2. Pain in 11 of 18 tender point sites on digital palpation.
Definition. Pain, on digital palpation, must be present in at least 11 of the following 18 sites:
Occiput: Bilateral, at the suboccipital muscle insertions.
Low cervical: bilateral, at the anterior aspects of the intertransverse spaces at C5-C7.
Trapezius: bilateral, at the midpoint of the upper border.
Supraspinatus: bilateral, at origins, above the scapula spine near the medial border.
Second rib: bilateral, at the second costochondral junctions, just lateral to the junctions on upper surfaces.
Lateral epicondyle: bilateral, 2 cm distal to the epicondyles.
Gluteal: bilateral, in upper outer quadrants of buttocks in anterior fold of muscle.
Greater trochanter: bilateral, posterior to the trochanteric prominence.
Knee: bilateral, at the medial fat pad proximal to the joint line.

Digital palpation should be performed with an approximate force of 4 kg.

For a tender point to be considered "positive" the subject must state that the palpation was painful. "Tender" is not to be considered "painful."


* For classification purposes, patients will be said to have fibromyalgia if both criteria are satisfied. Widespread pain must have been present for at least 3 months. The presence of a second clinical disorder does not exclude the diagnosis of fibromyalgia.

[ This ends the American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. The balance of this page is interpretation and clarification. ]


[ Translation of Tender Points ]

It's important to note that the tender points are simply the diagnostic criteria used by physicians to diagnose fibromyalgia. The symptoms of fibromyalgia usually include aching all over, poor sleep, stiffness on waking, and being tired all day. They also can include headaches, memory and concentration problems, dizziness, numbness and tingling, itching, fluid retention, crampy abdominal or pelvic pain and diarrhea, and several other symptoms.


[ Back to Index ]


Copyright© 1999 Co-Cure
Last Revision: October 6, 1999 (rc)
Please report any problems with this page to the Webmaster.