Prior to the publication of the American College of Rheumatology (ACR) 2010 Preliminary Fibromyalgia (FM) Diagnostic Criteria, diagnosis was simple, provided one knew how to perform the tender point examination. The examiner determined if the patient had widespread pain and then performed a 60-second examination of tender points as described by the ACR 1990 classification criteria.
The ACR 2010 criteria made diagnosis easier by eliminating the tender point examination, but made it more difficult by requiring evaluation of symptoms. The ACR 2010 criteria altered the case definition of FM by recognizing that symptoms were a central part of the syndrome. In doing this, the criteria imposed a special burden on the examiner: the necessity to interview the patient in detail sufficient to understand the extent and severity of the symptoms. The ACR 2010 criteria provided rules for categorizing symptom severity and making a diagnosis, but did not precisely define how symptom severity was to be ascertained, leaving this to the clinician.
The New ACR Criteria is divided into:
Part 1 where we examiner needs to determine the Widespread Pain Index (WPI) i.e. (0-19).
Part 2a – Symptom Severity Score (SS score)
Part 2b – Symptom Severity Score (SS score)
Important: The ACR 2010 criteria do not permit self diagnosis, and any diagnosis based primarily on self-report is not valid.
The American College of Rheumatology 1990 Criteria (old version) for the Classification of Fibromyalgia was:
History of widespread pain has been present for at least three months
Definition: Pain is considered widespread when all of the following are present:
- Pain in both sides of the body
- Pain above and below the waist
- In addition, axial skeletal pain (cervical spine, anterior chest, thoracic spine or low back pain) must be present.
- Low back pain is considered lower segment pain.
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 tender point sites:
Digital palpation should be performed with an approximate force of 4 kg. A tender point has to be painful at palpation, not just “tender.”