Fibromyalgia: An Environmental Scan

Table of Contents



American College of Rheumatology Criteria for Classification of Fibromyalgia

Widespread pain for at least three months, defined as the presence of all of the following:

  • Pain on the right and left sides of the body
  • Pain above and below the waist (including shoulder and buttock pain)
  • Pain in the axial skeleton (cervical, thoracic or lumbar spine, or anterior chest)

Pain on palpation with a 4-kg force in 11 of the following 18 sites (nine bilateral sites, for a total of 18 sites)

  • Occiput: at the insertions of one or more of the following muscles: trapezius, sternocleidomastoid,
    splenius capitus, semispinalis capitus
  • Low cervical: at the anterior aspect of the interspaces between the transverse processes of C5-C7
    Trapezius: at the midpoint of the upper border
  • Supraspinatus: above the scapular spine near the medial border
  • Second rib: just lateral to the second costochondral junctions
  • Lateral epicondyle: 2 cm distal to the lateral epicondyle
  • Gluteal: at the upper outer quadrant of the buttocks at the anterior edge of the gluteus maximus muscle
  • Greater trochanter: posterior to the greater trochanteric prominence
  • Knee: at the medial fat pad proximal to the joint line

NoteOriginal Author: Wolfe F, Smythe HA, Yunas MB, Bennett RM, Bombardier C, Goldenberg DL, et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum 1990;33:160-72.