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American College of Rheumatology definition 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.
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 he 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.

Wolfe F, Smythe  HA, Yunus 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.

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