Fibromyalgia. Table 2

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The 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, 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 defi- nition, 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 18 tender point sites :
  • occiput: bilateral, at the suboccipital muscle insertions.
  • low cervical: bilateral, at the anterior aspects of the intertransvese spaces at C5-C7
  • trapezius: bilateral, at the midpoint of the upper border
  • supraspinatus: bilateral, at origins, above thescapula spine near the medial border
  • second rib: bilateral, at the second costochondral junctions, on the upper surfaces
  • lateral epicondyle: bilateral, 2 cm distal to the epicondyles
  • gluteal: bilateral, in the 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 aproximate 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’.

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