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Medical Pack

The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia5


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.

Pain in 11 of 18 tender points sites on digital palpation
Definition: pain, on digital palpation, must be present in at least 11 of the following 18 tender points sites:

  1. insertion of nuchal muscles into occiput;
  2. upper border of trapezius mid-portion;
  3. muscle attachments to upper medial border of scapula;
  4. anterior aspects of the C5, C7 intertransverse spaces;
  5. 2nd rib space - about 3 cm lateral to the sternal border;
  6. muscle attachments to lateral epicondyle;
  7. upper outer quadrant of gluteal muscles;
  8. muscle attachments just posterior to greater trochanter;
  9. medial fat pad of knee proximal to joint line.

Digital palpation should be performed with an approximate force of 4 kg, as measured with a dolorimeter. 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.







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