Tools

2016 ACR Fibromyalgia Survey

Self-report screening questionnaire

This is not a diagnostic tool. The self-report fibromyalgia survey is validated for research and screening, not for diagnosing an individual. A score that crosses the threshold does not mean you have fibromyalgia, and a score below it does not rule it out. Use this to inform a conversation with your doctor, who can assess you properly and consider other causes.

What this survey measures

The 2016 revised ACR fibromyalgia survey questionnaire is a self-report instrument with two components: a Widespread Pain Index (WPI) that counts how many body areas you have had pain in during the past week, and a Symptom Severity Scale (SSS) that rates the severity of fatigue, unrefreshed sleep, and cognitive symptoms, plus the presence of headaches, abdominal pain, and depression.

The combined score (WPI + SSS) gives a Fibromyalgia Severity score (also called the Polysymptomatic Distress score), which ranges from 0 to 31. This is a continuous measure of symptom severity that is meaningful regardless of whether the criteria threshold is crossed.

The survey also checks whether your pain is widespread enough across body regions and whether symptoms have been present for at least 3 months, both of which are required for the criteria threshold to be met.

How to complete it

  • The survey takes 2–3 minutes.
  • Answer based on your symptoms in the past week for the pain areas and core symptoms, and in the past 6 months for the three additional symptoms.
  • Be honest rather than generous: tick a pain area only if you genuinely had pain there, not stiffness or tingling alone.

Understanding your fibromyalgia survey score

What the score measures

It has two parts. The widespread pain index (0 to 19) counts the body areas where you had pain in the past week. The symptom severity scale (0 to 12) rates fatigue, waking unrefreshed and problems with thinking or memory, plus whether headaches, lower abdominal pain or cramps, and depression bothered you in the past six months. Added together they give the fibromyalgia severity score, from 0 to 31.

The criteria were revised in 2016 to combine the clinician and self-report versions and to stop pain confined to one part of the body from counting as fibromyalgia (Wolfe et al. 2016).

Score bands

The 2016 criteria are met when the pain index is 7 or more with a symptom score of 5 or more, or the pain index is 4 to 6 with a symptom score of 9 or more; pain is present in at least 4 of 5 body regions, not counting the jaw, chest or abdomen; and symptoms have been present at a similar level for at least 3 months. A severity score below 12 cannot meet the criteria.

Wolfe and colleagues grouped severity scores into five categories: 0 to 3 none, 4 to 7 mild, 8 to 11 moderate, 12 to 19 severe and 20 to 31 very severe. In their 2016 review, average scores were about 19 in people with fibromyalgia and about 8 in people without it, and 92 to 96% of people scoring 12 or more met the criteria.

What a change in score means

No minimal important change has been published. The pain index covers only the past week, so it can move from week to week; a change is more convincing when it holds across results a month or more apart. For people already diagnosed, the criteria authors suggest a later score below 12 might be used as a measure of improvement.

What it does not measure

No. The criteria authors say the self-report version is valid for research but not for diagnosing an individual; a diagnosis needs a clinician, an examination and a check for other causes. The criteria apply regardless of other diagnoses: another condition does not rule fibromyalgia out, and fibromyalgia does not rule other illnesses out.

It does not measure fatigue in depth, post-exertional malaise or joint hypermobility, all of which overlap with fibromyalgia in post-viral illness. The Fatigue Severity Scale, the post-exertional malaise questionnaire and the Beighton score cover those.

Taking this to your GP or consultant

Bring the severity score, the pain index and symptom score, the body areas you ticked, and the date; the copied text from your result has all of these. In the UK, fibromyalgia is usually assessed by a GP or rheumatologist, and NICE guidance on chronic primary pain (NICE NG193) covers it. The 2016 criteria are widely recognised, but say that this was the self-report version, which supports a conversation rather than replacing an assessment. See also preparing for a GP appointment.

Sources