The current fibromyalgia diagnostic criteria are the 2016 revisions to the ACR 2010/2011 criteria (Wolfe et al.). A patient meets them when three conditions hold: (1) a Widespread Pain Index (WPI) of 7 or more with a Symptom Severity Scale (SSS) of 5 or more, or a WPI of 4 to 6 with an SSS of 9 or more; (2) generalized pain in at least 4 of 5 body regions; and (3) symptoms generally present for at least 3 months. A fibromyalgia diagnosis is valid irrespective of other diagnoses, and no laboratory test or tender-point exam is required.
Use the free calculator below to score a patient's WPI and SSS and check all three criteria in one step. The rest of this guide explains each scoring step, how the 1990, 2010, 2011, 2016 and AAPT 2019 criteria differ, and how to follow symptoms over time with validated questionnaires. It is part of SPRY's library of patient-reported outcome measures (PROMs). Last updated October 2026.
Fibromyalgia criteria calculator (WPI + SSS)
Enter the patient's responses below. The calculator returns the WPI, SSS, the combined Fibromyalgia Severity (FS) scale score, the number of regions with pain, and a pass/fail for each of the three criteria. To collect and trend these scores automatically across visits, see SPRY's PROMs and functional outcomes tracking.
Fibromyalgia criteria calculator (2016 ACR: WPI + SSS)
Step 1: tick every area where the patient had pain in the last 7 days (WPI, 0 to 19). Step 2: score the symptom severity items (SSS, 0 to 12). Step 3: confirm duration. The tool applies the 2016 criteria exactly as published.
Step 1. Widespread Pain Index (past 7 days)
Step 2. Symptom Severity Scale
Three items scored 0 to 3 (past 7 days):
Three items scored 1 point each if present during the previous 6 months:
Step 3. Duration
Clinical decision support only. A diagnosis of fibromyalgia is a clinical judgment, valid irrespective of other diagnoses, and this tool does not replace examination. Criteria source: Wolfe et al., Seminars in Arthritis and Rheumatism, 2016;46(5):319-329.
2016 ACR fibromyalgia criteria at a glance
| Criterion | Requirement | Notes |
|---|---|---|
| Pain and symptom scores | WPI ≥ 7 and SSS ≥ 5, or WPI 4–6 and SSS ≥ 9 | WPI ranges 0–19; SSS ranges 0–12 |
| Generalized pain | Pain in at least 4 of 5 regions | Regions: left upper, right upper, left lower, right lower, axial. Jaw, chest and abdominal pain are not counted for this criterion |
| Duration | Symptoms generally present for at least 3 months | Same level of symptoms, not a short flare |
| Other diagnoses | A fibromyalgia diagnosis is valid irrespective of other diagnoses | It does not exclude other clinically important illnesses |
| Combined scale | FS (also called PSD) = WPI + SSS, range 0–31 | The 2016 criteria cannot be satisfied with an FS below 12 |
Validation: across 14 studies with 6,411 patients, the 2016 criteria showed a median sensitivity of 86% and specificity of 90% against clinician diagnosis, and 92% to 96% of patients with an FS of 12 or more satisfied them (Wolfe et al., 2016). The American Academy of Family Physicians notes that fibromyalgia affects about 2% of the U.S. population, is a clinical diagnosis, and does not routinely need laboratory testing; basic tests such as a complete blood count and thyroid function may be used to exclude other causes of fatigue (AAFP, 2023).
How to score the Widespread Pain Index (WPI)
The WPI counts how many of 19 body areas were painful during the past 7 days. Each painful area scores 1 point, so the total ranges from 0 to 19. It measures distribution, not intensity. Ask about pain, not just tenderness or stiffness.
| Region | WPI areas | Counts toward generalized pain? |
|---|---|---|
| Left upper region | Jaw (left), shoulder girdle, upper arm, lower arm | Yes, except the jaw |
| Right upper region | Jaw (right), shoulder girdle, upper arm, lower arm | Yes, except the jaw |
| Left lower region | Hip (buttock, trochanter), upper leg, lower leg | Yes |
| Right lower region | Hip (buttock, trochanter), upper leg, lower leg | Yes |
| Axial region | Neck, upper back, lower back, chest, abdomen | Neck, upper back and lower back only; chest and abdomen are excluded |
Common WPI mistakes
- Wrong time frame: the WPI asks about the past 7 days; the three somatic SSS items ask about the previous 6 months.
- Skipping the generalized pain check: a WPI of 7 or more can still fail if the painful areas cluster in fewer than 4 regions, for example jaw, chest and abdomen pain. This is the main change the 2016 revision made, to avoid labelling regional pain syndromes as fibromyalgia.
- Scoring pain intensity: the WPI is a count of areas; severity is captured separately by the SSS and by questionnaires such as the FIQR.
- Treating the exam as required: tender-point counts are no longer part of the criteria, although exam findings still help rule out other causes.
How to score the Symptom Severity Scale (SSS)
The SSS (0 to 12) has two parts. Part A rates three symptoms over the past 7 days from 0 to 3 each (maximum 9). Part B gives 1 point each for headaches, pain or cramps in the lower abdomen, and depression during the previous 6 months (maximum 3).
| SSS item | Scoring | Recall period |
|---|---|---|
| Fatigue | 0 = no problem; 1 = slight or mild, generally mild or intermittent; 2 = moderate, considerable problems, often present; 3 = severe: pervasive, continuous, life-disturbing | Past 7 days |
| Waking unrefreshed | Same 0–3 scale | Past 7 days |
| Cognitive symptoms | Same 0–3 scale | Past 7 days |
| Headaches | 0 = no, 1 = yes | Previous 6 months |
| Pain or cramps in the lower abdomen | 0 = no, 1 = yes | Previous 6 months |
| Depression | 0 = no, 1 = yes | Previous 6 months |
Add the six items for the SSS. The WPI and SSS together give the FS scale (0 to 31), which clinicians also use as a continuous measure of polysymptomatic distress: higher FS scores track with worse physical and mental health and can be re-scored over time.
How the fibromyalgia criteria changed: 1990 to 2019
| Criteria | What it requires | Key facts |
|---|---|---|
| ACR 1990 | Widespread pain for at least 3 months plus tenderness at 11 or more of 18 tender points on examination | Sensitivity 88.4%, specificity 81.1%. Needed a trained examiner and ignored fatigue, sleep and cognition |
| ACR 2010 | WPI ≥ 7 and SS ≥ 5, or WPI 3–6 and SS ≥ 9. Somatic symptoms rated by the physician | Removed the tender-point exam |
| ACR 2011 (modified) | Same thresholds as 2010, but fully self-reported | FS ≥ 13 correctly classified 93.0% of patients (sensitivity 96.6%, specificity 91.8%) against the 2010 criteria |
| ACR 2016 revision | WPI ≥ 7 and SSS ≥ 5, or WPI 4–6 and SSS ≥ 9; generalized pain in 4 of 5 regions; 3 months | Raised the lower WPI band from 3 to 4 and added the generalized pain rule. Median sensitivity 86%, specificity 90% across 14 validation studies |
| AAPT 2019 | Pain in at least 6 of 9 regions for 3 months, plus moderate to severe sleep problems or fatigue | Sensitivity about 74% versus 78–80% for ACR 2011/2016 in a comparison study; similar specificity (AAFP, 2023) |
In practice, the ACR 2016 criteria remain the version most clinicians and payers recognize. Because the 2016 and AAPT 2019 sets overlap but do not identify exactly the same patients, document which criteria you used.
Questionnaires to follow fibromyalgia over time
The criteria establish the diagnosis; validated questionnaires track what happens afterwards. Pick one measure per domain and re-score at consistent intervals.
| Measure | Domain | Format and scoring |
|---|---|---|
| FIQR (Revised Fibromyalgia Impact Questionnaire) | Overall impact | 21 items rated 0–10 across three domains: function, overall impact and symptoms. Total 0–100; higher is worse |
| FIQ (original) | Overall impact | Total 0–100. Severity bands: mild below 39, moderate 39 to below 59, severe 59 and above (Bennett et al., 2009) |
| Jenkins Sleep Scale | Sleep | 4 items; total 0–20; higher is worse. See also the Insomnia Severity Index |
| Fatigue Severity Scale (FSS) | Fatigue | 9 items rated 1–7; higher is more severe. See also FACIT-Fatigue and the Modified Fatigue Impact Scale |
| MASQ | Cognition | 38 items across five domains: language, visual-perceptual, verbal memory, visual memory, attention/concentration |
| HADS-D | Depression | 7 items scored 0–3, total 0–21. Conventional bands: 0–7 normal, 8–10 borderline, 11–21 abnormal. See also the PHQ-9 and GAD-7 |
| Pain Catastrophizing Scale | Pain beliefs | See the Pain Catastrophizing Scale guide |
| Central Sensitization Inventory | Sensitization symptoms | See the CSI guide |
The FIQR and FIQ are related but not interchangeable, so apply the FIQ severity bands above only to FIQ scores. Fatigue, sleep, cognition and mood are individually scored on the SSS, but the questionnaires above give a finer, repeatable score for each domain, which is what shows whether treatment is working.
Applying the criteria in clinical practice
- Score before you label: have the patient complete the WPI body map and SSS items on the same visit, then confirm generalized pain and the 3-month duration.
- Do not exclude on comorbidity: the 2016 criteria allow fibromyalgia alongside inflammatory, degenerative and mood disorders. Use history and examination, and targeted tests only where another condition is suspected.
- Re-score at follow-up: FS and the FIQR give a simple trend line, and pairing them with a pain scale such as the Numeric Pain Rating Scale and the Global Rating of Change scale shows whether the patient feels better.
- Document the version: record the criteria used (ACR 2016 or AAPT 2019), WPI, SSS, FS, regions and duration so payers and colleagues can follow the reasoning.
- Automate it: see how SPRY scores and tracks PROMs inside your EMR, how reporting and analytics show outcomes across your caseload, or book a demo.
Criterios diagnósticos de fibromialgia (resumen en español)
Los criterios del Colegio Americano de Reumatología (ACR) de 2016 se cumplen cuando: (1) el Índice de Dolor Generalizado (WPI) es ≥ 7 con una Escala de Gravedad de Síntomas (SSS) ≥ 5, o el WPI es de 4 a 6 con una SSS ≥ 9; (2) hay dolor generalizado en al menos 4 de 5 regiones del cuerpo; y (3) los síntomas llevan presentes al menos 3 meses. El WPI cuenta de 0 a 19 áreas dolorosas en los últimos 7 días. La SSS suma de 0 a 12 puntos: fatiga, sueño no reparador y síntomas cognitivos (0 a 3 cada uno) más cefalea, dolor o calambres en la parte baja del abdomen y depresión (1 punto cada uno). El diagnóstico es válido aunque existan otros diagnósticos. Use la calculadora de esta página para obtener el WPI, la SSS y el resultado de cada criterio.
Frequently asked questions
What are the current diagnostic criteria for fibromyalgia?
The 2016 ACR criteria: WPI of 7 or more with SSS of 5 or more, or WPI of 4 to 6 with SSS of 9 or more; generalized pain in at least 4 of 5 regions; and symptoms present for at least 3 months. The diagnosis is valid regardless of other diagnoses.
What is the difference between the WPI and the SSS?
The WPI counts painful areas out of 19 over the past 7 days (0 to 19). The SSS scores fatigue, waking unrefreshed and cognitive symptoms from 0 to 3 each, plus 1 point each for headaches, lower abdominal pain or cramps, and depression over the previous 6 months (0 to 12).
What is the fibromyalgia severity (FS) score?
The FS score, also called the polysymptomatic distress scale, is the WPI plus the SSS, from 0 to 31. The 2016 criteria cannot be met with an FS below 12, and an FS of 13 or more was the best cut-off in the 2011 self-report version (sensitivity 96.6%, specificity 91.8%).
Are tender points still used to diagnose fibromyalgia?
No. The 1990 criteria required 11 of 18 tender points, but the 2010 criteria and every later version dropped the tender-point examination. Examination remains useful to look for other causes of pain.
Can you have fibromyalgia and another condition at the same time?
Yes. Under the 2016 criteria a diagnosis of fibromyalgia is valid irrespective of other diagnoses and does not exclude other clinically important illnesses.
How accurate are the 2016 fibromyalgia criteria?
Across 14 validation studies (6,411 patients) the median sensitivity was 86% and the median specificity was 90% against clinician diagnosis. A separate comparison reported about 78 to 80% sensitivity for ACR 2011/2016 versus 74% for AAPT 2019.
Which questionnaire should I use to monitor fibromyalgia?
The FIQR (21 items, 0 to 100) is the most common overall impact measure. Add domain measures for sleep, fatigue and mood, and re-score at consistent intervals so you can show change over time.
Is there a free fibromyalgia criteria calculator?
Yes. Use the calculator at the top of this page: tick the painful WPI areas, score the SSS, confirm 3-month duration, and it returns WPI, SSS, FS, regions affected and whether each 2016 criterion is met.
Sources and further reading
- Wolfe F, et al. 2016 revisions to the 2010/2011 fibromyalgia diagnostic criteria. Seminars in Arthritis and Rheumatism, 2016;46(5):319-329
- Wolfe F, et al. Fibromyalgia criteria and severity scales for clinical and epidemiological studies: a modification of the ACR preliminary diagnostic criteria. Journal of Rheumatology, 2011;38(6):1113-1122
- Bennett RM, et al. Minimal clinically important difference in the Fibromyalgia Impact Questionnaire. Journal of Rheumatology, 2009;36(6):1304-1311
- American Family Physician: Fibromyalgia: Diagnosis and Management (2023)
- Royal College of Physicians: fibromyalgia syndrome diagnostic worksheet
This page is educational and does not replace clinical judgment. Always interpret criteria and questionnaire scores alongside the patient's history, examination and goals.
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