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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 painbelow the waist. In addition, axial skeletal pain (cervical spine oranterior chest or thoracic spine or low back) must be present. In thisdefinition, shoulder and buttock pain is considered as pain for eachinvolving 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 tender point 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 the 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 approximateforce of 4 kg. For tender point to be considered "positive" the subjectmust state 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 three months. The presence of a second clinical disorder does not exclude the diagnosis of fibromyalgia. Reproduced with permission from: Wolfe, F, Smythe, HA, Yunus, MB, 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. Copyright © 1990 John Wiley & Sons.