m fitzcharles New Criteria for FM Old ….pain only, for research Old ….pain only, for research New Pain + other symptoms New Pain + other symptoms Clinically applicable Clinically applicable Take into account symptoms other than pain Take into account symptoms other than pain Addressing real concepts of FM Addressing real concepts of FM A severity scale A severity scale

m fitzcharles Somatic symptoms Pain + other symptoms

m fitzcharles Leg lower □ Rt. □ Lt. Shoulders □ Rt. □ Lt. Hips □ Rt. □ Lt. Jaw □ Rt. □ Lt. Leg upper □ Rt. □ Lt. Arm upper □ Rt. □ Lt. Arm lower □ Rt. □ Lt. □ Upper Back □ Lower Back □ Neck □ Chest □ Abdomen □ 19 Widespread pain index (WPI)….19 Pain

m fitzcharles All the other symptoms……12 Fatigue Fatigue Sleep Sleep Cognitive changes Cognitive changes “the mass of other symptoms” “the mass of other symptoms” Other symptoms

m fitzcharles New concept of FM Pain (WPI) 2/3 19 Pain (WPI) 2/3 19 Symptoms (SS)1/3 12 Symptoms (SS)1/ fatigue, sleep, cognition, fatigue, sleep, cognition, somatic symptoms 31 31

m fitzcharles “the mass of other symptoms” Muscle pain, irritable bowl syndrome, dizziness, insomnia, chest pain, nausea, diarrhea, wheezing, itching, ringing in ears, oral ulcers, seizures, dry eyes, shortness of breath, easy bruising, loss of appetite, bladder symptoms, etc… Muscle pain, irritable bowl syndrome, dizziness, insomnia, chest pain, nausea, diarrhea, wheezing, itching, ringing in ears, oral ulcers, seizures, dry eyes, shortness of breath, easy bruising, loss of appetite, bladder symptoms, etc… All collapsed into an MD question……. …………………..or a patient response

m fitzcharles 31 /13 Maximum score 31 Maximum score 31 Severity cut-off 13 Severity cut-off 13

m fitzcharles FM diagnosis 13 is a guide for grade of severity Pain  7 + Symptom Severity  5 Pain Symptom Severity  9