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Fibromyalgia Assessment: Determining a Diagnosis of a Mind-Body Syndrome
(Created by Dr. Howard Schubiner, 2018). Adapted by Simone Steyn
1.1. Symptoms begin without a physical reason (often occurring with no injury, upon waking up in the morning, or during a time of stress)
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Yes
No
1.2. Symptoms persist after an injury has healed (all injuries heal within 3-6 months and scars do not cause pain)
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Yes
No
1.3. Symptoms are in a distribution pattern that is symmetric in the body, mirror image on the left and right side (e.g., both shoulders or both hands)
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Yes
No
1.4. Symptoms are triggered by things that are not related to the actual symptom, such as foods, smells, sounds, bright lights, computer screens, menses, changes in the weather
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Yes
No
1.5. Symptoms spread over time to different areas of the body
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Yes
No
1.6. Symptoms move to the opposite side of the body or down a whole leg or arm
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Yes
No
1.7. Symptoms that occur in many different body parts at the same time (hands, lower back, neck, and stomach)
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Yes
No
1.8. Do you have multiple symptoms that are different (shoulder pain AND fatigue; or headaches AND digestive problems AND insomnia; or hip pain AND bladder urgency AND tinnitus)?
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Yes
No
1.9. Have you previously been to many doctors and health practitioners to try find a cause for your symptoms before receiving a fibromyalgia diagnosis?
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Yes
No
1.10. Symptoms are more or less intense depending on the time of day or occur first thing in the morning or in the middle of the night. You have an 8/10 pain in the morning and it drops to 4/10 at lunchtime
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Yes
No
1.11. Symptoms occur after, but not during, activity or exercise
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Yes
No
1.12. Symptoms occur when stress is increased or one thinks about stressful situations
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Yes
No
1.13. Symptoms are minimal or non-existent when engaged in joyful or distracting activities, such as when on vacation or when not thinking about the symptoms
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Yes
No
1.14. Symptoms are minimal or non-existent after some kind of therapy, such as massage, chiropractic, Reiki, or acupuncture
*
Yes
No
1.15. Does your personality tend to have the following traits: perfectionistic, overly conscientious, worrying a lot, a people-pleaser, insecure, doubtful of yourself, getting easily overwhelmed, and being self-critical?
*
Yes
No
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