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Fibromyalgia Assessment:
Determining a Diagnosis of a Mind-Body Syndrome and Neuroplastic Pain
(Created by Schubiner, 2018; Gordon & Ziv, 2021). Adapted by Simone Steyn
1.1. Symptoms/pain begin without a physical reason (often occurring with no injury, upon waking up in the morning, or during a time of stress)
*
Yes
No
1.2. Pain persists after an injury has healed (all injuries heal within 3-6 months and scars do not cause pain)
*
Yes
No
1.3. Symptoms/pain 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)
*
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
*
Yes
No
1.5. Pain spreads over time to different areas of the body
*
Yes
No
1.6. Pain moves to the opposite side of the body or down a whole leg or arm
*
Yes
No
1.7. Pain that occurs in many different body parts at the same time (hands, lower back, neck, and stomach)
*
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)?
*
Yes
No
1.9. Have you previously been to many doctors and health practitioners to try find a cause for your symptoms/pain before receiving a fibromyalgia diagnosis?
*
Yes
No
1.10. Symptoms/pain are more or less intense depending on the time of day. They 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
*
Yes
No
1.11. Symptoms/pain occur after, but not during, activity or exercise
*
Yes
No
1.12. Symptoms/pain occur when stress is increased or one thinks about stressful situations
*
Yes
No
1.13. Symptoms/pain are minimal or non-existent when engaged in joyful or distracting activities, such as when on vacation or when not thinking about the symptoms
*
Yes
No
1.14. Symptoms/pain 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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*
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*
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*
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