Can You Categorize Fibromyalgia According to a Number?


Over the past 5 years rheumatologists have reported a significant increase in the number of patients referred to them. This is probably due to increased awareness of fibromyalgia by physicians in the primary care setting, not a recent increase in the incidence of fibromyalgia.

In speaking to patients & physicians many categorize the condition according to the following rating: mild, moderate, or severe.

  • Mild fibromyalgia is characterized by mild muscle pain—that is, a pain level of 1, 2, or 3 on a 10-point scale. It is little or no hindrance in everyday functioning. Treatment is often by a primary care practitioner (PCP), who may prescribe a tricyclic antidepressant (Elavil, Sinequan, etc.). Symptoms respond to education, instruction in sleep hygiene, self-directed exercise, and over-the-counter medications.
  • Moderate fibromyalgia is characterized by moderate muscle pain—that is, a pain level of 4, 5, or 6 out of 10. It somewhat hinders everyday functioning. Some PCPs with pain management experience can manage moderate fibromyalgia, whereas others refer patients to physical medicine and rehabilitation (PM&R) specialists, also known as physiatrists. Patients with moderate fibromyalgia usually need supervised exercise, usually with a physical therapist. They often need a combination of medicines, including anti-inflammatories, muscle relaxants, anticonvulsants, and selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs). Patients with moderately severe fibromyalgia often need prescription analgesics.
  • Severe fibromyalgia is characterized by severe muscle pain—that is, a pain level of 7, 8, 9, or 10 out of 10. It greatly hinders everyday functioning. Patients are either unable to work or must frequently call in sick. Some have access to an in-patient multidisciplinary program, but usually a physiatrist or other pain management specialist puts together an individualized program that involves several health care providers specializing in the treatment of severe fibromyalgia. They titrate their treatments to maximize pain relief and functioning while minimizing pain flares.

I would classify my fibromyalgia as moderate.  How about you- how would you rate your condition & has your physician ever mentioned a rating scale?

Dr. Sharon Ostalecki, PhD

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4 Responses to Can You Categorize Fibromyalgia According to a Number?

  1. I had never heard of the rating system for fibromyalgia til about a week ago. After looking at the ratings and their descriptions, it worries me a bit. I’d rate mine closer to severe than PCP has been the one to treat my Fibro for the past few years. I’ve got a physical coming up in a week, perhaps I can show him this article and see how he rates my Fibro. Myabe its time to go back to a Rheumatologist and see what happens.

  2. Hi Teresa,
    Yes, I think a Rheumatologist has a different perspective on Fibromyalgia than a PCP, physician. Although, many of the PCP do a great job treating fibromyalgia.
    Let me know how it turns out.

    Nice to hear from you,

  3. Dear Sharon,
    I would rate my Fibro severe. The pain is always there, never gone. But I also have RSD/CRPS (caused by a stroke) , epstein- barr (Chronic Fatigue), TMJ and am a insulin dependent diabetic. So it is very difficult to blame it on any one thing. I have seen pain specialists, neurologists, physical medicine specialists, and had psychological counseling. Have tried MANY meds and still find the thing that helps most is a long acting pain med and muscle relaxers.
    Thanks so much for all the great information, you truly are a life saver!

  4. Anna Maneca fernandesamanecafernandes August 24, 2012 at 7:36 am

    I am very confused, when I was first diagnosed with fibromyalgia in 2000, hardly any doctors would even acknowledge the fact that fibromyalgia existed let alone where to place it in the medical journal. I know it fell somewhere under the “arthritis umbrella” but that was it. If you called a rheumatologist (back then) they would flat out tell you that they did not treat fibro patients. Believe it or not, it is still happening today, in good old Rhode Island anyways, after I was denied disability, I was told I should call this particular rheumatologist, “he can help you”, I was told. But when I called and gave them my fibro diagnosis, “Sorry Honey, we don’t treat fibromyalgia patients”. I’m so confused…my faith in God keeps me going, knowing that I have to stay strong for my children. I pray that he keeps them safe, as they are trying to keep our country safe. Love and Peace to us all!

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