Fibrocentre

Evaluate your symptoms

Fibromyalgia is a real and manageable condition.
This questionnaire can help you assess your symptoms.
Fill it out and take it to your doctor.

Pain

Chronic widespread pain
is the main symptom of fibromyalgia

1 I have had widespread pain for at least 3 months

2 I have pain on the right and left sides of my body

3 I have very tender spots on my body, mainly around my neck, shoulders, hips and knees

Graphic image of the tender spots on a body
See tender spots

Tender spots

Click on the areas of tenderness.

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4 I have pain above and below my waist

5 I have pain in my neck, back or shoulders

6 I sometimes feel anxious or depressed

7 Indicate your general level of pain

No pain

Worst
possible
pain

Sleep

About 70% of people with fibromyalgia
have sleep difficulties

1 I have problems sleeping

2I wake up feeling stiff and tired

3I feel fatigued during the day

4 Indicate your general sleep quality

Best
possible
sleep

Worst
possible
sleep

Daily activity

1I have trouble carrying out everyday activities

2Daily activity scale (Gardening, working, shopping,
cooking, etc.)

Does not
severely
interfere

Severely
interferes

Talk to your doctor

If you think you may have fibromyalgia talk to your doctor. It is important to keep in mind that it takes time and persistence to identify and diagnose fibromyalgia. Don’t get discouraged. Ask about treatments for fibromyalgia.