Use This Fibromyalgia Symptom Checklist to Rate the Severity of Your Symptoms
A fibromyalgia symptom checklist is typically divided into categories based on the areas of the body that are affected. So they may list general symptoms, pain symptoms, neurological, sleep patterns, psychological and emotional symptoms or gastrointestinal symptoms.
A typical fibromyalgia symptom checklist will ask you to rate the severity of all your symptoms one by one from one to ten in the past month. The aim of a checklist is to help you and your doctor to determine which symptoms are the most troubling and to get an overall symptom picture. This will help in planning a treatment regime designed to ease your unique symptoms.
Using the fibromyalgia symptom checklist below, indicate the severity of your symptoms on a scale from one to ten. Once you have completed the list take it to your doctor and discuss your treatment options.
Fibromyalgia symptom checklist:
(Source: http://www.anapsid.org/cnd/diagnosis/berne.html)
Fibromyalgia symptom checklist -GENERAL
____ Fatigue that is worsened by physical exertion or stress
____ 50% less activity than pre-illness state
____ Flu-like illnesses that recur
____ Sore throat
____ Hoarseness
____ Tender or swollen lymph nodes (glands), especially in neck and underarms
____ Shortness of breath on minimal exertion
____ Sighing
____ Tremor or trembling
____ Nasal allergies (new ones or worsening)
____ Cough
____ Night sweats
____ Low-grade fevers
____ Feeling cold
____ Feeling hot
____ Cold hands and feet
____ Low body temperature (below 97.6)
____ Low blood pressure (below 110/70)
____ Heart palpitations
____ Dry eyes and/or mouth
____ Increased thirst
____ Symptoms worsened by temperature changes
____ Symptoms worsened by air travel
____ Symptoms worsened by stress
Fibromyalgia symptom checklist - PAIN
____ Headache
____ Tender points or trigger points
____ Muscle pain
____ Muscle twitching
____ Muscle weakness
____ Paralysis or severe weakness of an arm or leg
____ Joint pain
____ TMJ syndrome
____ Chest pain
Fibromyalgia symptom checklist - GENERAL NEUROLOGICAL
____ Lightheadedness; feeling "spaced out"
____ Inability to think clearly ("brain fog")
____ Seizures
____ Seizure-like episodes
____ Syncope (fainting) or blackouts
____ Sensation that you might faint
____ Vertigo or dizziness
____ Numbness or tingling sensations
____ Tinnitus (ringing in one or both ears)
____ Photophobia (sensitivity to light)
____ Noise intolerance
Fibromyalgia symptom checklist - EQUILIBRIUM/PERCEPTION
____ Feeling spatially disoriented
____ Dysequilibrium (balance difficulty)
____ Staggering gait (clumsy walking; bumping into things)
____ Dropping things frequently
____ Difficulty judging distances (e.g. when driving; placing objects on surfaces)
____ "Not quite seeing" what you are looking at
Fibromyalgia symptom checklist - SLEEP
____ Hypersomnia (excessive sleeping)
____ Sleep disturbance: unrefreshing or non-restorative sleep
____ Sleep disturbance: difficulty falling asleep
____ Sleep disturbance: difficulty staying asleep (frequent awakenings)
____ Sleep disturbance: vivid or disturbing dreams or nightmares
____ Altered sleep/wake schedule (alertness/energy best late at night)
Fibromyalgia symptom checklist - MOOD/EMOTIONS
____ Depressed mood
____ Suicidal thoughts
____ Suicide attempts
____ Feeling worthless
____ Frequent crying
____ Feeling helpless and/or hopeless
____ Inability to enjoy previously enjoyed activities
____ Increased appetite
____ Decreased appetite
____ Anxiety or fear when there is no obvious cause
____ Panic attacks
____ Irritability; overreaction
____ Rage attacks: anger outbursts with little or no cause
____ Abrupt, unpredictable mood swings
____ Phobias (irrational fears)
____ Personality changes
