FIBROMYALGIA

DOCTOR DISCUSSION GUIDE

It can be hard to explain your pain and exactly how you’re feeling to your doctor. This Doctor Discussion Guide has 7 quick questions that can help you get the conversation started. You and your doctor can use it to see if you have fibromyalgia and how it’s affecting you.

Fill out the questions and take it with you to your next doctor’s appointment.

1
Have you been suffering from your pain for 3 months or more?
2
Where in your body do you feel pain?

Select all that apply

3
In the last week, how many days have pain and fatigue interfered with your daily activities?
4
I would rate the severity of my pain as:

No pain (0) : Most pain (10)

5
Select the places on the diagram where you feel pain.

Select all that apply

FM tender points
FM tender points
These “tender points” are based on the 1990 fibromyalgia
guidelines created by the American College of Rheumatology.
6
In the last 4 weeks, has your pain interfered with the ability to do any of the following things?

Select all that apply

7
Is your pain accompanied by any of the following?

Select all that apply

Thank you for completing the Doctor Discussion Guide
Download Your Completed Guide as a PDF
Mother with FM and daughter
Mother with FM and daughter
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