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I. Widespread Pain Index (WPI) Areas with pain over the past week.
Jaw, left
No
Yes
Jaw, right
No
Yes
Neck
No
Yes
Shoulder girdle, left
No
Yes
Shoulder girdle, right
No
Yes
Upper arm, left
No
Yes
Upper arm, right
No
Yes
Lower arm, left
No
Yes
Lower arm, right
No
Yes
Chest
No
Yes
Upper back
No
Yes
Abdomen
No
Yes
Lower back
No
Yes
Hip (buttock, trochanter), left
No
Yes
Hip (buttock, trochanter), right
No
Yes
Upper leg, left
No
Yes
Upper leg, right
No
Yes
Lower leg, left
No
Yes
Lower leg, right
No
Yes
II. Symptom Severity Score (SS scale score) For the each of the 3 symptoms below, indicate the level of severity over the past week.
Fatigue
:
no symptoms
slight or mild problems, generally mild or intermittent
moderate, considerable problems, often present and/or at a moderate level
severe: pervasive, continuous, life-disturbing problems
Waking unrefreshed
:
no symptoms
slight or mild problems, generally mild or intermittent
moderate, considerable problems, often present and/or at a moderate level
severe: pervasive, continuous, life-disturbing problems
Cognitive symptoms
:
no symptoms
slight or mild problems, generally mild or intermittent
moderate, considerable problems, often present and/or at a moderate level
severe: pervasive, continuous, life-disturbing problems
Considering somatic symptoms in general, the patient has
:
no symptoms
few symptoms
a moderate number of symptoms
a great deal of symptoms
III. Duration
less than 3 months
3 months or more
IV. Etiology
pain can be attributed to another etiology
pain cannot be attributed to another etiology
Result :
WPI:
0
SS scale score:
0
DOES NOT MEET CRITERIA: Symptoms at a similar level of at least 3 months. Pain can be attributed to another etiology. SS scale score of 5 or more AND WPI of 7 or more.
References
Wolfe (2010) Arthritis Care Res 62:600
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