is based upon the symptoms. The most widely accepted set of criteria was elaborated in
1990 by the American College of Rheumatology:
A history of widespread pain lasting more than three months—affecting all four
quadrants of the body, i.e., both sides, and above and below the waist
Tender points—there are 18 designated possible tender or trigger points
(although a person with the disorder may feel pain in other areas as well).Referred pain
Referred pain is a term used to describe the phenomenon of pain that is caused in one
area of the body but felt in another. One of the best examples of this is during a heart
attack where pain is often felt in the neck, shoulders, back and/ or down the inner side
of the left arm rather than in the chest where the heart is located.
Although there is no agreement as to how referred pain is caused, one of the popular
theories is that the pain nerve fibres from the affected organ go to the same point in the
spinal cord as the pain nerve fibres from the muscles and skin in the surrounding area.
From here, there is a common sensory pathway to the brain which decodes the location
of pain. It is possible that the brain is unable to differentiate whether the pain sensation
is from an organ or the tissues around it hence pain in one area is felt as referred pain in
another. For example, a heart attack may be felt as pain in the left shoulder or pain
radiating down the inner side of the left arm, jaw pain or pain in the back. Infections in
the pelvis or pain during menstruation may present as severe backache. Some of the
conditions that can present as back pain are:
a. Acute myocardial infarction (heart attack)
b. Acute or chronic pancreatitis (inflammation of the pancreas)
c. Acute cholecystitis (inflammation of the gall bladder)
d. Kidney infections – Acute pyelonephritis/ perinephric abscess
e. Aortic aneurysm (ballooning of a weak area in the largest blood vessel
arising from the heart)
f. Peptic ulcer (an ulcer in the stomach or upper intestine)
g. Impacted gall bladder stone