Fibromyalgia Checklist

 

Symptoms Today 1 Month 3 Months 6 Months
Allergies        
Anxieties        
Bruising        
Burning Pain in Feet        
Carpal Tunnel Syndrome        
Chest Pain        
Chronic Fatigue        
Chronic Headaches (Migraine)        
Chronic Muscle Pain        
Clumsiness        
Confusion        
Coordination Impaired        
Depression        
Dizziness        
Dropping Things        
Dry Eyes & Mouth        
Exremity(ies) "Going to Sleep"        
Eye Prescription Changes        
Feeling of Swelling        
Fluid Retention        
Hair Loss        
High or Low Temperatures        
"Hot Spots" in Muscles        
Insomnia        
Irritability        
Irritable Bowel Syndrome        
Joint Pain (Arthritis)        
Lack of Endurance        
Low Back Pain        
Mental Fogginess        
Memory Blanks        
Mood Swings        
Mouth Sores        
Muscle Spasms        
Muscular Jerking at Night        
Numbness - Tingling in Hands/Feet        
Pain Attacks        
Premenstrual Syndrome (PMS)        
Restless Leg Syndrome        
Sensitivity to Environment        
Short-term Memory Loss        
Skin Itch, Mottling, Rash        
Skin Sensitivities        
Sleep Apnea        
Sore Throat        
Stiffness        
Swollen Glands        
Tender Lymph Nodes        
Tender Trigger Points (up to 18)        
TMJ-like Symptoms        
Trouble Concentrating        
Using Wrong Words        
Losing Words        
Vision Changes & Eye Pain        
Weight Gain or Loss        
Other        

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