Are Tender Points Still Used to Diagnose Fibromyalgia?

Fibromyalgia is a complicated illness. It’s not a disease that can be seen on x-rays or ultrasound and much of the symptoms are self-reported by patients. What doctors know about fibromyalgia continues to change and adapt with time. When doctors came up with the initial diagnostic criteria in 1990, the standards used to diagnose fibromyalgia were different. Back then, most doctors used the presence of tender points to diagnose fibromyalgia. But today, things are a little different. Learn more about the criteria doctors use to make a fibro diagnosis now.

WHAT ARE TENDER POINTS?

Once the diagnostic gold standard for identifying fibromyalgia, doctors checked for sensitivity when specific tender points on the body were touched. Under this original standard, you had to experience intense pain and tenderness when doctors pressed or touched at least 11 of 18 specific points. In addition, a positive fibromyalgia diagnosis required widespread pain throughout the entire body. Although other symptoms were often associated with fibromyalgia, the tender points and widespread pain were the only criteria required for getting a fibro diagnosis.

WHY DID DOCTORS CHANGE HOW THEY DIAGNOSE FIBROMYALGIA?

Tender points were an unpopular method for diagnosing fibromyalgia. Doctors wanted something more scientific and less subjective than just the patient’s experience of tenderness or pain. Many doctors also felt uncomfortable with having to touch so much of the patient’s body to make the diagnosis.

An additional factor in why doctors sought a change for how to diagnose fibromyalgia was that the old diagnostic standard didn’t account for other health problems associated with fibro. Many patients with fibromyalgia often have other coexisting health problems, including fatigue, depression and anxiety, joint pain, digestive problems, hormonal imbalances, and headaches. An improved diagnostic standard allows these other conditions to be taken into consideration.

NEW DIAGNOSTIC CRITERIA

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The American College of Rheumatology updated their diagnostic guidelines in 2010. Their new guidelines for use in diagnosing fibromyalgia include scores on two different scales: the widespread pain index (WPI) and symptom severity (SS) scale. The new criteria do not completely replace the original criteria and pain at tender or pressure points can still be useful information.

However, most doctors feel that there should be a more comprehensive evaluation. The symptom severity scale asks patients to rate their experience of the following symptoms:

  • Muscle pain
  • Fatigue and/or chronic tiredness
  • Irritable bowel syndrome
  • Headaches
  • Problems with thinking or memory
  • Dizziness
  • Insomnia
  • Nausea/vomiting
  • Mood changes, including depression and anxiety
  • Problems with urination, including frequent urination or bladder spasms

The severity score on these symptoms is combined with the extent of widespread physical pain to help a doctor make a fibromyalgia diagnosis. Many fibromyalgia patients also find that their symptoms began after a traumatic or highly stressful event, such as a car accident, job loss, or the death of a loved one.

RULING OUT OTHER CONDITIONS

Although doctors can diagnose fibromyalgia from the criteria listed above, it’s also important to rule out other conditions. Many other conditions have similar symptoms to fibromyalgia. These conditions can be detected by simple blood tests. These health conditions with symptoms that mimic fibromyalgia are often more easily treated than fibro as well.

Some of the other health conditions doctors can test for and possibly rule out on the way to making an accurate fibro diagnosis include the following:

  • Low vitamin D levels, which may be a widespread problem
  • Autoimmune diseases, including Sjogren’s, lupus, and rheumatoid arthritis
  • Neurological illnesses, such as multiple sclerosis and myasthenia gravis

Tests that can diagnose these conditions include a general vitamin D test, sedimentation rate (or sed rate) test, thyroid function test, and complete blood count. An MRI and lumbar puncture (or spinal tap) are also used to diagnose diseases like multiple sclerosis.

NEW TESTING OPTIONS

For decades, it was believed that making a fibromyalgia diagnosis was a matter of trial and error. Doctors would rule out one condition after another. After this, they would conclude that symptoms equaled fibromyalgia. But now there may be a blood test that can help in diagnosis.

A company named EpicGenetics has developed the Fm/a blood test. This test looks for specific immune system abnormalities in the white blood cells.

Fibromyalgia diagnosis is still an imprecise process. But scientists are getting closer every day to finding a definite means of diagnosing the illness.

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