A Critical Analysis of the Tender Points in Fibromyalgia. Pain Med. 2007 Mar;8(2):147-156.
Harden RN, Revivo G, Song S, Nampiaparampil D, Golden G, Kirincic M, Houle TT.
Center for Pain Studies, Rehabilitation Institute of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
PMID: 17305686
Objective. To pilot methodologies designed to critically assess the American College of Rheumatology's (ACR) diagnostic criteria for fibromyalgia.
Design. Prospective, psychophysical testing.
Setting. An urban teaching hospital.
Subjects. Twenty-five patients with fibromyalgia and 31 healthy controls (convenience sample).
Interventions. Pressure pain threshold was determined at the 18 ACR tender points and five sham points using an algometer (dolorimeter).
Outcome Measures. The patients "algometric total scores" (sums of the patients' average pain thresholds at the 18 tender points) were derived, as well as pain thresholds across sham points.
Results. The "algometric total score" could differentiate patients with fibromyalgia from normals with an accuracy of 85.7% (P < 0.001). Even a single tender point had a diagnostic accuracy between 75% and 89%. Although fibromyalgics had less pain across sham points than across ACR tender points, sham points also could be used for diagnosis (85.7%; Ps < 0.001). Hierarchical cluster analysis showed that three points could be used for a classification accuracy equivalent to the use of all 18 points
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There are still doctors who believe that fibro is a "wastebasket diagnosis", i.e., if you don't know what else to call it, diagnose fibro. This research proves that there is a very accurate way to diagnose fibro, so any doctor who's just lumping all pain into that diagnosis is misdiagnosing at least some of his patients.
If your doctor has diagnosed fibro without testing the 18 tender points, ask him why not done that test. If he has no clue what you're talking about, visit Co-Cure.org and find a doctor in your area who does know that there's a specific test for it.
If your doctor, like one of mine, diagnosed fibro when you had 11/18 tender points and then tried to un-diagnose it when you fell slightly below that, you should know that the 11/18 points are only required for an initial diagnosis. The diagnostic criteria recognized that there were times when you might not hurt as much. Less than a year after my doctor tried to claim my fibro diagnosis was in error because on one particular day I only had 10/18, another doctor got 18/18. He had a dolorimeter -- a device that measures the amount of pressure being applied. To make the diagnosis, you need to feel pain at 10 pounds or less of pressure. On some spots, I could barely take 1.5 pounds before tears formed. He had absolutely no doubt that I had fibro, and, in fact, a pretty bad case of it.
This new research makes it clear that it's not necessary to have 11/18 points for a diagnosis. The diagnosis can be made just as accurately with 3/18, and nearly as accurately with only one.
Be aware, also, that fibro-like symptoms can result from sleep deprivation. At the worst of my sleeplessness, I had pain all over, all the time. I found out that you can test a Sleep Number bed for 30 nights and return it owing only the delivery fee. After one week, the pain was greatly reduced.
The tender points now hurt only when someone actually presses on them. While this did not take away my fibro diagnosis, it did make day-to-day life more bearable.
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