The Truth About Fibromyalgia Tender Points

The phrase “tender points” isn’t something you hear every day. But if you have fibromyalgia, you may be familiar with those words. In fact, your doctor may have used tender points to diagnose you.

What Are Tender Points?

In 1990, the American College of Rheumatology (ACR) introduced criteria for diagnosing people with fibromyalgia. Part of the criteria included 18 possible tender points throughout the body. Tender points are small spots located around your neck, shoulders, chest, hips, knees and elbows. 

To be diagnosed with fibromyalgia, patients had to experience pain in at least 11 of those 18 sites when their doctor pressed firmly on them. In addition to tender points, you had to have pain in all four quadrants of your body (left side; right side, above the waist; below the waist) lasting longer than three months. 

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The Problem With Tender Points

A lot has changed since the original ACR criteria for diagnosis was released. A 2010 study found that approximately 25% of people diagnosed with fibromyalgia didn’t satisfy the ACR’s criteria for having the disease, even though their doctors believed they had fibromyalgia based on their other symptoms. 

Tender points posed a significant issue for doctors and patients alike. For example, if a person experiences improvement and no longer has as many tender points, does that mean he or she no longer has fibromyalgia, even if the person still has other symptoms like widespread pain? The pain is often described as a dull, constant pain in the muscles. 

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New Ways of Diagnosing Fibromyalgia

In 2010, the ACR updated its criteria for diagnosing people with fibromyalgia. Among several changes, it removed tender points from the criteria. Today, diagnosis relies more on patients’ self-reported symptoms than a doctor’s physical examination of the tender points. 

In addition to pain, doctors consider symptoms that weren’t included in the original criteria, such as fatigue, sleep problems, and cognitive issues like trouble concentrating. They also use a tool called the symptom severity scale. The scale acknowledges that with a chronic pain condition like fibromyalgia, your symptoms may change with time. Pain can be more or less severe under different circumstances, such as how tired you are, your stress level, and your level of physical activity. 

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As a result, making a diagnosis no longer relies on a fixed set of criteria, such as tender points, and gives more weight to your personal experience with the condition. The symptoms of fibromyalgia resemble other chronic pain conditions, such as rheumatoid arthritis. For this reason, doctors may use specific blood tests and other evaluations to rule out these conditions before making a fibromyalgia diagnosis.

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