Why new diagnostic criteria were needed

This major revision of the diagnostic criteria was precipitated by numerous shortcomings of the 1990 ACR standards. Dr. Robert M. Bennett of Portland, Oregon, one of the FM specialists who helped to create the original criteria, discussed some of these problems in a recent FM publication.

Dr. Bennett stated that considerable skill is needed to correctly check for a patient’s tender points (i.e., digital palpation that is done with certain amount of applied pressure), yet this technique is not typically taught at most medical schools.

Many primary care physicians have been avoiding tender point examinations, or if the exams were performed, they might often have been done incorrectly.

It is thought that a percentage of patients who likely have FM have not been diagnosed with it, either due to poor examination of their tender points or not having the minimum number of required tender points. As a result, physicians had already started to rely on symptoms commonly found in FM patients (i.e., sleep problems, decreased mental clarity, forgetfulness, and impaired function during daily activities) when making a diagnosis of FM, but with no consistent standards in place.

Other specialists mentioned in their criticisms:

• that the excessive focus on tender points, which had not improved overall medical knowledge about the cause of pain in FM
• that the examination of tender points also did not accurately measure the effectiveness of treatments (i.e., treatments which might help FM patients may not cause any changes to their tender points)
• that the fluctuation of pain and presence of many other symptoms had been long overlooked
• that studies of FM were disproportionately limited to females.

One of the study authors, Dr. Robert S. Katz, a rheumatologist at Rush University Medical Center, elaborated on this discrepancy in a June 2010 issue of Science Daily, "The tender point test also has a gender bias because men may report widespread pain, but they generally aren't as tender as women. Fibromyalgia may be under-diagnosed in both men and women because of the reliance on 11 tender points, rather than considering other central features of the illness.”

However, most researchers felt the old criteria had helped to bring the science and recognition of FM to where it stands today.