Diagnosis of FM

A second debate considered whether tenderpoints are necessary or not to diagnose Fibromyalgia. This debate stems from the release of new clinical criteria that require no physical examination. These were published by the American College of Rheumatology in 2010. The physician need only check off the patient’s symptoms and record the number of painful areas on a patient in order to confirm or reject the diagnosis of FM.

Dr. Roland Staud (University of Florida) argued the superior value of tenderpoints compared to dolorimetry (a mechanical device for measuring the severity of tender points), as well as the correlation of tenderpoints with fatigue, anxiety, depression and sleep. He pointed out that tenderpoints reflect the amount of distress more than pain. He was especially negative about the new clinical criteria because it is self-reported and ‘too easy to check off boxes’ and therefore meet criteria for FM.

Dr. Dan Clauw (University of Michigan) used David Letterman’s Top Ten List format to argue against tenderpoints. He argued that tenderpoints convey an incorrect message that FM is about pain alone; that many practitioners don’t know how to test for tenderpoints; tenderpoints are not a good measure of pain threshold; and there is no evidence they are necessary to make a diagnosis.

[Ed. note:  Both debaters made excellent points but I think they missed two big ones. First, finding more than 11 tenderpoints on a patient confirms the clinical impression for the doctor, and second, tenderpoints represent a physical sign of “something wrong.” They validate for the patient and doctor alike that the pain is real and meets some internationally accepted standard. Besides, I firmly agree that patients need to be examined and touched. Just providing another checklist (like the new clinical criteria) just doesn’t do it!]