- Last Updated: 05 December 2015 05 December 2015
A lively debate followed between R.Staud (Florida, USA) and D.Clauw (Ann Arbor, USA) entitled: “Are tender points necessary?” Staud outlined the American College of Rheumatology criteria for FM (1990) which includes widespread body pain of 3 months duration and presence of 11 out of 18 tender points. The tenderness should be with 4kg of thumb pressure.
In trials this has not been found to be reliable and a more accurate diagnosis can be made using the 2010 provisional FM criteria: 3/12 duration of pain with a widespread pain index in 19 areas with a severity scale of at least 9. This scoring system is quite different, and additional symptoms include fatigue, unrefreshing sleep, cognitive symptoms and somatic symptoms. (There is overlap with CFS).
Many different ways have been looked at for triggering pain for measurement. Emotional “windup” could be useful, but is not reliable. Tonic heat and mechanical stimulation can be applied to painful and non-painful areas. This can be used for assessment of pain or for stimulating pain. Tenderness does correlate with pain and can be measured by quantitative measurement of pain sensation (QST). For clinical purposes, tender points provide little mechanistic information about an individual’s pain and associated symptoms.
Clauw feels that tender points in diagnosis are unnecessary, and outlined 10 reasons why:
- Convey inappropriate message about FM
- Excludes males
- Practitioners do not know how to do it, and often do not want to learn
- Very few chronic pain states have a specific examination to diagnose pain
- Tender points are an inadequate measure to assess experimental pain threshold
- There are better ways to assess pain threshold
- Tender points are not normally distributed
- Tender point count was never meant to be a “physical exam” and should not replace routine clinical examination
- No evidence that they are necessary in diagnosis
- Is the horse dead yet?!!