New Definition for Fibromyalgia Published: Tender Point Exam Not Required

The American College of Rheumatology has published in the May 2010 issue of Arthritis Care Research a new definition for Fibromyalgia.  A tender point exam is no longer required to result in a Fibromyalgia diagnosis for the patient.  Here is an abstract of the article from the website:

OBJECTIVE: To develop simple, practical criteria for clinical diagnosis of fibromyalgia that are suitable for use in primary and specialty care and that do not require a tender point examination, and to provide a severity scale for characteristic fibromyalgia symptoms.

METHODS: We performed a multicenter study of 829 previously diagnosed fibromyalgia patients and controls using physician physical and interview examinations, including a widespread pain index (WPI), a measure of the number of painful body regions. Random forest and recursive partitioning analyses were used to guide the development of a case definition of fibromyalgia, to develop criteria, and to construct a symptom severity (SS) scale. RESULTS: Approximately 25% of fibromyalgia patients did not satisfy the American College of Rheumatology (ACR) 1990 classification criteria at the time of the study. The most important diagnostic variables were WPI and categorical scales for cognitive symptoms, unrefreshed sleep, fatigue, and number of somatic symptoms. The categorical scales were summed to create an SS scale. We combined the SS scale and the WPI to recommend a new case definition of fibromyalgia: (WPI > or =7 AND SS > or =5) OR (WPI 3-6 AND SS > or =9).

CONCLUSION: This simple clinical case definition of fibromyalgia correctly classifies 88.1% of cases classified by the ACR classification criteria, and does not require a physical or tender point examination. The SS scale enables assessment of fibromyalgia symptom severity in persons with current or previous fibromyalgia, and in those to whom the criteria have not been applied. It will be especially useful in the longitudinal evaluation of patients with marked symptom variability.

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  1. Hum, I don’t think this is likely to be good news. It seems to suggest that it will allow almost anyone to diagnose and that, along with reduced criteria, will mean even more misdiagnoses. All that will do is increase the number of “miracle cure” claims by people who got better, though obviously, they didn’t have fibromyalgia in the first place, even though they got a spurious diagnosis.

  2. Gloria_Lynn says:

    I was diagnosed in 1980 after extensive tests by physicians who could not fathom why I hurt everywhere all the time; they FINALLY sent me to a physiologist, a sports therapy doctor who first gave me the electromyography test where they stabbed me with a needle while I screamed in anguish & pain and cried hysterically for at least a half hour because no one had told me to take any pain medication prior to the test.
    This doctor, who is probably now deceased – he was in his 80’s at the time, asked me to lay down on my stomach and asked me to let him know when I felt additional pain………
    He diagnosed me in 5 minutes. A wonderful doctor who realized it wasn’t in my head, it wasn’t made up and I was suffering needlessly without proper pain medications, without heat & massage therapies so I was able to ‘handle’ the constant severe pain.
    Unfortunately for me, I was forced to move to Ohio in 2005 after living in my car from May 2004 on due to being outsourced by a major Fortune 500 company where they believe it’s just in my head and I can’t possibly hurt all over all the time and my insurance refuses to cover any treatments.
    There is no ‘miracle’ coming my way……. I will suffer in constant, debilitating pain for the rest of my life, at least as long as I live in Ohio, where they think anyone who ‘imagines’ they have fibromyagia is seeking hard core narcotics.
    Lyrica didn’t help me but did make me incredibly tired, more tired than I already am.
    They put me on anti-depressants for a short time, thinking “Oh, some hysterical female suffering from deep depression, let’s put her on anti-depressants”. I could not tolerate them, every one they tried caused more sleeplessness because I woke up with night terrors every night for months on end as they switched me from one to another.
    I don’t mean to complain but, man…… I NEED some actual medical treatment; not lip service from some corporate money hound who refuses to believe that I hurt.

  3. I have been in a flare for about three weeks I even told my husband it feels like I first got FM and what happens to me is I sleep a whole lot between 12and 14 hours and the rest of the time I am so tired. I have my four grandkids and they understand my FM they been with me for almost seven years I have had FM since 1989. I would have a few good days that were good and I told my doctor I’m I getting better is it going away and he would just stare at me and shake his head and say no! After a couple times he got though to me and I wouldn’t ask. I meant to say that I feel guilty I have to set my phone alarm so I can wake up after the first one comes home he will let the others in. This week for some reason my alarm hasn’t woke up somehow my alarm got turn off so my poor grandson had sometimes 20 minutes ringing the door bell and pounding how the door. He is graduating to 7th grade he is the youngest and i have been crawling out of bed to all the school functions they are really important.
    The only thing I want to ask i really like to write like you tell I have not been well enough to get on the computer. Anyway, will someone explain to me what is this new way to measure FM in regular language because I don’t understand the money I went to college was sure wasted! They also said it’s not a syndrome no more please someone explain Why? All done sorry so long

  4. I also have fibromyalgia.It has been about 21 years,I have been suffering tremendesly with pain all over my body.I was diagnosed about 2 years ago.The only thing is that no one believed me and I went to every single doctor that exsisted.They thought I was depressed and I told the dr. wouldn’t you be if you were in pain and no one believed you.The only thing with the medicines that treat this are antidepresants and me personally,I can’t take them.I stared going to a pain management dr that also does accupunture and I feel wonderful.My trigger points pain have 80% disapeared.I told my pain management dr.I felt very tired and he recomenended different kinds of vitamins,not multi. he says you don’t get the total absorbstion.I told my primary I was tired and he said I was depressed and I told him I can’t function,I think something is wrong.Didn’t want to hear me.Took my bloodwork my vitamin d level is at 11 and my colesterol is high and then he recomended vitamins that my pain management dr. told me to take by me just saying Im so tired.These dr. don’t listen or care.Thank God for my pain management dr.It gets expensive but it is worth it.I went for the first month once a week and now I will go every other week and then once a month.It works.Consider acupunture but be careful.Some accupuncture don’t do it right or will only do one part of your body.Mine is a pain management and he charges $50 to do my whole body and my co payment is $50,so I pay $100 evry time I go.This is the best I’ve felt in years and now that I know that my vitamin d level is very low ,now I know why I’ve been in such pain that also contributes to fibromyalgia.So make sure you also get that checked.Stay well all.The pain does get better.I promise I feel awesome.

  5. Not surprised – we have socialized medicine now, so like every other country with socialized medicine, they’re going to do what they can to save money. Keep in mind the “ethicist” in the UK who, a couple years ago, said Alzheimer’s patients had a “duty to die” to “save the NHS (National Health Service) money.” She further went on to suggest that families whose Alzheimer’s patients were too far gone to understand the “need” for suicide, be prepared to do in their own relatives! If that’s ethics, don’t tell me what evil is (I already know; I used to be involved deeply in the occult before I was saved). It’s been rumored for a few decades that the euthanasia program in the Netherlands, which was supposed to be voluntary & for terminally ill patients only, had been extended to involuntary for anyone over 62 to the extent that even a person who fell & broke an arm would come out “feet first” if they went to the hospital – even if they were otherwise healthy – something denied by the government & of course, the doctors (who tend, after all, to bury their mistakes & cover each others’ backs even with “angel of death” doctors, while insisting on capital punishment for RNs who become “angels of death.”). In the UK, whose hospitals in the 80s resembled American hospitals in the 30s – down to beds that didn’t even hand crank up & down, I was told by citizens of the UK that there was a 7 yr waiting list for knee replacements & 5 yr for hips, & that any emergency orthopedic surgery (like what I had to have when we lived there, for a badly fractured arm) pushed back dates for surgery for waitlisted people; & that if you’d ever been fat or smoked – even if you’d remedied the problem – you couldn’t have heart surgery because it was your fault you had the problem in the first place – same for joint surgery or anything remotely blamed on your bad habit. While that sounds good, cervical, breast, & ovarian cancers have been linked to promiscuous sexual behavior in the past – so women who get those cancers might need to expect someone to interrogate them on every tryst they’ve ever had, to determine if they “caused” their cancer. Plus, the UK had a 33% income tax plus sales tax &, on some items, VAT (value added tax) – & they have to pay an annual TV tax (no, not cable – that’s more, if it’s available). So, the UK citizens were taxed pretty thoroughly in the 80s, & from what I hear, their income tax is now in the 40% range to support NHS. Their NICE (National Institute for Clinical Excellence) rations care. And all research into ME over there is CLASSIFIED, according to my online sources.
    So yeah, anything they can find to deny care is going to be used, & overused.
    Plus, it does make me wonder if that guy in Canada with his conspiracy theories is right…why else would the UK classify research…he alleges they created a prion from bacteria & virus scraps & then tested it over the US, UK, Canada, & parts of W. Europe, & that once in the blood, depending on the person, it can show up as CFS, fibro, Alzheimer’s, Parkinson’s, MS, MG, in fact, just about any illness that can be tied to the neurologic &/or immune system. Plus, when you consider that half of the US population has at least one chronic illness…does make you wonder if the guy’s right.

  6. The tender point exam is the most convenient approach in identifying fibromyalgia. Take it away and misdiagnosis will occur more.

  7. Interesting… is it all possible that having fibromyalgia at an any point, early or later stages could actually result to anxiety problems for patients? Should tender exam be able to determine this as we all know, pain management in the hands of a person who has less pain tolerance could lead to dependency on pain killers and soon be subject to addiction.

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