Did you know that the ‘Tender Point Test’ for fibromyalgia has been deemed as innacurate, unreliable & outdated? Yet, this 27 year old test (1990) it is still being carried out by many doctors and specialists today – even though it is considered to be highly inconclusive.
The (Outdated) 18 Tender Point Test
The 18 point tender point test is a physical exam that focuses on 18 points throughout the body. When light pressure is applied to these points, clustered around the neck, shoulder, chest, hip, knee, and elbow regions, patients with fibromyalgia feel tenderness or pain.
The 18 point test of tender points has been proven to be unreliable for several reasons:
1. Fibromyalgia symptoms come and go and fluctuate in regards to pain and location
2. Doctors are uncertain about the amount of pressure to apply when carrying out a tender point exam
3. Pain is just ONE of the many symptoms that make up fibromyalgia – not THE symptom
Back in 1990, the American College of Rheumatology (ACR) established two criteria for the diagnosis of fibromyalgia:
1. Widespread pain lasting at least three months
2. At least 11 positive tender points in specific places — out of a total possible of 18 (see diagram) in all 4 quandrants on the body.
Why the Change in Testing Was Needed
In 2010, Dr Robert Katz, a rheumatologist at Rush University Medical Center and one of the authors of the new fibromyalgia diagnostic criteria said, ‘These new criteria recognize that fibromyalgia is more than just body pain.”
Dr Katz goes on to say, “This is a big deal for patients who suffer symptoms but have had no diagnosis. A definite diagnosis can lead to more focused and successful treatment and reducing the stress of the unknown.” (The average time it takes to get a fibromyalgia diagnosis is FIVE YEARS!!!).
“There are numerous shortcomings with the previous criteria, which didn’t take into account the importance of common symptoms including significant fatigue, a lack of mental clarity and forgetfulness, sleep problems and an impaired ability to function doing normal activities,” said Katz.
The other concern that Dr Katz expressed is that the tender point test is gender bias because although men may report widespread pain, they generally aren’t as tender as women. Therefore, fibromyalgia may be under diagnosed in both men and women because of the reliance on the tender point test which fails to take into account the other central features of the illness.
A Standardized Diagnostic Scale
The tender point test is being replaced with a widespread pain index and a symptom severity scale. The widespread pain index score is determined by counting the number of areas on the body where the patient has felt pain in the last week. The checklist includes 19 specified areas.
The Symptom Severity Score
This score is determined by rating on a scale of 0 to 3, 3 being the most pervasive, the severity of three common symptoms:
2. Waking unrefreshed
3. Cognitive symptoms
An additional 3 points can be added to account for the extent of additional symptoms such as:
4. Irritable bowel syndrome
The final score is between 0 and 12.
In order to meet the criteria for a diagnosis of fibromyalgia a patient would need seven or more pain areas and a symptom severity score of 5 or more; or three to six pain areas and a symptom severity score of 9 or more.
Some Criteria is Unchanged
The criteria still remains as per the 1990 test, which is:
1. The symptoms must have been present for at least three months
2. The patient does not have a disorder that would otherwise explain the pain.
The New Test Criteria Study Background
In order to develop and test the new criteria, a multi-center study of 829 previously diagnosed fibromyalgia patients and a control group of rheumatic patients with non-inflammatory disorders using physician physical and interview examinations was carried out by researchers. The data were processed by the National Data Bank for Rheumatic Diseases.
Here is the link to the article in which the American College of Rheumatology proposed the new criteria, due to the tender points test has been found to have such extreme shortcomings.
This is the PubMed research article on the Criteria for the Diagnosis of Fibromyalgia: Validation of the Modified 2010 Preliminary American College of Rheumatology Criteria and the Development of Alternative Criteria.
This new (and improved!) way of diagnosing fibromyalgia is certainly much more inclusive of all the different symptoms that go hand in hand with fibromyalgia – beyond pain. (There are over 200+ co-existing conditions and symptoms!).
The outdated and unreliable 18 tender point test possibly has affected millions of people in not getting the right diagnosis for fibromyalgia – this ultimately means hat the average of 5% of the population having fibro are those diagnosed, meaning that this figure is wildly inaccurate. (It also means MANY people are possibly struggling with their health and being told that it is ‘all in their head’, meanwhile it IS fibro!). Question is whether or not doctors are even aware of this new criteria for diagnosing fibromyalgia! What is your experience of getting a diagnosis and was it the tender point test or the new and improved diagnostic test? Please leave a comment!