Fibromyalgia 18 ‘Tender Point Test’ Inaccurate, Unreliable & Outdated

In Blogby Alyssa Reid2 Comments

Did you know that the ‘Tender Point Test’ for fibromyalgia has been deemed as innacurate, unreliable & outdated?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The (Outdated) 18 Tender Point Test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:Image result for tender points fibromyalgia

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.
Ouch All Natural Pain Capsules

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:

1. Fatigue

2. Waking unrefreshed

3. Cognitive symptoms

An additional 3 points can be added to account for the extent of additional symptoms such as:

1. Numbness

2. Dizziness

3. Nausea

4. Irritable bowel syndrome

5. Depression

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!).

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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!


  1. I’ve recently found your wonderful app and am gradually getting to grips with it. I live in the UK and things are a lot different here to the US. As far as I know there is only one Fibro clinic in the country and I am waiting to go and see them. I was diagnosed in 98 and told that it is not debilitating. I now use an electric wheelchair and am losing the use of my left arm due to all the muscle spasms that have rendered most of my body un-useable. I have the brain fog and speech problems and all the other wonderful things that go with this wonderful condition. The one problem we have over here is that if the docs can’t diagnose a condition, it is put down to Fibro and constantly mixed in with CFS/ME. I understand they are similar, but Fibro is a different condition and mixing them together and constantly being told ‘You can get better by doing this’ does not help people who have Fibro and know that you do not recover from Fibro, trust me I have tried. Thankfully I have a wonderful GP who is willing to help me get the help I need.
    My daughter has EDSH and she is using your app as well and learning what she needs to get from it for all her docs that she has to see for her many problems.

    1. Author

      Hi there and thank you for your comment, we are also based in the UK, I am glad you find the app of benefit.

      What you have most likely not been told by any doctor is the fact that fibromyalgia and CFS root issues have to do with mitochondrial dysfunction due to things like toxic antibiotics smothering and killing the mitochondria (which are your cell’s powerhouses). Gut health is also a huge overlooked factor.

      Toxic overload is a MASSIVE issue that is one of the main root issues of fibro and also CFS. Your doctor will not be helping you in regards to this simply because Big Pharma are unable to actually undo what they have caused – toxicity. You/we are BIG money! And it is important to know that they are not looking for cures…we are customers.

      The best thing that I can recommend to you that has helped turn my life around and thousands of others, is to look at reducing your toxic load as well as doing a cleanse every few months.

      We are all highly toxic. We are born toxic in fact. And we are subjected to on average 515 toxic chemicals alone in our body care products – EVERY SINGLE DAY.

      This is the cleanse that I recommend – it is helping 1000s of people. It reduces fatigue (mitochondria dysfunction and the toxic sludge built up in our livers and colons) and toxins such as heavy metals and fungus cause fatigue and brain fog), pain (inflammation is gut health based), IBS and bloating (up to 25lbs of toxic waste is in our bodies…) and so much more can be reduced – and even eradicated, combined with a low carb, high fat, medium protein diet and reducing toxic aspects to our lives (ie plastic food containers, body care products full of chemicals and foods full of antibiotics, pesticides and more) can all make a difference.

      BTW – all the meds you have been on will have also hugely impacted your toxic load and the antibiotics…heavy duty health implications as mentioned above as well as wiping out all your good gut bacteria. Look into Leaky Gut Syndrome, if you haven’t done so already.

      We actually CAN heal ourselves. Honest. It’s about research and educating ourselves, and choosing to make changes OUTSIDE the system. Just because a product is for sale – or even prescribed, in no way or means makes it SAFE.

      After 9 years of struggling and tons of research daily, this is the product that has made the largest impact combined with taking my health back into my own hands. I realised that all the prescription meds I was on were causing me to be even MORE ill! And that is certainly the case in regards to polls I have run on our Facebook page, as well.
      Thing is, you can literally start today in regards to taking your health back instead of waiting for another doctor to put you on even MORE drugs. Honest.

      There is also more information on toxic overload available at

      I hope that you find this helpful. I am passionate about this stuff. I am watching thousands of people becoming even MORE ill with fibro and CFS and I have supported thousands (voluntarily) as well in regards to making life changes to help them feel better and alive again – instead of just existing. Honest.

      Be well,


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