The tender-point exam is no longer the standard. Here is how fibromyalgia is diagnosed today, and what to expect at the appointment.
If you were told years ago that fibromyalgia is diagnosed by pressing on eighteen specific points on the body, that information is out of date. The approach changed, and the change was good news for patients.
What the old exam involved
The 1990 criteria from the American College of Rheumatology required widespread pain plus tenderness at a set number of eighteen defined tender points, which a physician pressed with a specific amount of force.
The method had real problems. Tenderness fluctuates from day to day, so the same patient could pass the exam one week and fail it the next. Many physicians were never trained to apply the right pressure. And the exam captured only pain, ignoring the fatigue, sleep trouble, and cognitive symptoms that patients consistently describe as the most disabling parts of the condition.
What replaced it
The criteria were revised in 2010 and updated again in 2016. Today diagnosis rests on two scored measures, taken together:
The Widespread Pain Index. You identify which of nineteen body areas have been painful over the past week — shoulders, upper and lower arms, hips, upper and lower legs, jaw, chest, abdomen, upper and lower back, and neck. Each area counts one point.
The Symptom Severity Scale. Three symptoms — fatigue, waking unrefreshed, and cognitive problems — are each rated from 0 (no problem) to 3 (severe). Added to that is a score for other general symptoms such as headaches, abdominal pain, and depression.
A diagnosis generally requires either a fairly high pain index with moderate symptom severity, or fewer painful areas with more severe accompanying symptoms. The symptoms must have been present at a similar level for at least three months, and pain must be generalized — present in at least four of five body regions.
Importantly, the current criteria state that a fibromyalgia diagnosis is valid regardless of other diagnoses, and does not exclude the presence of other illnesses. You can have fibromyalgia and rheumatoid arthritis. You can have fibromyalgia and lupus. One does not rule out the other.
Why this version is better
The scored approach counts what patients actually report. Fatigue counts. Unrefreshing sleep counts. Fibro fog counts. It also means the diagnosis does not depend on how hard a particular physician happened to press on a particular day.
It can also be completed in a standard office visit, without specialist referral, which matters when rheumatology waitlists run for months.
What your doctor will still rule out
These criteria do not replace a workup. Several conditions produce similar symptoms and need to be excluded first, typically with bloodwork:
• Hypothyroidism
• Rheumatoid arthritis and lupus
• Vitamin D deficiency
• Anemia
• Sleep apnea
• Certain medication side effects, notably from statins
Normal results on these tests do not mean nothing is wrong. In fibromyalgia, normal results are the expected finding.
How to prepare for the appointment
Bring three written things:
1. A list of which body areas have hurt in the past week. Use the nineteen-area list above as your guide.
2. A rating from 0 to 3 for your fatigue, your unrefreshing sleep, and your cognitive symptoms.
3. How long this has gone on. Three months is the threshold.
Walking in with that information already organized turns a vague conversation into a scorable assessment, and often shortens the road to an answer considerably.
Talk with your doctor or pharmacist about your own symptoms and any products you are considering.
These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.
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