Pain, on digital palpation, must be present in at least 11 of the following 18 tender point
sites: Occiput: Bilateral, at the suboccipital muscle insertions.
These studies have shown that certain complaints, such as generalized muscular pain and tender points
, are present in people with fibromyalgia and not commonly present in healthy people or people with other rheumatic conditions.
While eight of the people with CFS had no current musculoskeletal pain, the average tender point
examination of the remaining 19 CFS patients was nearly identical to that of the fibromyalgia patients.
Relationships between the fibromyalgia impact questionnaire, tender point
count, and muscle strength in female patients with fibromyalgia: a cohort study.
The sum of PPT of 18 points for tender points
, 12 points for the sciatic valleix, and 4 points for the lumbar paravertebrae were calculated separately as final scores in kg/[cm.
An audience member objected to eliminating the tender point
Instead, the diagnosis has been made by a tender point
test, a physical exam that focuses on 18 points throughout the body.
According to ACR criteria, a person is considered to have fibromyalgia if he or she has widespread pain for at least 3 months in combination with tenderness in at least 11 of 18 specific tender point
He points out that some physicians may not have even heard of the tender point
concept or various other indications of fibromyalgia.
Total myalgia score (TMS), which represented the severity of the clinical symptoms, was calculated by summing up total tender point
count (TPC) and the tenderness score for each point, as determined on a 4-point scale (0= no tenderness, 1= mild tenderness, 2= moderate tenderness with grimace, 3= severe tenderness with flinch).
Alternative diagnostic criteria that do not require a tender point
exam are being investigated for use in clinical practice.
This year the American College of Rheumatology published diagnostic criteria for fibromyalgia that shifted the emphasis from tender point
examination and focused instead on the other symptoms that cause misery in these patients, such as sleep disturbance and fatigue (Arthritis Care Res.