Tender Points test for Fibromyalgia

As far as I am aware this theory ie 11-18 tender points has been discredited.

This means you don't have to have these tender points to have Fibromyalgia.

Unfortunately nobody has told half the doctors I have seen which is one of the reason I have not been treated for anything.

I would like to know why some of the doctors think this 11-18 tender points is still a valid test for Fibromyalgia and some don't. Could not the so called specialists at least be aware of the current up to date research that even I am aware of?

I am male btw. Maybe this out dated tender point test is the reason there are so few males on this forum.

13 Replies

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  • I wasn't aware that it had been discredited but was aware that it was never meant to be used by the medical profession as a diagnostic tool in the first place but was used in an experiment in the States and in the abscence of any further thing to go on has always been used since. I wouldn't say that it would be the reason there are less males than females with the condition diagnosed as any rheumatologists or doctors that have been employing the technique would not have had any reason to not test men but test women with it. It just seems to be that there are all over the world where FMS is recognised a lower number of men than women with it as there are differences in gender in a lot of illnesses. The Tender point test has never been the only measure as to whether they think that Fibromyalgia is the diagnosis anyway as it also involves taking a fairly detailed medical history and looking at other symptoms that you have as well. As you know you needed to have had pain in all four quadrants of the body for over 3 months also before it was suggested and at the end of the day there is no definitive test for FMS other than the likelihood it is that and after other illnesses have been discounted as it is so similar to a lot of illnesses including MS and Rheumatoid Arthritis and Lupus. I am sure the so called specialists are aware of the up to date research but are still trying to give people answers working on what they have at the moment to go on which like I said involves more than the Pressure point tests anyway,

  • It's not so much that it has been discredited, but that it was dropped when the 2010 Diagnostic Criteria was developed, largely because it is often not performed correctly and is not understood, so can be unhelpful.

    Performed correctly, it can be a good way of measuring the widespread hyperalgesia (hypersensitivity to pain) that is characteristic of Fibro. But many doctors are unaware of how the test should be carried out (e.g. they don't tell patients to say if a spot is tender and rate the pain, so anyone toughing it out and not yelping will get a lower score even if they're in pain!) and unaware of what it is for. There is nothing special about the tender points, but some doctors still believe that they cause Fibro symptoms or something.

    It also doesn't reflect the state of people with Fibro who have their symptoms well managed, so might score below 11 on a tender point test despite still having Fibro.

    One issue with the tender point test is that men will often score lower than women. No one knows why - it may be that women are more likely to say "that hurts!" on examination, so are more likely to get a "positive" even with a doctor not performing the test ideally.

    The 2010 Diagnostic Criteria is more for primary care professionals, e.g. GPs. It does rely even more heavily on all other possible causes of symptoms being ruled or identified and isolated, so isn't perfect either.

    There is information on the Diagnostic Criteria here:

    fibroaction.org/Pages/New-D...

    If anyone is struggling to get diagnosed simply because of a low TP score, I would suggest taking info on the new criteria to your GP.

    Btw - I am aware that the new criteria is not discussed on the actual Diagnosis page of the website. It's being updated!

  • Hey mojoman, gentle hugs,

    I was diagnosed about 7 years ago via a Rheumatologist specialising in Fibro and he used the pressure point test - I scored the full 18. And boy, he did know what he was doing! Every time he pressed each point - I virtually hit the ceiling and roared in agony. I only knew the shoulder points as my shoulders were very sore and painful for years. When all the other points were found so painful I was shocked - but at least I had a name for what ailed me and it was not "all in my head" - never knew that the test was finally dropped.

    Love,

    Carol xx

  • Well I have had "had pain in all four quadrants of the body for over 3 months" but I never scored 1 point on the Tender point tests.

    I know doubt has been cast on this test which seems to be only valid for some people. ie only a subset of the people who have the other symptoms.

    I have also been diagnosed as having Fibromyalgia because I have all the muscle pains etc and not having Fibromyalgia because I failed the tender point test by different doctors.

    Surely the doctors can at least come to a general consensus about the correct test. If this test cant be relied on for everyone it must be removed! It has not because it seems to me so called specialists are about 10 years out of date.

    Again no one is accountable!

    This has led to a lot of heartache for me because I have been waiting many months for doctors to treat me and then they dismiss me because of this test that nobody is sure about.

    Im sorry but all we get is a load of waffle about the poor doctors but this could be rectified. I am tired of excuses about this.

    "it was dropped when the 2010 Diagnostic Criteria was developed, largely because it is often not performed correctly and is not understood, so can be unhelpful.

    "

    Well it has not been dropped because I have been dismissed because of it.

    Can't these doctors talk amongst themselves or have a body to do this, so I don't have to explain to them about the current research which they don't know about!

    "If anyone is struggling to get diagnosed simply because of a low TP score, I would suggest taking info on the new criteria to your GP.

    "

    And then what are they going to do?

  • I meant that it was dropped from the 2010 Diagnostic Criteria, not that it was dropped entirely. The 2010 criteria was designed mainly for primary care physicians (i.e. GPs in the UK) and there has been some debate about whether it would need to be backed up by a specialist opinion (and possibly tender point score) anyway.

  • Lindsey please,

    Can you please tell me with your advanced knowledge of the Tender points is a valid tests for all sufferers?

    If so I don't have Fibromyalgia.

  • Used correctly, the 1990 Diagnostic Criteria with Tender Point test will identify Fibro in 88% of patients.

    ncbi.nlm.nih.gov/pubmed/230...

    So yes, it is entirely possible to have Fibro and not meet the full criteria. Some consultants use the diagnosis 'atypical Fibromyalgia'. I believe that was your diagnosis? Other consultants will diagnose a patient with 'Chronic Widespread Pain', meaning the same thing (looks like Fibro but doesn't fulfil all criteria).

    Dr Yunus discusses the concept of concept of incomplete fibromyalgia syndrome in a recent paper:

    ncbi.nlm.nih.gov/pubmed/223...

    The 1990 Criteria does assume as well that 1, all other possible causes of symptoms have been either ruled out or identified and isolated (ie. you know what symptoms are caused by something else and so can discount them for the Fibro diagnosis) and 2, the Tender Point Test is performed correctly. There is more information on the TP test here:

    fibroaction.org/Articles/Ex...

  • So if you agree I can still suffer from Fibro and I have indeed been diagnosed as 'Chronic Widespread Pain', as well as Fibro which you say is the same thing..

    Then why do the so called specialist I have seen discharge me or tell me they dont know what to do because I did not have the Tender points?

  • "The Tender point test has never been the only measure as to whether they think that Fibromyalgia is the diagnosis anyway as it also involves taking a fairly detailed medical history and looking at other symptoms that you have as well. "

    Well I don't think you have been an NHS patient then because none of this was ever done with me and I've seen a lot of doctors and there was nothing detailed about any treatmernt I got.

    Also

    "I am sure the so called specialists are aware of the up to date research "

    Well Im sure they are not up to date on research because I have tried to ask them things in the 5 minutes yiou get on the NHS and they dont know!

  • The 18 tender points were only meant for a spacific scientific study and was not supposed to be used as a diagnostic tool, I didn't have any but my tender points were in other places and not all the time ?? this condition is to wide and varied for that test to be accurate. I'm interested to see what others think :-)

  • "

    I meant that it was dropped from the 2010 Diagnostic Criteria, not that it was dropped entirely. The 2010 criteria was designed mainly for primary care physicians (i.e. GPs in the UK) and there has been some debate about whether it would need to be backed up by a specialist opinion (and possibly tender point score) anyway.

    "

    So it is still used by the specialists you accept? But I knew that anyway. But it is wrong!

    Thats why I always fail it and can't get any specialist treatment. But the Specialist never offer me an alternative just discharge me.

    Ever wonder why I am always so angry?

    Complete confusion! Therein lies the problem with treatment of Fibro in this country. Its not lack of funds but poor management, organisation and accountability.

    Even on this little thread there is complete confusion about the Tender points issue.

  • I have had pain throughout my body since I was a very small child 3/4yr old PE teachers believed I was lazy and full of wining excuses to get out of any physical activity. this was not the case and when I complained I was told it was just growing pains and I would grow out of them. I was still experiencing widespread pain in my 20's 30's 40's in my 50's a new GP at my surgery sent me to see a phsyciatrist at our local Mental Health Department I was given several tests and was told the pain was not all in my mind....I asked for a certificate to prove my sanity (No Joke) and was told by the phsyciatrist that she could not give me one I replied to her that this was unfair as they could certify me insane she just nodded in agreement then she handed me a letter for my GP armed with this I dutifully took this to the surgery's reception desk a few days later I had a call from them saying that my doctor had referred me to a Fibromyalgia Consultant I was finally diagnosed with Fibromyalgia in 2000 I was 47yrs old I am now 59yrs old the pain is getting worse it is terrible daily and constant I also have type 2 diabetes yet I am not overly weighty I also have IBS a Hiatus Hernia several sore dry skin conditions artheritus reflux and depression muscle cramps blood pressure and incontinence due to the IBS I was hoping to retire next year 2013 yet I have been told I will have to wait until 2016. I had to attend my ESA Work Capability Medical Assessment on the 21st May 2012 The ATOS Doctor was sickly sweet saying that we were all girls together and adding that she could only type with 2 fingers my 25yr old niece and I were amazed how quickly she did type and she used all of her10 digits she asked to see my medication which my niece offered to her she randomly picked some questions asking me to raise my arm as if to pop something into a pocket I couldn't even raise a smile all I wanted to do was to get home and lie down and I told her so. she said she would not ask me to do the bending and walking up steps test as she could see I was in pain however she was watching every move I made even when the assessment had ended and I was struggling to shuffle out of the door she stood watching me as I made my way down a long corridor once outside I was exhausted, my niece looked up to the fourth floor and noticed her looking down at us out of the window,t is believed that for each person they test fit for work they recieve between £70-80 now that's some inscentive dont you think!!!! I am waiting to hear my fate she did tell me it would take a couple of weeks and she had no influence over any decision and it would be decided by the DWP.I intend to appeal if I loose any of my benefits as I was awarded all of them indefinately and there is no way I can work unless they magically produce a Cure. Sorry my blogg seems a bit long winded and please forgive any spelling mistakes I just want to make all Fellow FM Sufferer's ware of what the ATOS Staff are up to. Be Guarded and realise that they are out to get you back to work where ever possible. Hope your problems are soon over Gentle Hugs KatiMaiTayx

  • KatiMaiTai,

    This blog is really about Tender points. But it sounds like you've had a tough time!

    People like you need guidance but don't get any just like me.

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