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If you’ve been diagnosed with fibromyalgia, it probably felt like you had to move mountains just to figure out what was wrong with you. That’s because diagnosing fibro is a beast. Part of the reason is that, in addition to having an array of seemingly disconnected symptoms or symptoms that mimic other conditions, everyone’s experience of pain is different. Meaning that one person’s scratch is another’s gaping wound. I speak in hyperbole, of course, but that is to demonstrate the vast differences in experience. It is for this reason that the American College of Rheumatology set the Criteria for the Classification of Fibromyalgia in 1990. It’s supposed to be an acid test of sorts to make a conclusive diagnosis. But is it reliable?

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Fibromyalgia Tender Points

This probably isn’t the first time you’ve seen the chart that shows the tender points on the body. You may have accidentally discovered these on your own or your physician may have pressed on them when you were initially diagnosed. As you can see on the chart, there are 18 tender points which are found on the front and back of the neck, inside the knees and elbows, and on the back just above and just below the buttocks. During a clinical visit, a physician trying to determine whether you have fibromyalgia will test each of these precise locations with a specific amount of pressure. Traditionally, if you experience extreme sensitivity in 11 out of the 18 tender points, then you are officially given a fibromyalgia diagnosis.

Do All Fibromyalgia Patients Have Tender Points?

The tender points have been the key criteria for making this diagnosis, in addition to other factors such as pain on both sides of the body and pain both above and below the waist. Furthermore, experts say that there are conditions that can make tender point pain worse. These include:

• Anxiety
• Changes in weather
• Depression
• Fatigue
• Hormonal fluctuations
• Infections
• Lack of sleep or quality sleep
• Periods of emotional stress
• Physical exhaustion
• Sedentary lifestyle

You may have fibromyalgia, however, your experience with the tender point locations may not be the same. It is important not to confuse tender points with trigger points, which do not always hurt by themselves. Rather, as the name suggests, trigger points cause pain on a different part of the body when the area is triggered with pressure.

A little digging reveals a good deal of conflict regarding the use of tender points as a criterion for diagnosing fibromyalgia. Now, even the Mayo Clinic states that the 18 tender points are no longer necessary for diagnosing fibro. “Instead, a fibromyalgia diagnosis can be made if a person has had widespread pain for more than three months – with no underlying medical condition that could cause the pain.”

Is Getting Rid of the Tender Point Test a Good Idea?

Perhaps one of the most important reasons to stop relying so heavily on the tender points test has to do with catching those fibromyalgia patients who otherwise would have been dismissed or misdiagnosed. For example, we often think of fibro as a “woman’s disease/condition/problem/etc.” because we do not often hear about men with fibro. But Dr. Ginevra Liptan argues that the tender point exam is the culprit of this gross misconception: “Why have we vastly underestimated how many men have fibromyalgia? It turns out the way we have been diagnosing it since 1990 – a tender point exam – is not as accurate in men. To be diagnosed with fibromyalgia from a tender point exam requires tenderness in at least 11 of 18 specific muscle areas. But this test was developed from studying women! Newer research shows that the men with fibromyalgia tend to have less tender points than women, and require much more pressure to elicit a pain response. This means the tender point exam is often going to miss the diagnosis in a man.”

Apparently, the exam misses the diagnosis in women as well because many of you have had a similar experience. Thankfully, more physicians are expanding their testing options beyond the tender point exam. Nevertheless, it is a strange symptom of the vast majority of women who suffer from fibromyalgia. What has your experience been with tender points? Are you a male who was misdiagnosed for this reason? Please share your story with us to help spread the word!