Say goodbye to tender points!

The title of this article did attract me. "Say goodbye to tender points" seems the right way to go for diagnosis. But then, the test is done on tender points as felt by the patient. And worse, it requires a subjective evaluation and a minimum score of Fatigue.

In the article, the author already says that Fatigue is almost always present. So if you have fibromyalgia and no fatigue you are left undiagnosed.

In the free test that we offer, about 6% do not complain of Fatigue but all had a probability of suffering from fibromyalgia that was more than 50%. In fact, all of those but one did complain of poor sleep.

So they have poor sleep but do not complain of fatigue. Perhaps they do not relate fatigue to their subjective evaluation of their status when others with the same status would complain of fatigue. Perhaps their personality or their stress activity does not allow fatigue to be taken in account as such. Perhaps they do not understand the word. Perhaps they forgot to tick it. No one has the same reaction when confronted with the same problems. Some people put everything inside and they by pass some feelings that others would complain about.

There was a famous study in Sweden that was looking for headaches after a procedure. Whilst the rest of the world had an incidence of 50-60%, that study showed an incidence of 93%! The way the questionnaire was done would have given a headache even without the procedure!

The same error is made again in diagnosing fibromyalgia: without objective tests, it will remain a probability diagnosis. A probability above 50% needs consideration. A probability below that needs to be followed up because it may indicate a symptomatically starting condition.

New developments in the diagnosis of fibromyalgia syndrome: say goodbye to tender points? Wilke WS. Cleveland Clinic Journal of Medicine. 2009 Jun;76(6):345-52