Ever since 1990, tender point exams have been the gold standard for diagnosing fibromyalgia. In order to be diagnosed with fibromyalgia, most patients had to have experienced significant pain for three months or longer in at least 11 of 18 specific areas located throughout the body. 

While the exam worked for most, patients and doctors experienced problems achieving accurate diagnoses since patients' pain levels were self-reported and subjective and the severity and location of their pain varied over time. That's led rheumatologists to reconsider whether tender point exams, which were originally intended only to qualify subjects for clinical studies, not for use as a diagnostic tool, are the right diagnostic tool for the job. New diagnostic methods may mean that tender point exams are becoming a thing of the past.

There are no definite diagnostic tests (like blood or tissue examinations) for diagnosing fibromyalgia.  Instead, doctors must rule everything else out and establish that patients are experiencing symptoms that are consistent with a diagnosis of fibromyalgia. The American College of Rheumatology says that approximately 25 percent of fibromyalgia patients don't meet the diagnostic criteria established in 1990 so they set out to establish new criteria. 

After performing a multicenter study of 829 previously diagnosed fibromyalgia patients, the ACR determined that two new tools were more effective for diagnosing fibromyalgia. These include:

1. The Widespread Pain Index (WPI) determines by counting the number of areas on the body where the patient has felt pain in the last week. The checklist includes 19 specified areas.

2. The Symptoms Severity (SS) scale determines by rating on a scale of zero to three, (three being the worst), the severity of three common symptoms: fatigue, waking up unrefreshed, and cognitive symptoms. An additional three points can be added to account for the extent of additional symptoms such as numbness, dizziness, nausea, irritable bowel syndrome or depression. The final score is between 0 and 12.

To meet the criteria for a diagnosis of fibromyalgia, a patient would have seven or more pain areas and a symptom severity score of five or more; or three to six pain areas and a symptom severity score of nine or more.

The ACR says that using these tools will help identify 88.1 percent of patients with fibromyalgia and help track severity of the disease over time.  Patients that suspect they may have fibromyalgia, but have not previously met diagnostic criteria based on tender point exams, should consult with a physician who is familiar with these newer diagnostic criteria.  The ACR hopes this will lead more patients to successful treatment options to manage fibromyalgia symptoms and live a healthier life.


National Fibromyalgia Association


National Institutes of Health

Arthritis Care Res (Hoboken). 2010 May;62(5):600-10.

The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity.

Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, Russell AS, Russell IJ, Winfield JB, Yunus MB.