Fibromyalgia is a neurological disorder that affects approximately 12 million people in the U.S. This chronic disorder causes aches and pains in the body that are severe enough to impact normal activity and disrupt sleep. A person with a fibromyalgia diagnosis may feel pain in the muscles, tissues, joints, and tendons in different areas of the body.

Getting a fibromyalgia diagnosis

Fibromyalgia Diagnosis - Tender Points And The Symptom Intensity Scale | PainDoctor.comAlong with these physical symptoms, people suffering from fibromyalgia also experience mental issues as a result of fibromyalgia, including depression and anxiety. Fibromyalgia can also cause deep fatigue and exhaustion, even with very little activity.

Even with so many people suffering from fibromyalgia, it remains a difficult disorder to diagnose. 1 of the most valuable tools for a fibromyalgia diagnosis is the tender point count.

Although most of the population has a spot or 2 on their body that may be more sensitive than others, people with fibromyalgia often experience excruciating tenderness in very specific locations that are spread across their body. Tenderness is generally mirrored on both sides of the body and is located at 9 specific places on the body.

The 9 locations are as follows:

  • Low cervical region: Front neck area just below the chin near the C5-C7 vertebrae
  • Second rib: Front chest area below the collarbone about 2 inches from the shoulder joint
  • Occiput: Back of the neck at the base of the skull
  • Trapezius muscle: Back shoulder area where this large muscle drapes over the top of the shoulder
  • Supraspinatus muscle: Shoulder blade area just at the top of the shoulder blade
  • Lateral epicondyle: Elbow area in the inside of the arm crease
  • Gluteal: Rear end at upper outer quadrant of the buttocks
  • Greater trochanter: Rear hip in the back
  • Knee: Knee area on the inside where the fat pad sits

These 9 areas are also sometimes called tender points or tender spots. Because fibromyalgia cannot be diagnosed with a lab test, counting tender points and taking a detailed patient history are often the best ways to get a clear diagnosis.

Tender points are then rated on a Symptom Intensity (SI) Scale to get a diagnosis. The SI Scale was developed using survey results from nearly 12,800 patients with osteoarthritis, rheumatoid arthritis, or fibromyalgia. These patients located pain in 38 anatomic areas of their body and then also completed a fatigue visual analogue scale. The fatigue analog scale requires a patient to mark their level of fatigue on a 10-centimeter line on the day they identified their pain symptoms.

Using both of these measures, the developer of the survey identified that those patients who already have a fibromyalgia diagnosis indicated pain in a common set of 19 places. These sites of pain were named the Regional Pain Scale. When patients experience pain in at least 8 places on the Regional Pain Scale and then also indicate at least a 6-centimeter mark on their fatigue visual analogue score, then a confident diagnosis of fibromyalgia can be made.

In 2006, Frederick Wolfe and Johannes J. Rasker completed an evaluation of 25,417 patients using the Symptom Intensity Scale and found that it was the best and clearest diagnostic tool for fibromyalgia and also found that higher Scale scores also indicated increases in hospitalization, disability, serious medical issues, and death. Because