Drs Bennett & Clauw Debate Abandonment of Tender Point Test in Revised FM Diagnostic Criteria

The Fall 2010 Issue of Fibromyalgia AWARE is available free online now. Published by the Fibromyalgia Association of America, the beautiful 72-page magazine can be purchased in ‘hard’ copy, but it is fun and easy to flip through it online for free. (Click on the CONTENTS tab HERE to find the part you want to dive into; click on a page to enlarge for reading; use the little arrow icon to move around; and turn pages by clicking in the bottom corners.)

In particular, we recommend “A Farewell to Tender Points? Two FM Experts Weigh In on Proposed New Diagnostic Criteria” (pages 19-24)

The two experts are Dr. Robert Bennett, MD (retired FM clinician & researcher at Oregon Health & Science University), and Dr. Daniel J Clauw, MD (director of the University of Michigan Chronic Pain and Fatigue Research Center).

The article explains and discusses the new American College of Rheumatology FM diagnostic criteria, proposed recently by Dr. Clauw and 9 other leading rheumatologists to replace the 1990 ACR diagnostic criteria, which require pain on palpation at 11 of 18 tender points. It includes three parts:

1. “The Study that Started It All.” Dr. Bennett gives a concise explanation of the 1990 ACR diagnostic criteria, their shortcomings, and the research & conclusions underlying the proposed new ACR criteria per the recent article – “The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity.”

2. “Don’t Throw Out the Baby with the Bath Water,” admonishes Dr. Bennett. He explains why he believes it is important for diagnosing physicians to retain the tender point palpation as part of a structured physical exam, so as to thoroughly assess the patient’s pain.

3. “Time to Move Forward,” counters Dr. Clauw. He states, “I see no place for performing a tender point count in clinical practice in 2010,” and explains why he believes the practice has “inadvertently helped reinforce the notion that fibromyalgia only occurred in distressed, middle-aged females.”

Since some update of the American College of Rheumatology diagnostic criteria seems very likely, it's important for patients and their doctors to understand the issues involved.

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