Why were the 18 fibromyalgia tender points selected for use in diagnosis?
Fibromyalgia syndrome has a long and complex history. The 18 tender points were selected in 1990 by a group of six doctors who were working to establish reliable criteria for the American College of Rheumatology’s “Criteria for the Classification of Fibromyalgia”. A diagnosis under the ACR criteria requires the presence of at least 11 of the 18 points and pain in all four quadrants of the body for at least three months. A tender point is a location that is painful when pressure is applied to it, either by hand or using a dolorimeter to quantify the pain. The pain occurs at the tender point itself, differing from referred pain which occurs elsewhere in the body when pressure is applied to a specific location. The knowledge of “tender points” had been around for some time, but had not been formalized as a method of evaluation until 1990. Some argue that there are many more tender points and the diagnosis should not be restricted to the 18 chosen. There have been some 60 tender points tha
