Friday, August 5, 2011

In with the New, Out with the Old: Fibromyalgia diagnostics

Times are changing, but we aren't quite there yet. The preliminary diagnostic criterion intends to do away with the tender point model, which has become the hallmark for diagnosing FM.

Fibromyalgia is a central sensitization problem thought to be brought on by a dysfunction of the HPA (hypothalamus-pituitary-adrenal) axis and other central nervous system (CNS) disruptions. The criterion considers the effects of FM on CNS sensitization, and comorbid conditions; migraine, IBS, irritable bladder, cognitive deficit, RLS, hypothyroidism, Raynaud’s, disordered sleep etc.

However, it does not address the co morbidity of chronic myofascial pain, a peripheral nerve to muscle disease that causes myofascial trigger points (MTrPs). Trigger points are knotted up muscle fibers in a taut (tight) band of muscle. They are EASILY felt unless behind bone or other muscles, or the band of muscle affected is too tight. It is an objective piece of evidence to indicate the presence of chronic myofascial pain (CMP) in FM and research suggests possibly all FM patients have them. This is not new to me, and is why myofascial pain is covered extensively in our book. These MTrPs are peripheral pain generators that bombard the brain with pain messages keeping the central nervous system sensitized. Exercising a muscle riddled with MTrPs, will only make the pain and dysfunction worse, leading both the patient and the physician down a road of misguided confusion.

Hashimoto’s thyroiditis may put the patient at greater risk of developing FM. The proposed criteria considers hypothyroidism as a comorbid condition in FM, however, waxing & waning hormones in Hashimoto’s makes it difficult to detect in routine tests. I have had the honor of discussing this with Dr. I Jon Russell, one of the co-authors of the proposed criteria. I believe it prudent that patients with a normal thyroid panel, but symptoms of thyroid disease, (the ups and downs of thyroid hormones, palpitations one minute, and unable to get out of bed the next), should have thyroid antibodies drawn.

For now the tender point model is being used to diagnose fibromyalgia. See a complete account of the tender point model at

And symptoms at

As fibromyalgia expert at, this question is based on my original answer to, “What criteria must I meet to be diagnosed with fibromyalgia?

View other answered questions on my profile at

All blogs, posts and answers are based on the work in Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection by Celeste Cooper, RN, and Jeff Miller, PhD. 2010, Vermont: Healing Arts press

Information here is not meant to replace medical advice.

Direct links at


Shirley Donalds said...

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KathyG_NC said...

Thank you Celeste for the great info and also thanks to commenter Claudia I'm looking into these tablets. According to the site, the recommend taking Desiccated Whole Adrenal Glandular along with the Porcine to achieve optimal results. I'll start with the Porcine and if that isn't enough, then I'll look into adding the glandular. Not certain on how to add a link for the Glandular product, but it is available at the same site Claudia's link for Porcine takes you.

The Pained Ink Slayer said...

You are welcome. I don't get alerts to comments. So sorry I missed these. Harmony and Hope, Celete

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