Diagnosis of fibromyalgia

Michael Puttick noted that a diagnosis of fibromyalgia can be made if multiple tender points are present.1 According to the American College of Rheumatology, this condition can be diagnosed even if only 6 tender points are present, provided there is “moderate or greater tenderness.”2 I wish to point out that even if there is only one tender point in one of the typical areas for fibromyalgia, the pain in the tender point can be relieved by massage so dramatically as to confirm the diagnosis.

For example, there may be occipital pain, perhaps radiating over the skull to the frontal area, giving the patient the impression that she or he suffers from migraine. One feels a fibrous band in the muscle attachment in the occipital area, which softens on being massaged. Likewise, there may be only one painful point in the supraspinatus, but when one massages the area one senses a sort of bubbling or crackling under the thumb or palm, and with this the patient's pain begins to subside. The relief may be complete if the treatment begins soon after the onset of the pain but only gradual if the pain has been present for several days. The plasma myoglobin concentration has been shown to increase after massage for myofascial pain,3^,4 and the degree of tension and pain in the muscle is positively correlated with the plasma myoglobin level after the muscle is massaged.4

However, physician be warned. Treatment by massage is extremely painful; patients find it difficult not to shrink away from the pressure. Yet because the relief is so dramatic, they withstand the pain for the few minutes necessary and usually return when the pain recurs, perhaps after several weeks or months, to receive the treatment again.