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 criteria considers the effects CNS sensitization, and comorbid conditions, migraine, IBS, irritable bladder, cognitive deficit, RLS, 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 FM when other comorbid conditions are present, research suggests possibly all FM patients have them. This is not new to me, but many patients with FM and is why myofascial pain is included in our book, Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection by Celeste Cooper, RN and Jeff Miller, PhD. These MTrPs are peripheral pain generators that lend to sensitization, and keep the FM brain in wind-up.
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 suggested to Dr. I Jon Russell, one of the co-authors of the proposed criteria that all patients with normal thyroid panel, but symptoms of thyroid disease, and the ups and downs of thyroid hormones, palpitations one minute, and unable to get out of bed the next, should have thyroid antibodies drawn.
Doctors that diagnose FM need comprehensive, non-confusing guidelines to diagnose & provide helpful treatments. 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 conception.
You can find a resource list regarding this answer in my blog “Univeiling Myofascial Trigger Points in Fibromyalgia,” http://fmcfstriggerpoints.blogspot.com/2011/03/unveiling-myofascial-trigger-points-in.html