The tender-point concept is a bit too arbitrary. These painful areas can remain almost static in certain areas or can move from one area of the body to another, causing the pain to vary from day to day. Thus, the diagnosis may be eliminated one very day for lack of tender point, and be obvious on the next day. Pain also varies greatly depending on a person's ability to tolerate it. People with high pain thresholds may feel only a little aching, or even no pain at all over the tender-point areas. This seems to be an inherited trait, since I often see patients who are exquisitely tender to touch, whereas others can be prodded with impunity. The question is what does one do with someone with all the symptoms of FMS but who has only 9 tender points in the locations to be checked? Is the doctor supposed to ask him to come back in half-a-year with more tender points? What happens if the patient has 20 palpable sore areas in other places, but few among the predetermined sites? The concept of tender-point seems unduly limiting.

My examination finds large and small areas, sometimes entire muscle bundles, which are painful, but not always, or swollen. For this reason, we prefer to call them the lumps and bumps of FMS, and we don't need to count them. We merely map them and they will be of a great indication of the effectiveness of the GUAIFENESIN treatment.

The official diagnosis criteria insists on pain areas and not on lumps and bumps.