One audience member vigorously objected to eliminating the tender point examination.
"The trigger point exam has always been a way for physicians to assess whether the patient is believable. Without using a trigger point exam, I might as well just sign a blank check. How am I going to weed out those who have fibromyalgia from those who are faking and seeking disability status?" he asked.
Dr. Fitzcharles responded: "I think we all know that depending upon who is doing the trigger point exam and how hard you’re pressing, you can make positive trigger points or you can cool them down. So it really is a very inaccurate clinical assessment. However, I will concede that in taking away the security blanket of trigger points from this condition, we now have to think very hard about putting something back in its place for the average primary practitioner to use in the office," the rheumatologist said.
Just what that might be remains unclear, she said. "The conundrum of fibromyalgia is that we have no defining biomarker as yet," Dr. Fitzcharles noted.
She reported serving as a consultant to and/or receiving research funding from Purdue Pharma, Eli Lilly, Pfizer, and Valeant. Dr. Ablin is a consultant to Pfizer.