Fibromyalgia Tender Points


Sufferers of Fibromyalgia often have one thing in common: tender points. Tender points alone cannot form the basis of a diagnosis but they are considered by many to be a defining attribute to the syndrome.  Considering them alongside a long list of other symptoms can help lead doctors to the conclusion that a patient has Fibromyalgia, though  recent revisions  to fibromyalgia diagnostic criteria has lessened the focus on tender points in the diagnostic process as compared to older diagnostic guidelines.

This article will explain what tender points are and how they differ from “trigger points.” It will then show you where they are located and explain how they help doctors to make a diagnosis.

What Are Tender Points?

Tender points are specific areas of the body that hurt when pressure is applied to a disproportionate level. The pain experienced can be excruciating despite only minor amounts of pressure being applied. The size of tender points is usually about the size of a quarter but can be much larger. They hurt when pressed lightly with a finger. The pain feels as if it is directly beneath the skin though it made radiate to the immediate area and deeper into the muscular tissue. Tender point pain generally will not radiate to other parts of the body, but rather the pain remains local to where the pressure was applied. Though tender point pain may ache to a minor degree on an ongoing basis, the pain tends to be focused and amplified by touch.

Due to the nature of Fibromyalgia, broad pain tends to travel around the body and this may contribute to the waxing and waning of individual tender point severity. A tender point that causes you intense pain one day may feel fine the next. The level of pain associated with a tender point can also vary wildly. One day a tender point may be excruciating to the touch,  the next day the spot may exhibit only minor pain and the next no pain at all, with no apparent causal factors or triggers noted.

What causes these tender points to hurt? Research into Fibromyalgia has only recently intensified. Scientists are discovering new facts regarding Fibromyalgia, but the causes of tender points are still unknown.

Difference Between “Tender Points” and “Trigger Points”

Trigger points are frequently mistaken for fibromyalgia tender points, even among healthcare professionals. There is a tremendous amount of confusion about these two distinct symptoms with many articles and discussions incorrectly using the terms, both by confusing them for each other or even noting them as the same thing.

A condition known as chronic myofascial pain can cause trigger points, whereas Fibromyalgia causes tender points. The similarities between trigger points and tender points sometimes lead doctors to misdiagnose Fibromyalgia as chronic myofascial pain or vice-versa. Fibromyalgia frequently occurs alongside other muscular and nervous disorders (including chronic myofascial pain). Thus, Fibromyalgia patients can have both tender points and trigger points, possible at the same time. In this event, it is important to distinguish the two so that care providers can correctly understand the symptoms they seek to treat.

Trigger points are characterized by painful cramping in muscle and connective tissue, typically with the cramping becoming so severe that the tissue becomes bound in hard clumps or muscular knots. These knots often ache and radiate pain on a continual basis. Trigger points may exhibit increased pain when touched and this tenderness can lead to confusion with Fibromyalgia tender points, but unlike the tender point a trigger point will exhibit the hard muscular knotting.  Trigger points often radiate pain beyond the immediate location of the muscular knots.  Often, massage or myofascial release therapy can cause the trigger points to “release” or become un-bound and in effect vanish, even if only temporarily.

Tender points are more characterized by their extreme tenderness and the lack of muscular knotting. Tender point pain also tends to remain more focused to the specific location with the aching or radiating to other body areas being less prevalent.

Where Are The Tender Points?

Tender points occur in 18 specific locations throughout the body. They occur in symmetry on opposite sides of the body. They are as follows:

 Fibromyalgia tender points front body

Back Side Tender Points

Fibromyalgia Diagnosis Using Tender Points

The American College of Rheumatology released general guidelines in 1990 for diagnosing Fibromyalgia  (Note – these 1990 diagnostic criteria have since been updated. Go HERE for details).

The two main criteria for diagnosis were:

1.       Widespread pain

2.       Pain at 11 or more of the 18 tender points

To determine whether or not pain is experienced at a tender point, light pressure should be applied with the fingertip. Press such that the nail of the finger should cause the skin just in front of the nail on the finger to turn slightly white. If intense pain is felt in a very particular location,  this is likely an active tender point.

Even if you do not meet the tender point criteria, this does not rule out Fibromyalgia (as noted in the revised 2010 Diagnostic Criteria). This diagnosis was originally developed for selecting Fibromyalgia patients for clinical studies. In practice, your doctor will consider a wide range of other symptoms, as well.

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Veronica April 9, 2013 at 9:19 pm

Excellent explanation of the differences between Tender points and Trigger points.
I feel that I have both.


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