Fibromyalgia Tender Points

Fibromyalgia, a chronic pain disorder, is often characterized by pain in multiple tender points. These tender points are sometimes confused with trigger points, which are associated with chronic myofascial pain. The primary difference between tender points and trigger points is that trigger points can produce referred pain (that is, they can cause pain in other parts of the body).

Making things all the more confusing is that chronic myofascial pain often accompanies fibromyalgia, so it's possible that you may experience pain from tender points (due to fibromyalgia) and trigger points (due to chronic myofascial pain).

In 1990, the American College of Rheumatology outlined criteria for the classification of fibromyalgia. They determined that there are 18 tender points on your body. To be diagnosed with fibromyalgia, you must feel pain—not simply tenderness as the name suggests—in at least 11 of 18 tender points when pressed upon (1).

The fibromyalgia tender points are symmetrical; they occur on both sides of the body. The trigger point locations are:

• Front lower sides of your neck
• Upper chest
• Inner elbows
• Just above inner knees
• Back of your head
• Top of the shoulders
• Upper back (at shoulder blades)
• Upper buttock
• Hips

When it comes to tender points, it's important to understand that fibromyalgia is not a consistent syndrome. What that means is that you may feel intense pain in some areas one day and in other areas the next. Fortunately, there are days when you may not even experience pain at all. If you see your doctor on a day when you're feeling less pain than normal, he or she may not think you have fibromyalgia. That's why it's vital to monitor your tender point pain (by keeping a pain diary, for example) to ensure a proper diagnosis.

Reference

1. Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia: report of the multicenter criteria committee. Arthritis Rheum 1990;33:160-172.