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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
- 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.
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