Fibromyalgia Tender Points : Comprehensive Understanding and Management

Fibromyalgia tender points, also known as trigger points, are specific areas on the body that are particularly sensitive to pressure. They are a characteristic feature of fibromyalgia, which is a chronic pain condition characterized by widespread musculoskeletal pain, fatigue, sleep disturbances, and cognitive difficulties.⁽¹⁾

There are 18 designated tender points associated with fibromyalgia, located at specific anatomical sites. These points are symmetrically distributed across the body and are typically found near joints. Some of the common locations for fibromyalgia tender points include the back of the head, neck, shoulders, chest, lower back, hips, elbows, and knees.⁽²⁾

Back in 1990, the American College of Rheumatology outlined these 18 spots, which were frequently, though not always, tender in individuals with fibromyalgia. These points were integrated into a diagnostic assessment.⁽³⁾

Before 2010, it was a requirement for at least 11 out of these 18 points to demonstrate tenderness in order for a doctor to officially diagnose fibromyalgia. However, it is worth noting that diagnostic criteria and approaches have evolved over time, with a broader consideration of symptoms now being emphasized.

Now, for a doctor to diagnose fibromyalgia, a patient should exhibit tenderness in at least 11 of these 18 designated points upon palpation. It is important to note that while tender points are a significant aspect of fibromyalgia diagnosis, they are just one part of the broader clinical picture. Other symptoms, such as widespread pain, fatigue, and sleep disturbances, are also crucial in making an accurate diagnosis.

Fibromyalgia tender points are not the same as trigger points in other types of pain conditions. They are unique to fibromyalgia and play a key role in differentiating it from other disorders with similar symptoms. However, it is worth mentioning that in recent years, the diagnostic criteria for fibromyalgia have evolved, and tender points are no longer the sole focus. A more comprehensive evaluation of symptoms and medical history is now considered in diagnosis.

Fibromyalgia used to be diagnosed, in part, by identifying tender points through a physical examination. The process involved the following steps:

• Identification of Tender Points: A healthcare provider would apply pressure to 18 specific anatomical points on the body, known as tender points. These points were located in pairs on various parts of the body, including the neck, shoulders, chest, lower back, hips, elbows, and knees. To qualify as tender, a spot should elicit localized pain when pressed by a healthcare provider’s finger. The pressure applied should be sufficient to cause the provider’s fingernail to blanch or turn white. If a point registers as tender, the pain is typically experienced exclusively at the precise spot where pressure is applied.
• Assessment of Pain Response: The doctor would evaluate the patient’s pain response at each tender point. If the patient experienced tenderness or pain in at least 11 of the 18 points during the examination, it was considered a positive indication for fibromyalgia.
• Medical History and Symptom Evaluation: In addition to the tender point examination, the healthcare provider would consider the patient’s medical history and assess other fibromyalgia-related symptoms, such as widespread pain, fatigue, sleep disturbances, and cognitive difficulties.
• Exclusion of Other Conditions: To confirm a fibromyalgia diagnosis, the healthcare provider would rule out other medical conditions that could potentially mimic fibromyalgia symptoms.

It is important to note that this diagnostic method, which heavily relied on tender points, was widely used until around 2010. However, in recent years, the diagnostic criteria for fibromyalgia have evolved. The focus has shifted towards a more comprehensive assessment of symptoms and medical history, rather than relying solely on tender points.⁽⁴⁾

While a tender point test remains a valuable tool for physicians, broadening the diagnostic criteria has proven instrumental in ensuring that more individuals receive accurate diagnoses. Today, fibromyalgia diagnosis may involve a multidimensional approach that considers factors like widespread pain, the presence of other symptoms, and a thorough evaluation by a healthcare provider who is knowledgeable about fibromyalgia. This updated approach aims to provide a more accurate and holistic understanding of the condition.

Trigger point injections serve to deactivate painful trigger points, offering targeted pain relief in specific areas of discomfort.

The primary goal of trigger point injections is to relieve pain and improve the range of motion in the affected area. For individuals with fibromyalgia, these injections can be part of a broader pain management strategy. Trigger point injections can provide immediate relief from localized pain. They can also help break the cycle of muscle tension and pain associated with trigger points. The frequency of trigger point injections can vary depending on the individual and their response to the treatment. Some may find relief with a single injection, while others may benefit from a series of injections over time. Trigger point injections are often used in conjunction with other treatments for fibromyalgia, such as physical therapy, medications, and lifestyle modifications.⁽⁵⁾

These injections should only be administered by a skilled pain specialist utilizing specialized equipment. The injectable solution may comprise substances like saline, steroids, or a local anesthetic such as lidocaine.

A study featured in the Journal of Manipulative and Physiological Therapeutics revealed promising results for women with fibromyalgia who underwent two specific types of massage therapy.⁽⁶⁾

One of these approaches, manual lymph drainage therapy, involves a massage technique aimed at redirecting fluid away from areas where lymph vessels may be obstructed or impaired.

The second technique, connective tissue massage, is a more intense form of massage that focuses on manipulating myofascial tissue. Researchers have indicated that both methods contribute to a reduction in pain levels, an enhancement in overall quality of life, and an increase in pain thresholds.⁽⁷⁾

However, it is important to note that not all massages offer the same benefits. Therefore, it is advisable to seek recommendations from trusted sources, such as friends, family physicians, or specialists in fibromyalgia, to ensure you receive the most effective treatment for your condition.

Coping with fibromyalgia tender points can be challenging, but there are strategies that may help manage the discomfort and improve quality of life. Here are some tips:⁽⁸⁾

1. Indulge in Gentle Exercise: Engage in low-impact exercises like walking, swimming, or yoga. Gradual and regular movement can help alleviate stiffness and improve muscle strength.
2. Heat Therapy: Applying heat, such as warm baths, heating pads, or warm compresses, can help relax muscles and alleviate pain around tender points.
3. Cold Compresses: Cold packs or ice wrapped in a thin cloth can help reduce inflammation and provide temporary relief from pain.
4. Stress Management: Practice relaxation techniques like deep breathing, meditation, or mindfulness to help reduce stress, which can exacerbate fibromyalgia symptoms.
5. Balanced Diet: Maintain a balanced diet rich in fruits, vegetables, whole grains, and lean proteins. Avoiding processed foods and excessive caffeine or alcohol can help manage symptoms.
6. Adequate Sleep: Establish a regular sleep routine and create a comfortable sleep environment. Quality sleep is crucial for managing fibromyalgia symptoms.
7. Pain Management Techniques: Explore non-pharmaceutical pain management techniques like acupuncture, physical therapy, or massage therapy.
8. Medication Management: Work closely with a healthcare provider to determine appropriate medications to help manage pain and other symptoms.
9. Mind-Body Practices: Engage in activities like tai chi or qigong, which combine movement, breathing, and meditation to promote relaxation and ease pain.
10. Consult your Healthcare Provider: Keep open communication with your healthcare provider about your symptoms and treatment options. They can offer personalized advice and adjustments to your treatment plan.

Remember, what works for one person may not work for another, so it is important to find a combination of strategies that best suit your individual needs. Always consult a healthcare professional for personalized advice and treatment recommendations.

Recognizing and addressing fibromyalgia tender points is pivotal in managing this condition. It’s vital to adopt a comprehensive approach, including lifestyle modifications, tailored therapies, and effective communication with healthcare providers, to improve overall well-being for individuals with fibromyalgia.

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Also Read:

• FAQ on Fibromyalgia: Symptoms, 11 Painful Trigger Points, Causes, Risk Factors
• Is Fibromyalgia Pain Real?|Are Opioids an Effective Treatment for Fibromyalgia
• Fibromyalgia (FM or FMS): Epidemiology, Pathophysiology, Causes, Symptoms, Diagnosis, Prognosis, Treatment, Tests
• Yoga for Fibromyalgia: 4 Best Asanas To Relieve Painful Tender Points
• 10 Best Exercises For Fibromyalgia
• What Happens When You Have Fibromyalgia?
• What Does a Fibromyalgia Flare-up Feel Like & How Long Does it Last?