The General Well-Being Scale

I came across this while wondering the web, thought it would be a nice item to share with you all. Hope you enjoy! Leave some feedback if you can. Thanks everyone!

The General Well-Being Scale Worksheet

Alternative Therapies for Fibromyalgia

Herbs and Supplements for Fibro Pain

At some point during your fibromyalgia treatment, you may decide to try a complementary or alternative fibromyalgia treatment. Herbal remedies and dietary supplements are some of the many complementary and alternative treatments people use to relieve the symptoms of fibromyalgia.

Herbs and supplements as fibromyalgia treatments may not work for everyone, although some people find them very effective. If you decide to try an herb or supplement as a fibromyalgia treatment, be sure to talk with your doctor first to make sure it’s safe for you. Even though they're often labeled as "natural" products, herbs and supplements can cause serious side effects and interact with other drugs you may already be taking. Unlike drugs, herbs and supplements don’t have to receive FDA approval for safety or effectiveness before they can be sold.  In addition to talking with your doctor, it’s important to learn as much as you can about any alternative therapy before using one.

Although studies about the effectiveness of herbs and supplements are limited and overall evidence has been inconclusive, researchers are beginning to research them more. Some small studies have been promising, but many study results have been mixed.

Research is ongoing, but here are just a few of the herbs and supplements that may be helpful in treating fibromyalgia symptoms:

Anthocyanidin. This supplement is a type of flavonoid found in red-blue fruits like red cherries, blueberries, raspberries, and purple grapes that has been used to treat other types of chronic diseases. In one small study of people with fibromyalgia, researchers found that anthocyanidins helped improve participants’ quality of sleep. Researchers found no improvement in the patients’ pain or fatigue. The side effects were minor, but included nausea, indigestion, and nasal congestion.

Capsaicin. Capsaicin is an extract of chili peppers that is applied to the skin in a cream. In a small study, capsaicin was found to significantly relieve tenderness in patients with fibromyalgia. However, it didn’t help improve pain or quality of sleep. The only side effect was a slight stinging or burning on the skin.

Magnesium and malic acid supplements. Some studies have found that people who have fibromyalgia have too little of a substance called ATP in their body. ATP is a substance that helps provide energy to your body and muscles. Some researchers believe a lack of ATP may cause the muscle pain associated with fibromyalgia. Because magnesium and malic acid help the body produce ATP, taking these supplements may help increase ATP levels and decrease pain.

SAM-e (S-Anenosylmethionine). SAM-e is a substance that occurs naturally in the body. It has been studied in many clinical trials over the past 20 years in patients who have joint pain and osteoarthritis. These studies have found that SAM-e may be as effective in relieving pain as nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and aspirin. SAM-e is used as a drug in Europe, where many of these studies have been done. One U.S. study in patients with osteoarthritis found that SAM-e reduced pain and improved joint function as effectively as Celebrex, a type of NSAID. In addition, new research has found that SAM-e may also help reduce the symptoms of depression, another common fibromyalgia symptom. SAM-e may interact with some medications for depression, so be sure to talk with your doctor about drug interactions before trying it. Other reported side effects include upset stomach and dizziness.

St. John’s wort. This herb may not help with your fibromyalgia pain, but it may help ease the depression that many people with fibromyalgia experience. Studies have shown that St. John’s wort may help improve mood and reduce the insomnia and anxiety common to depression. Some studies have found St. John’s wort as effective in treating mild to moderate depression as antidepressant drugs. However, it may not be as effective in treating more severe depression. St. John’s wort can interact with many other medications, so be sure to check with your doctor or pharmacist before using it.

Valerian. Some researchers believe valerian root may help with sleep and ease fibromyalgia pain. One small study showed that people who took valerian for 28 days reported better sleep and an improvement in their general quality of life.

Vitamin D supplements. Well-known for supporting bone strength and bone health, vitamin D is also being studied for its use in treating other conditions, including fibromyalgia. Some small studies showed that people with fibromyalgia were more likely to be deficient in vitamin D. Other studies have shown that there is no connection. Vitamin D is generally safe in recommended amounts for most people and rarely causes side effects when taken in recommended amounts.

WebMD Medical Reference

Reviewed By Louise Chang, MD

Magnesium Malate - Soothes Muscles by Supporting Energy Production

My new life with Magnesium Malate

I started taking a new supplement this week. I know it's been only a week and I didn't expect this to work at all, but the first couple days, I wondered why I had SO much energy. Then I remembered that I was taking the new supplement Magnesium Malate. (Malate aka Malic Acid) Once I realized this, I was so excited, but wanted to make sure it wasn't just lucky coincidence. By day 7 now, I'm very impressed. I know it's still a little early to tell, but like I said, I'm impressed. The energy I have found is something I haven't seen in over 4 years! So in my eyes, even if it only lasts a week, I'm thankful, but let's hope this continues. I also read that you should up the dosage slowly so I'm still on the lowest dosage. 1 tablet per day. The bottle says 1-3 per day. The internet dosage information is all over the place. So I will just follow the directions on the bottle. I will keep you updated. Until then, here's more info about this supplement. 

Here's some basic info about Magnesium Malate: 

Magnesium Malate is a compound of magnesium and malic acid, clinically shown to soothe and energize muscle cells. Malic acid is a natural fruit acid that is present in most cells in the body and is an important component of numerous enzymes key to ATP synthesis and energy production. Therefore, magnesium malate may be helpful in those suffering from fatigue due to fibromyalgia.


Magnesium is an essential mineral in over 300 enzymatic reactions in metabolism. These reactions include those involved in the Krebs cycle (one of the body's main energy production processes), energy storage, the breakdown of fatty acids, protein synthesis, DNA metabolism, neurotransmitter activity, and hormone regulation. Magnesium is stored primarily in the bones and plays a role in the absorption of calcium by the bones.

Shopping around:

Also you really want to shop around for this item as prices really vary a lot and I highly recommend buying them as one supplement, not two separate.

http://www.drugstore.com/search/search_results.asp?N=0&Ntx=mode%2Bmatchallpartial&Ntk=All&srchtree=1&Ntt=magnesium+malate&Go.x=0&Go.y=0

and one more: http://www.energeticnutrition.com/source_naturals/Magnesium-Malate.html

Here are some more links to more information about Magnesium Malate that are very helpful. I didn't want this article to get too long. 


http://www.livestrong.com/article/531142-the-dosage-of-magnesium-malate-for-fibromyalgia/

http://www.smartbodyz.com/Magnesium-Malate-Ingredients-Dose.htm

http://www.ehow.com/about_6529483_magnesium-malate-fibromyalgia.html

http://laura-owens.suite101.com/trigger-point-therapy-to-relieve-chronic-pain-a75812

Here's the data and facts behind it all

Fibromyalgia Pain: Magnesium and Malic Acid

Research Finds Taking Both Supplements Together Is More Effective

Laura Owens

Contributing Writer

While magnesium can reduce pain in some fibromyalgia patients, not everyone with FMS has low levels of magnesium. Yet research indicates that taking adequate doses of magnesium in combination with malic acid over an extended period of time can significantly reduce the muscle and soft tissue pain associated with fibromyalgia.

Fibromyalgia and Muscle Energy Disruption

It's unclear how or if these two elements work synergistically, yet magnesium and malic acid are both key components in how energy is produced and transported within the cells of the muscles. Evidence suggests that one cause of fibromyalgia pain is local hypoxia in the muscles (low oxygen) which contributes to muscle tissue breakdown.

Magnesium activates the most important enzyme in the body, ATP (adenosine triphosphate) an energy molecule produced within a component of cells called the mitochondria, the body's "energy furnace." About 20 percent of the body's production of ATP is located in the brain. As a result, diminished levels can reduce the brain's cognitive functions, a common problem in people with fibromyalgia.

Magnesium is needed in the production of serotonin, a brain neurotransmitter involved in the perception of pain. Serotonin levels have been shown to be significantly lower in people with fibromyalgia. Magnesium is one of the many co-factors needed to release and bind serotonin in the brain to provide balanced mental functioning.

Magnesium deficiency increases a chemical in the body called substance P, a neurotransmitter and protein found in the brain and spinal cord. People with fibromyalgia have abnormally high levels of substance P. Substance P serves as a pain messenger and is associated with inflammatory processes in the joints. Excess levels can cause pain signals to be sent to the brain even when there is no actual injury or illness.

Malic Acid and Fibromyalgia Pain

Malic acid is an organic substance found in fruits (particularly apples) and plants.

Malic acid is involved in the production of energy in the body. It plays a role in the molecules involved in controlling mitochondrial, energy production, within the cells. Malic acid provides greater stamina and endurance in muscle cells.

Malic acid is particularly useful in helping remove aluminum from the body. Aluminum toxicity is thought to be one contributor to fibromyalgia symptoms. While magnesium also helps block the toxic affects of aluminum, malic acid may be even more effective.

Studies On Magnesium and Malic Acid To Reduce Fibromyalgia Pain

In a 1992 study 15 fibromylagia patients received an oral dose of 1200-2400 mg of malate (malic acid) and 300-600 mg of magnesium over a four and 8 week period. Patients reported a reduction in pain across a tender point index (TPI). Six subjects felt an improvement in 48 hours.

During another study conducted in 1995, researchers gave 24 subjects with fibromyalgia a "Supermalic" low tablet with 50 mg magnesium and 200mg malic acid. Scientists measured pain levels through patient self-assessment and the tender point index. Results showed that the low dose, short term trial was not effective to reduce fibromyalgia pain. However, higher doses over an extended duration significantly reduced subjects' pain.

Magnesium Malate Dosage and Side Effects

Magnesium Malate has been shown to be the most effective form of magnesium to reduce fibromyalgia pain. The recommended dose is 1,500 mg, although people should adjust their dose according to their pain level and side effects.

Side effects with extended use may include headache, muscular pain, and mild gastrointestinal symptoms. The most common side effect is loose stools. Should this occur people should decrease their next dose by 50%.

Resource:
http://laura-owens.suite101.com/ 

Today on Dr. Oz- Chronic Pain

DR. OZ “WHY YOUR DOCTOR THINKS YOU’RE CRAZY! IS YOUR CHRONIC PAIN A DISEASE?”
There is a growing epidemic your doctor may be ignoring. Your Pain: When To Worry

Learn to think about pain like a doctor. These four rules can help to uncover the root of your problem and find effective treatment. Today’s audience is filled with people afflicted with chronic pain as Dr. Oz helps to shed some light on the groundbreaking research proving its existence.

Audience members Hilary (Chalfont, PA), Jacqueline (Montclair, NJ) and Shelia (Hillsborough, NJ), who all suffer from severe chronic pain, share their emotional stories, and how their primary practitioners told them there is nothing wrong with them, and try and make them believe this pain is all in their head. Chronic pain sufferer and woman’s health advocate Dr. Donnica Moore teams up with Dr. Oz, Dr. Sean Mackey member of The Institute of Medicine Committee that released the ground breaking findings on chronic pain. Dr. Julie Silver Physiatrist, who specializes in pain management to disclose the best multi-dimensional treatment for chronic pain.

Dr. Oz today talked about chronic pain, your doctor thinks it’s in your head: your doctor isn’t telling you something and Dr. oz said a lot of doctor’s are going to be really angry after todays show. Plus Dr. Oz shares the worst and best treatments for your pain. Plus Dr. Oz’s 4 critical questions you need to ask your doctor about pain.

Dr. Oz started off this segment of the show saying a lot of doctor’s are going to be really angry about what he’s talking about today. Millions of people have been suffering from chronic pain and doctor’s haven’t been taking us seriously. There is ground breaking new science proving that chronic pain is real, it’s a disease and it’s not something you’re making up.

Dr. Oz spoke with one woman in the audience who has complained of back pain and leg pain and her doctor told her to go home and have more sex with her husband and that it would help with her pain and then proceeded to show her positions that might work.

Dr. Oz said he was Peed off and said it frustrates him that it’s hard for one to get proper treatment for pain and in his opinion doctor’s do think you are crazy, they think the pain is all in your head. There are 4 reasons why doctors won’t be able to help you with chronic pain like they should.

Why You Doctor Thinks You’re Crazy

1. Doctor’s Can’t See Your Pain – If they can’t see your pain it doesn’t exist

2. Doctor’s Don’t Have Pain Management Training

3. Doctor’s Think You’re Out To Score Some Drugs

4. You’re A Woman – Dr. Moore said male doctor’s treat female patients differently.

We can now call chronic pain a disease according to the new study released, the pain itself is a disease just like diabetes, heart disease and the like says Oz. Dr. Mackay said this study is now validating what chronic pain sufferers in the audience have been saying.

Dr. Oz 4 Questions To Find The Right Pain Specialist

Next we moved on the the 4 questions you need to ask to find a doctor to treat your chronic pain:

• How Much Pain Management Training Do You Have?
• What Is Your Approach?
• How Long Before I Begin To See Results?
• How Much Will It Cost

4 Rules

Dr. Silver is the author of You Can Heal Yourself and an award-winning book from the American Cancer Society titled What Helped Get Me Through: Cancer Survivors Share Wisdom and Hope, here is what she says about When to Worry About Your Pain.

Learning to treat pain effectively takes years. As a medical doctor who specializes in Physical Medicine and Rehabilitation (PM&R), I have extensive training in treating pain. Doctors who specialize in PM&R are formally called physiatrists and are sometimes informally referred to as pain doctors.

One of the first things we learn is when to worry about pain. Since we are taught to treat so many different kinds of pain, we need to know when to sound an alarm about a patient’s condition and how to act to treat them most effectively. If you’ve been experiencing pain, it’s important that you learn to think like a pain doctor. While these “rules” about when to worry certainly do not cover every person and every situation, they are important to know to get to the source of your problem.

How to Think Like a Pain Doctor

1. Two-Week Rule 
Any pain that lasts for more than two weeks should be checked out. A lot of people think that new pain means that they have cancer. In fact, most new pain is due to bones, joints, nerves and other musculoskeletal structures. Many doctors use the two-week rule because a lot of musculoskeletal pain will resolve within a two-week period. Also, a two-week delay in diagnosis is very unlikely to change someone’s prognosis if the pain is due to cancer. Though the two-week rule applies to most pain, there are times when doctors ignore this rule and become immediately concerned (See Rules 2, 3 and 4).

2. Acute-Trauma Rule 
Doctors should immediately check all pain associated with acute trauma, such as a car accident or fall off a ladder. Usually, people aren’t overly worried that cancer is causing their pain if they have trauma that results in immediate or even slightly delayed pain. However, all pain associated with trauma necessitates an evaluation; this includes a physical examination and possible imaging tests such as x-rays or MRIs.

3. Worst Pain of My Life Rule
Doctors should be alarmed at any new and severe pain that a patient reports. It’s not unusual for a patient to actually say, “This is the worst pain I’ve ever experienced!” Often, the “worst pain of my life” is not cancer, but may be the result of something serious, such as a heart attack, appendicitis or ruptured blood vessel (aneurysm). If the pain is severe but chronic and has been worked up previously, then the “alarm bells” ring less vigorously.

4. I Can’t Sleep Rule
Doctors should be concerned about any pain that awakens a patient at night. Sometimes, night pain is more serious than pain that occurs during the day with normal activities. This is because, usually, when you rest, pain improves. Pain that doesn’t improve with rest is sometimes worrisome. However, resting too much with chronic pain leads to weakness and more pain. If you have chronic pain, try and alternate rest with activity to stay strong and keep your overall pain levels down. Cancer pain is one type of pain that often doesn’t improve with rest and will awaken people at night. However, it’s important to know that a lot of musculoskeletal pain problems will bother patients at night. Hip bursitis or shoulder tendinitis can often keep a patient awake if they lie on the affected side and put pressure on the injured part of the body. It’s important not to make assumptions about what is causing night pain, and to identify the cause and treat it appropriately.

There is no doubt that pain is undertreated and that physicians and patients need to work together to find solutions. When someone tells me, “I’ve tried everything,” I often ask if he or she has had a consultation with a physiatrist. Often the answer is no. To find out more about doctors in your area who specialize in treating pain and helping people to function at the highest possible level, visit the American Academy of Physical Medicine and Rehabilitation.

Source: doctoroz.com

http://www.doctoroz.com/

It’s Time to Become Disability-Aware

A Different Normal

Living with a Chronic Condition

Richard C. Senelick, MD is a physician specializing in both neurology and the subspecialty of neurorehabilitation. He is the Medical Director ofHealthSouth RIOSA, The Rehabilitation Institute of San Antonio, and an associate clinical professor in the Department of Neurology at the University of Texas Health Science Center in San Antonio. He has authored several books on stroke, spinal cord injuries, and brain injuries. Dr. Senelick is an expert in the WebMD Stroke Community.

Did you go see the movie Tropic Thunder?  Have you rented the movie, There’s Something About Mary? Both movies have scenes that generate laughs at the expense of the disabled. It may seem like “nit picking,” but had a different minority been similarly stereotyped, the outcry would have been much louder.  The disabled are a minority who still have a significant barrier to overcome. People rarely understand the simple fact that the disabled have the same desires, dreams and aspirations of able-bodied people.

I work every day with people who have disabilities.  I am the medical director of a rehabilitation hospital where I am surrounded by patients with brain injuries, missing limbs, severe deformities and impairments. This is my “normal” environment— one in which I am totally at ease and comfortable.  In fact, I have been doing this for so many years that I frequently don’t notice the alarm or discomfort of first time visitors.

By virtue of this familiarity, the assumption is that I have either learned or intuitively know how to interact appropriately with someone with a disability. In my world, it is the rare occasion where someone actually receives criticism or a comment related to something they said or did while interacting with a disabled individual.  But, the wars in Iraq and Afghanistan have produced large numbers of “wounded warriors” who have no qualms telling us what they want and how they want to be treated.  While caring for these young men and women, it has become apparent that it is time to “test” our own disability awareness and examine whether we act in an appropriate manner.

The difficulty here is that many people are simply not aware that even though their intentions are good, their words can come across as patronizing or insensitive. Below are a couple of common missteps in our interactions with the disabled.  See if these ring true and whether you need to reassess your approach.

Greetings: It is second nature to offer your arm and shake the hand of someone you have just met.  However, I have seen many people hesitate to shake the hand of a disabled person out of fear that the person is paralyzed or missing a limb.   Greetings come in a wide variety these days, from a fist bump to a high five.  Extend an arm in greeting and an individual will respond.  However, do not invade their personal space by assuming you can rub a shoulder or pat a knee without permission. Even in our increasingly casual society, it is not acceptable to call someone honey, sweetie, baby, sugar or – my least favorite current greeting — “dude.” A few years ago, I was a patient in the hospital and an aide asked me, “How you doin’, dude?”  If not for my wife’s restraining “not now” stare, I would have come unglued.

“You are so courageous”: I recently spoke with a young woman who told me, “I always make sure to tell people with disabilities whom I meet how courageous they are.”  The definition of courage is, “the mental or moral strength to withstand danger, fear or difficulty.” Yes, a soldier’s courageous act may have resulted in their injury, but now, they may feel afraid, anxious and depressed, and need someone to acknowledge and empathize with these emotions. It is not helpful for us to tell them they are courageous, for that sets an expectation that they must check their emotions at the door and show an “expected” strength at a time when they are barely coping.

“It could have been worse”: Don’t tell a disabled person how “lucky” they are or that it could have been worse.  It diminishes the importance of the event or illness.  Statements like this come off as judgmental about the impact of the injury on that individual.  If you had a stroke that left you with the ability to walk but you still had a paralyzed arm, would you feel lucky?

“I know how you feel”: You should avoid the use of phrases such as, “I know how you feel” or, “I can imagine what it must feel like.”  Unless you have the same or similar disability, you do not know how they feel.  It is better to say, “I have never had to sit in your chair nor walk in your shoes.  I hope that I never have to, but I will be here to help you get through this difficult time.” Empathy without sympathy.  Assistance without patronization.

We recently watched moving memorials for those who died on September 11, 2001.  Ten years later we have tens of thousands of soldiers who have unfortunately joined the 5.6 million Americans who have to live in wheelchairs.   Will we honor their “new normal” with appropriate social interactions and greetings? You may say, “Of course, I will.”  But I challenge you to go a step further and become a disability etiquette educator.  Spread awareness among your co-workers, your associates and your family. And, from time to time, it never hurts to look in the mirror.

Coping - Family Involvement

Expert advice from Leslie Epstein, M.S., MFCC

While only one person in a family may suffer from fibromyalgia the entire family is affected by it. Your family faces a troublesome time while learning to cope with the anxieties, fears and trauma produced by fibromyalgia. Thus, it is essential that the family become part of your therapeutic program. More explicitly, family support is crucial to the successful management of any chronic and painful condition.

A common problem for patients is disassociation, where a family member may want to deny that their is anything wrong with you. That family member seems to feel that if he/she pretends nothing serious exists, the illness and its problems will go away. This type of person rationalizes that "if their is nothing I can do (about my loved one having fibromyalgia), I may as well act as if nothing is wrong and go on living my own life." The patient, in turn, resents this apparent disinterest and interprets it incorrectly to mean that their family member does not care, creating added stress.

Open communication among family members is important. The family must learn to discuss all feelings that arise, including frustration, resentment and impatience. Expression must not be restricted. The patient should be comfortable discussing personal needs and feelings with the family, and the converse should also be true. In this connection, it is vital that changes in family roles and responsibilities be discussed openly in order to prevent repressed anger and resentment, since hostile family attitudes may cause a patient's symptoms to flare.

The difficulty seems to be in finding the best response at a particular time: empathy when the symptoms appear to be worse; support during times of fear and crisis; and allowing patient control in periods when they are feeling better. Thus, a good system of communication within your family is essential.

Finally, family members are not immune to depression. It is frustrating to watch people who are sick and in pain, and yet to have little control over their illness. This can anger family members, who typically are unwilling to vent their frustrations onto you for fear of inducing more stress and causing an exacerbation of your condition. Instead, the family member's anger turns inward, creating depression.

Maintaining Healthy Relationships with your spouse, partner, children, family, friends, and others. 20 experts in the field answer questions posed by fibromyalgia patients in this specially crafted, 20-page Special Issue: Explaining your limits to others Handling demands on your time Helping children understand your illness Enjoying intimacy in spite of your pain and fatigue Saying "No" without regrets Handling unwanted advice Controlling angry outbursts Don't let chronic illness interfere with your ties to family and friends. Get our Special issues on Relationships

Fibromyalgia Network

If you haven't subscribed to these guys (FM Network http://www.fmnetnews.com), I HIGHLY recommend it. They send out awesome newsletter's in the mail every other month. They do survey's from members and post results in there. Also every month there is an E-Newsletter that is as good or better than the print version. I've been with them for 6 years now. They also have an 800 # if you need ANYTHING you can call them. From references to good doctors, to just a shoulder to cry on. (BENEFITS: http://www.fmnetnews.com/about-benefits.php) I have 6 years worth of these newsletters collected and the articles 98% pertain to me. Which is hard to find. Here I'm going to give you some links and info about the company and what the website has to offer since the website is rather confusing.


Main Site: http://www.fmnetnews.com/index.php
Here you can sign up for free articles too and has a basic intro of what the newsletters are about.


Facebook Page: This may make more sense to us now days. Check it out! :D


Site Map: This helps clear up the confusion of the website and give you an idea what they are all about as well.


The Store: Finally, here's where you become a member, get your stuff and benefits. Just click "Click here to Join" Also they are always giving away some free stuff with membership too. So watch for those. 


Here's what I got free with mine, it costs $5 on the site now. This list is a little outdated now, but still an awesome reference!! If you'd like this emailed to you let me know by email. Email me here

FYI: Data did not fit on main page. If you go across the tabs at the top and look for "Resources/Downloads" and click that, go all the way to the bottom of the page and the Top 25 Fibromyalgia Medications and an E-Newsletter are posted there. If you want anything else for a preview before purchasing a membership, let me know with this email. Email me here

Fibromyalgia: Healing Begins

Fibromyalgia Effects My Entire Life

PAIN Inspirational

P= Perserverance, the tenacity you need to get through your illness!

A= Attitude, your attitude determines your altitude! Keep your thoughts positive.

I= Initiate, Initiate your future by keeping close to family and friends. Don't   isolate.

N= NEVER, ever, give up or loose hope.  Your breakthrough 

Hope

Fibromyalgia is god's way of saying, your tougher than the rest and you can handle it.

Chronic Pain: OTC or Prescription Medicine?

I came across this article in my email. I find it very interesting. There's 4 pages to it. Thought I would share it with you all. Let me know what you all think, comment below please. Thanks!!

http://www.webmd.com/pain-management/features/when-to-call-doctor

Fibromyalgia Tender Points

Fibromyalgia syndrome is a common disorder characterized by multiple tender points, widespread deep muscle pain, fatigue, and depression. The term fibromyalgia comes from the Latin word for fibrous tissue (fibro) and the Greek terms for muscle (myo) and pain(algia).

What are tender points?

Tender points are pain points or localized areas of tenderness around joints, but not the joints themselves. These tender points hurt when pressed with a finger.

Tender points are often not deep areas of pain. Instead, they are superficial areas seemingly under the surface of the skin, such as the area over the elbow or shoulder.

Are tender points large areas of pain?

No. The actual size of the point of most tenderness is usually very small, about the size of a penny. These areas are much more sensitive than other nearby areas. In fact, pressure on one of the tender points with a finger will cause pain that makes the person flinch or pull back. Tender points are scattered over the neck, back, chest, elbows, hips, buttocks, and knees.

What causes tender points?

The cause of these pressure points is not known. Even though it would seem these areas might be inflamed, researchers have not found particular signs of inflammation when examining the tissue. What is known is that the locations of tender points are not random. They occur in predictable places on the body. That means many people with fibromyalgia experience similar symptoms with tender points.

Can my doctor diagnose fibromyalgia from the tender points?

Your doctor can test the painful tender points during an examination.Yet even with tender points, you need to tell your doctor about the exact pain you feel in those areas. You also need to tell the doctor about your other symptoms of fibromyalgia, such as deep muscle pain, fatigue, sleep problems, depression, irritable bowel syndrome, and more.

If you don't explain all your fibromyalgia symptoms fully to your doctor, the doctor will not be able to effectively treat the fibromyalgia. As a result, you won't get good relief from the chronic pain and other symptoms.

When a doctor tests tender points for pain, he or she will also check "control" points or other non-tender points on your body to make sure you don't react to these as well. Some physicians use a special instrument called a "doximeter" or "dolorimeter" to apply just the right amount of pressure on tender points.

How many tender points are important for fibromyalgia?

There are 18 tender points important for the diagnosis of fibromyalgia (see illustration below). These tender point are located at various places on your body. To get a medical diagnosis of fibromyalgia, 11 of 18 tender point sites must be painful when pressed. In addition, for a diagnosis of fibromyalgia, the symptom of widespread pain must have been present for three months.

Is there a prescription medication that eases the pain of tender points?

Pain management for tender points with fibromyalgia involves a multifaceted treatment program that employs both conventional and alternative therapies. While the reason is not entirely clear, fibromyalgia pain and fatigue sometimes respond to low doses of antidepressants. However, the standard treatment for fibromyalgia and tender points involves medications, daily stress management, exercise, hydrotherapy using heat and ice, and rest. Other remedies for symptoms may also be used.

What at-home treatments might help in managing tender point pain?

Alternative treatments or home remedies are important in managing fibromyalgia and the pain of tender points. As an example, therapeutic massage can manipulate the muscles and soft tissues of the body to help ease pain, muscle tension, spasms, and stress.

Twice daily moist heat applications are also helpful in easing the deep muscle pain and stiffness. To benefit from moist heat, you can use a moist heating pad, warm shower, or a heat "cozy" that you warm in the microwave. You can also relax in a Jacuzzi.

With fibromyalgia, it's extremely important to manage your schedule and to control your level of stress. Be sure to block time each day to rest and relax. Avoid making too many commitments that can increase stress and fatigue. In addition, you can do relaxation exercises such as guided imagery, deep-breathing exercises, or the relaxation response to manage how you respond to stress.

Staying on a regular bedtime routine is also important. Doing so allows your body to rest and repair itself. In addition, regular exercise is vital to managing the pain, depression, and other symptoms of fibromyalgia.

What can make fibromyalgia symptoms and tender point pain worse?

A number of factors can make fibromyalgia symptoms worse. They include:

• Anxiety
• Changes in weather -- for example, cold or humidity
• Depression
• Fatigue
• Hormonal fluctuations such as PMS or menopause
• Infections
• Lack of sleep or restless sleep
• Periods of emotional stress
• Physical exhaustion
• Sedentary lifestyle

Tender Points in Fibromyalgia

Reviewed by Brunilda Nazario, MD on April 30, 2009

© 2009 WebMD, LLC. All rights reserved.