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

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