Fibromyalgia Trigger Points and Tender Points

Fibromyalgia syndrome is a common disorder characterized by multiple trigger points or 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 trigger points?

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

Trigger points or 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 trigger 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 trigger areas are much more sensitive than other nearby areas. In fact, pressure on one of the trigger points with a finger will cause pain that makes the person flinch or pull back. Trigger points are scattered over the neck, back, chest, elbows, hips, buttocks, and knees.

What causes trigger points and 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 trigger points are not random. They occur in predictable places on the body. That means many people with fibromyalgia experience similar symptoms with trigger points.

Can my doctor diagnose fibromyalgia from the tender points?

Your doctor can test the painful trigger points during an examination.Yet even with trigger 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 trigger 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 trigger points.

How many trigger 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.