If you’ve been diagnosed with fibromyalgia, you’re probably familiar with the term  “tender points” and you’ll certainly know how excruciatingly painful they can be.  Or you might be at the stage when you’re just starting off your fibromyalgia research, googling everything there is, only to find yourself in a muddle with the vast array of conflicting information.

What we do know is that fibromyalgia is a systemic disorder, meaning that it affects the whole body, albeit in different ways and characterised by widespread pain and fatigue as a consequence of abnormal pain processing in the central nervous system.

Every sufferer will experience a range of symptoms unique to themselves which will differ in degree sometimes on a daily basis. Key influencers of symptoms include co-morbid health conditions, medications and their side effects, as well as lifestyle choices such as diet, activity level, posture, mind-set, belief system, worry and stress, all of which will vary for each individual.  This diversity is what makes fibromyalgia so complex and difficult to treat and there is no single solution or protocol that suits all cases.  

One aspect that all sufferers will have in common are tender points, which are the multiple, specifically located, painful pressure points that are highly sensitive to touch.

Tender points are often mistakenly referred to as “trigger points”  –  but there is a major difference between the two!  Having said that, although you will have tender points to receive an accurate diagnosis of fibromyalgia, you might also have trigger points.

Knowing the difference between tender points and trigger points is key to finding safe and effective pain relief.

Both tender and trigger points have their own distinctive pain characteristics and each require a specific treatment approach.  When there’s any confusion between the two, the wrong treatment could cause adverse effects, which is the last thing you want with fibromyalgia!

Tender Points – What are they?

Up until 2010 tender point examination was used to determine a diagnosis of fibromyalgia, where the presence of 18 specific points had to occur on both sides of the body, above and below the waist had to be present, shown on diagram below. 


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Location of Tender Points

Tender points are small, but extremely painful areas and sensitive to touch, located around specific joints, neck and back, chest, elbows, buttocks, hips and knees, just under the surface of the skin. Each tender point radiates pain closely around its location and is far more sensitive than other areas. 

Although this diagnostic criteria has since been abolished,  an accurate diagnosis of FM still includes the presence of pain in at least 11 of the 18 tender points alongside a medical history of symptoms and widespread pain for three months or more.

What causes Tender Points?

The fact is that nobody really knows exactly the root cause for these sensitive points, let alone why they are located symmetrically in specific areas of the body.  Some experts believe they are caused by muscle spasms which reduce the flow of oxygen and blood, resulting in a build up of acid and carbon dioxide and increasing the pain in the muscle.  However, that doesn’t explain why the spasm occurs in the first place and why only in specific areas??  My jury is out on this explanation.

What we do know is that tender point pain tends to inflame during a flare up, accompanied by other fibromyalgia symptoms and prolong long after the flare has subsided.  Triggers of tender point pain include sensitivities to temperature changes, poor posture, over exertion, immobility, food and chemical intolerances / sensitivities, other illness or infection and stress.

Although tender points tend to be invisible to the eye, nonetheless they can make you feel pretty miserable and cause reduced activity.  People with fibromyalgia suffer with low pain threshold and the worst-case scenario can leave a person debilitated by the pain for days, or weeks!  

At this point it has to be noted that tender points do not trigger referred pain to other parts of the body, unlike trigger points which could be located on or around a tender point.

Treatments for Tender Points

What works for one person may not for another, but both conventional and alternative therapies may offer some relief.

Treatments include acupuncture, hydrotherapy, physio and correcting posture.  Learning to manage stress is key, reducing the tension in the body with relaxation techniques brings many benefits including improved sleep.  Cognitive Behaviour Therapy (CBT) may also help and many sufferers find relief with a combination of medication and applying topical oils that contain magnesium.  For some, massage can be too painful which can trigger heightened pain in these areas.

What are Trigger Points

Trigger points are defined as painful areas of the myofascial tissue of the muscle that develop taut, ropey bands causing localised or referred pain to other regions of the body.  There is no single cause for the occurrence of trigger points but common factors include muscle overuse, muscle trauma, repetitive muscle activity such as lifting and psychological stress.

Stress is considered a major cause of trigger points which can eventually develop into a chronic pain condition known as Myofascial Pain Syndrome, which unsurprisingly very often coexists alongside fibromyalgia.  The problem here is that all too often a diagnosis of either one might be overlooked or confused as being one and the same condition.  Categorically speaking, they are not the same thing – but symptoms may overlap!

Fibromyalgia Tender Points vs.  Myofascial Pain Syndrome (Trigger points)

  • Trigger points in Myofascial Pain Syndrome can be located, which appear as little knots which can be felt as a small bump just below the surface of the skin whereas FM tender points are not visible to the eye.
  • Trigger points can be localised in any muscle area and can also refer pain to other regions of the body. Tender points of fibromyalgia are localised areas of pain and do not cause referred pain.
  • Tender points occur symmetrically on 18 points above and below waist, unlike trigger points which are not symmetrical and may be singular or multiple points.
  • Trigger points themselves may or may not be tender, whereas FM tender points are sensitive to pressure.  
  • Anyone can develop trigger points, whereas tender points are symptomatic of fibromyalgia.  
  • There are several different types of trigger points, active trigger points are painful nodules within a taut band of muscle and can cause referred pain.  Secondary trigger points are an area of muscle tissue that is activated by the stress of another muscle.  Latent trigger points are nodules that don’t cause pain when touched and can remain dormant for years but inflame following  stress or trauma.  A satellite trigger point is a painful spot that becomes activated because it is located close to another trigger point.  

Treatment of Trigger Point Myofascial Pain Syndrome

Treatment of myofascial pain can be trial and error, with a combination of medication, such as nonsteroidal anti-inflammatory (NSAID’s) drugs, analgesic patches, muscle relaxants and anti-depressants.  Some sufferers opt for Botox injections that prevent muscle contraction or trigger point injection therapy.  Dry needling, carried out by a specialist, involves the insertion of a fine needle into the trigger point and literally poking it, which is an effective method to inactivate the trigger point. Less invasive treatments include ultrasound, massage, myofascial ball rolling and hot and cold application. Ball rolling is a useful natural home remedy and there’s a huge variety of exercises and myofascial treatment tips on YouTube.

To conclude, both fibromyalgia pain, tender points and myofascial pain syndrome can co-exist which can affect your quality of life, it really is worth knowing the difference and obtaining the right treatment to avoid unnecessary pain and muscle damage.

For answers to fibromyalgia frequently asked questions, read here https://thefibroclinicsouthwest.co.uk/fibromyalgia-faqs/

If you have a question or would like to leave a comment below

Author Jok Saunders, founder of the Fibro Clinic South West   

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