Fibromyalgia is a chronic condition that causes widespread pain throughout the body, often accompanied by fatigue, sleep disturbances, and cognitive difficulties. Understanding the specific areas of pain, often called “pain points,” is important for recognizing this condition.
Understanding Pain Points in Fibromyalgia
People frequently encounter the terms “trigger points” and “tender points” when researching chronic pain conditions. While both involve localized areas of discomfort, their characteristics and relevance to fibromyalgia differ. Trigger points are localized, hyperirritable spots found within a taut band of skeletal muscle, which can cause pain in other areas of the body, known as referred pain. These are more commonly associated with myofascial pain syndrome.
In contrast, tender points, historically significant in the context of fibromyalgia, are specific, localized areas that produce pain upon direct pressure without causing referred pain. These points are found in the soft tissues, such as muscles and muscle-tendon junctions. The distinction is important because while trigger points involve muscle dysfunction and referred pain, tender points reflect a heightened sensitivity to pressure directly at the site.
Common Tender Point Locations
Fibromyalgia pain often involves 18 classic tender points, appearing as nine symmetrical pairs across the body. These penny-sized spots are hypersensitive to touch and located both above and below the waist. Common locations include:
- Occiput points: Found at the base of the skull, where the neck muscles attach.
- Lower cervical points: Located on the front of the neck, specifically at the anterior aspects of the intertransverse spaces of C5-C7.
- Trapezius points: Situated on the mid-upper shoulder muscle, approximately halfway between the base of the neck and the shoulder’s edge.
- Supraspinatus points: Found above the medial border of the scapula, near the shoulder blade.
- Second rib points: Located at the second costochondral junctions, where the ribs meet the cartilage near the breastbone.
- Lateral epicondyle points: On the outer part of the elbow, just distal to the epicondyles.
- Gluteal points: Found in the upper outer quadrant of the buttocks.
- Greater trochanter points: Located posterior to the bony prominence of the outer hip bone.
- Knee points: Identified on the medial fat pad proximal to the joint line of the inner side of each knee.
Identifying Tender Points
Historically, clinicians identified tender points through a process of manual palpation. This involved applying firm pressure to specific anatomical locations. A tender point was considered positive if the patient reported pain upon this pressure, rather than just general tenderness. The amount of pressure applied was standardized, often described as enough to cause the examiner’s fingernail to blanch.
While the tender point count was a key diagnostic criterion in the past, such as requiring pain in 11 out of 18 points, current diagnostic approaches for fibromyalgia are broader. Modern criteria do not solely rely on tender points but incorporate a wider assessment of widespread pain and other symptoms. Despite this shift, understanding tender points remains relevant for comprehending pain patterns in fibromyalgia.
Role of Tender Points in Fibromyalgia
Although tender points are no longer the sole diagnostic criteria for fibromyalgia, their presence still offers insights into the condition. These points help characterize the widespread pain that is a hallmark of fibromyalgia. Their sensitivity illustrates the heightened pain perception, which can include allodynia (pain from normally non-painful stimuli) and hyperalgesia (increased pain from painful stimuli).
The identification of these sensitive areas helps to map the diffuse nature of pain experienced by individuals with fibromyalgia. While the method of diagnosis has evolved, tender points continue to be a component in understanding the unique pain experience associated with this condition. They underscore the body’s altered pain processing pathways in fibromyalgia.