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Donna Zuehl

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Fibromyalgia Trigger Points and Tender Points
2/16/2009 11:54:49 PM
Here is a general overview of fibromyalgia trigger points and tender points.

WebMD Medical Reference provided in collaboration with the Cleveland Clinic

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.

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

Pain management for trigger points or 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 trigger 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 trigger point pain?

Alternative treatments or home remedies are important in managing fibromyalgia and the pain of trigger 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 trigger 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
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Leonie Parker

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Re: Fibromyalgia Trigger Points and Tender Points
2/17/2009 12:48:03 AM

Hi Donna,

Very interesting article. I tried out each of the trigger points and not one caused pain.

So it looks like I don't have fibromyalgia. But I do know I have osteoarthritis so I am still researching what I can do about it that doesn't require prescription medication.

Thank you for clearing that up.

Leonie

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Rinna Rani

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Re: Fibromyalgia Trigger Points and Tender Points
2/17/2009 2:06:33 AM
Hi Donna,
Greetings!
A truly wonderful presentation.  This is good information.  I noticed one thing - the points shown in the diagram is very much on the lymphatic nodes.... this nodes are very important because if it stimulated it helps cells to regrow and generate faster and seems to attack some of the lymph nodes --- hmmmm, interesting.

Lots of love, Rinna
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Nick Sym

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Re: Fibromyalgia Trigger Points and Tender Points
2/17/2009 8:41:19 PM
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Re: Fibromyalgia Trigger Points and Tender Points
2/18/2009 8:58:52 AM
This is a good article.  These trigger points were used when a Dr. told me I had Fibro.  I could hardly sleep because it hurt my hip when I laid on my side.  I thought it might be deterioration.  This was many yrs. ago and the only help I have gotten with this is from a Chiropractor even though there is still some pain it is bearable.  Even sitting on a chair that presses there is painful.  It is too bad more Drs. don't know about these things.
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