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