Tender points are known to fibromyalgia patients and they are crucial in diagnosing fibromyalgia. Tender points are frequently confused with trigger points. The two terms are sometimes used interchangeably, however, they are not the same in nature, treatment and role in the fibromyalgia.
The confusion between the two terms possibly surfaced because it is
utterly common for people with fibromyalgia to have both trigger points
and tender points concurrently. Furthermore, treating trigger points can
also improve health-related quality of life for fibromyalgia patients
who have both, hence, leading to the misconception that tender points
and trigger points are the same.
Let’s make the distinction between the two loud and clear today.
Trigger points are characteristic symptoms of myofascial pain syndrome
(MPS). Needless to say, tender points, on the other hand, are
distinctive symptoms of fibromyalgia. Trigger points also appear in
fibromyalgia patients because myofascial pain syndrome is a chronic pain
disorder that is frequently co-exist with fibromyalgia and show
overlapping symptoms such as widespread pain, fatigue, sleeplessness,
brain fog etc. Till date, experts are still debating on whether the two
chronic pain diseases are the same illness.
Although tender points and trigger points can co-exist in fibromyalgia, they different in nature. Here are some key differences between the two:
|Tender Points||Trigger Points|
|On 18 (pairs of 9) specific locations on the body, which are near the joints.||Can appear anywhere on the body in the muscle (myo) and connective tissues (fascia).|
|A superficial point around the size of a penny which is just under the skin.||A palpable small hard knot in the muscles or fascia which can be felt under the skin.|
|Pressure applied using a mere finger on a tender point can cause enough pain to make a patient wince. The tender point can result in immediate areas being more sensitive.||Pain can be felt when pressure is applied on the point. Without applied pressure, the trigger point can cause pain in immediate areas or referred pain where pain is felt in other unexpected areas.|
|Presence of 11 out of the 18 points for at least 3 months is a crucial prerequisite for diagnosing fibromyalgia.||MPS is diagnosed when patients suffer from chronic pain due to the presence of multiple trigger points.|
|Does not appear as any anomaly in muscles tissues. No medical technology can help with the location of tender points.||Appears as anomalies in muscle tissues which can be observed and located with magnetic resonance elastography and tissue biopsy.|
The Role of Trigger Point in Fibromyalgia
Various studies have found that trigger points plays a significant role in affecting pain in people with fibromyalgia. In a 2011 study published in The Clinical Journal of Pain, researchers were able to re-enact the spontaneous fibromyalgia pain in participants by manipulating their trigger points. They also observed a direct relationship between the number of active trigger points and the level of widespread pain experienced by participants. It was explained that local and referred pain caused by active trigger points can result in central sensitization, a phenomenon associated with fibromyalgia, where by the central nervous system becomes a lot more sensitive to pain and other stimuli including light, sound, temperature and touch etc.
The findings of this study are in line with earlier studies done in 2009 and 2010 which also support the theory that widespread active trigger points can lead to central sensitization. The 2010 study, conducted with 30 participants with fibromyalgia, found that most of the 18 specific locations of tender points lies in common myofascial trigger points sites and that the induced pain caused by the trigger points on tender points imitates overall fibromyalgia pain.
Distinguishing between the tender points and trigger points is important to determine an appropriate treatment. A polish article published in 2009 suggest that the inability to make a clear distinction between the two symptoms and terms can result in misdiagnosis and inappropriate treatment.
For fibromyalgia patients who have both, treating myofascial trigger points can significantly help in alleviating fibromyalgia pain and other symptoms.
- Alonso-Blanco C, et. al. Multiple active myofascial trigger points reproduce the overall spontaneous pain pattern in women with fibromyalgia and are related to widespread mechanical hypersensitivity. The Clinical journal of pain. 2011 Jun;27(5):405-13.
- Ge HY, et. al. Contribution of the local and referred pain from active myofascial trigger points in fibromyalgia syndrome. Pain. 2009 Dec 15;147(1-3):233-40.
- Ge HY, et. al. The predetermined sites of examination for tender points in fibromyalgia syndrome are frequently associated with myofascial trigger points. The journal of pain. 2010 Jul;11(7):644-51.
- Ge HY. Prevalence of myofascial trigger points in fibromyalgia: the overlap of two common problems. Current pain and headache reports. 2010 Oct;14(5):339-45.
- Kuncewicz E, Samborski W. Tender points and trigger points – differences and similarities. Chir Narzadow Ruchu Ortop Pol. 2009 Nov-Dec;74(6):367-71. (Abstract referenced. Article in Polish.)
- Mense S. Differences between myofascial trigger points and tender points. Schmerz. 2011 Feb;25(1):93-103. (Abstract referenced. Article in German.)