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Trigger Points, Tender Points. Is there really a difference?

What a hot button topic. I have seen many sites on the internet reference both tender points and trigger points when discussing Fibromyalgia. In my own life I have encountered physical therapists, who over the past 20 years, have intertwined tender points and trigger points while seeming to have no idea of how to treat either.

Some health care providers and popular authors are touting trigger point injections for Fibromyalgia relief.

Where does the truth lie? What can we learn from medical science and current clinical studies?

To date, science has proven that Trigger points are distinct in their physical characteristics, in their ability to radiate pain to other areas of the body and in how they are formed. (Medical science has proven how TrP's are formed, while tender points remain a mystery)

Tender points on the other hand, do not refer pain to other parts of the body, their pain comes when pressure from an outside source is applied. They tend to occur in the same, (usually around 18) basic locations in all fibromyalgia sufferers while trigger points can occur just about anywhere they want.

To review, Trigger Points are present in those suffering from Chronic Myofascial Pain. Tender Points are present in those with Fibromyalgia.

If your care provider prescribes trigger point injections for Fibromyalgia, and you experience major pain loss, the odds are that you have either been misdiagnosed with Fibromyalgia or you have both Fibromyalgia and Chronic Myofascial pain. The two conditions often go hand in hand, feeding off of each other.

This is not one persons considered opinion, as always we strive to offer facts, leaving you the visitor, to form your own opinion. Below is a small sampling of published data on the subject. Read our offerings and do your own research before making any decisions concerning your health care.

Jane Kohler
Copyright 2009

What are Fibromyalgia Tender Points?

By Carol & Richard Eustice,
About.com Health's Disease and Condition content is reviewed by the Medical Review Board

  • Tender points are specific places on the body (18 specific points at 9 bilateral locations) that are exceptionally sensitive to the touch in people with fibromyalgia upon examination by a doctor.

  • The 18 Tender Points of Fibromyalgia

    Tender points of fibromyalgia exist at these nine bilateral muscle locations:

  • Low Cervical Region: (front neck area) at anterior aspect of the interspaces between the transverse processes of C5-C7.

  • Second Rib: (front chest area) at second costochondral junctions.

  • Occiput: (back of the neck) at suboccipital muscle insertions.

  • Trapezius Muscle: (back shoulder area) at midpoint of the upper border.

  • Supraspinatus Muscle: (shoulder blade area) above the medial border of the scapular spine.

  • Lateral Epicondyle: (elbow area) 2 cm distal to the lateral epicondyle.

  • Gluteal: (rear end) at upper outer quadrant of the buttocks.

  • Greater Trochanter: (rear hip) posterior to the greater trochanteric prominence.

  • Knee: (knee area) at the medial fat pad proximal to the joint line.

  • Also Known As: tenderpoints, tender spots, trigger points (note: this is an incorrect term since referred pain differentiates trigger points from tender points)


    Trigger Points vs. Tender Points
    AAFP, a peer reviewed journal

    DAVID J. ALVAREZ, D.O., and PAMELA G. ROCKWELL, D.O., University of Michigan Medical School, Ann Arbor, Michigan
    Read Here


    Are tender point injections beneficial: the role of tonic nociception in fibromyalgia. Staud R.

    Division of Rheumatology and Clinical Immunology, University of Florida, PO Box 100221, Gainesville, FL 32610-0221, USA. staudr@ufl.edu

    Characteristic symptoms of fibromyalgia syndrome (FM) include widespread pain, fatigue, sleep abnormalities, and distress. FM patients show psychophysical evidence for mechanical, thermal, and electrical hyperalgesia. To fulfill FM criteria, the mechanical hyperalgesia needs to be widespread and present in at least 11 out of 18 well-defined body areas (tender points). Peripheral and central abnormalities of nociception have been described in FM and these changes may be relevant for the increased pain experienced by these patients. Important nociceptor systems in the skin and muscle seem to undergo profound changes in FM patients by yet unknown mechanisms. These changes may result from the release of algesic substances after muscle or other soft tissue injury. These pain mediators can sensitize important nociceptor systems, including the transient receptor potential channel, vanilloid subfamily member 1 (TRPV1), acid sensing ion channel (ASIC) receptors, and purino-receptors (P2X3). Subsequently, tissue mediators of inflammation and nerve growth factors can excite these receptors and cause substantial changes in pain sensitivity. FM pain is widespread and does not seem to be restricted to tender points (TP). It frequently comprises multiple areas of deep tissue pain (trigger points) with adjacent much larger areas of referred pain. Analgesia of areas of extensive nociceptive input has been found to provide often long lasting local as well as general pain relief. Thus interventions aimed at reducing local FM pain seem to be effective but need to focus less on tender points but more on trigger points (TrP) and other body areas of heightened pain and inflammation.

    PMID: 16454721 [PubMed - indexed for MEDLINE]


    Trigger Points and Tender Points: Why the Difference Is Important to You

    by Devin J. Starlanyl

    There is general confusion and lack of information concerning chronic myofascial pain (CMP). Many of the symptoms mistaken for fibromyalgia syndrome (FMS) may actually be due to myofascial trigger points (TrPs) instead. TrPs are easily treated if they caught early.

    Understanding the differences between FMS and CMP and how they can interact may be necessary before the most effective therapies for your symptom control can be chosen.

    There is no such thing as a fibromyalgia trigger point. You may have read about them in articles and even books written by respected

    physicians, but they do not exist. FMS tender points and myofascial trigger points (TrPs) are different in fundamental and significant ways.

    Failure to differentiate myofascial pain from TrPs may lead to unnecessary tests and procedures that may cause harm as well as unnecessary expense.

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