Pressure pain and tender points in fibromyalgia

Tender points or trigger points are defined areas on the body that are sensitive to pain when pressed. They were used in the diagnosis of fibromyalgia.

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Fibromyalgia is a chronic pain disorder that is categorised as soft tissue rheumatism in the rheumatic spectrum.

Fibromyalgia is accompanied by various symptoms. One of the main symptoms of fibromyalgia is chronic pain, which can occur throughout the body without a perceptible trigger and in varying degrees of intensity. Pressure pain can also occur at defined points. These points are called tender points or trigger points.

This article sheds light on pressure pain and pain points in fibromyalgia.

What is pressure pain?

Pressure pain is a specific form of pain sensation. Pressure pain describes an unpleasant sensation caused by mechanical pressure applied to a specific part of the body. Similarly, pressure pain describes the ability of a tissue or body structure to produce pain when pressure is applied:

In principle, different parts of the body are sensitive to pressure in different ways. Tissues or body structures can also react with pressure pain in the event of illness. The pain typically occurs when an area of skin is touched or when pressure is applied to a diseased internal organ. Doctors often palpate areas of the body to check for sensitivity to pressure pain.

Pressure pain belongs to the category of receptor pain (nociceptive pain), which is caused by irritation of pain receptors in the tissue. It often manifests itself as dull, pressing or cramp-like.

Pressure pain can be a symptom of various diseases. Pressure pain is an important diagnostic feature that can indicate different diseases depending on its localisation.  It is therefore interpreted in the context of other symptoms and clinical findings.

What are tender points?

Tender points, also known as trigger points, are specific, pressure-sensitive points on the body that cause pain when touched.

In fibromyalgia, pain occurs primarily in the area of the muscles and tendons. Trigger points in fibromyalgia are clearly defined points in the area of various joints that react painfully to pressure.

In the past, 18 trigger points have been identified in fibromyalgia, which are symmetrically distributed on both sides of the body. They are located in the neck, chest, shoulders, elbows, hips and knees.

What do pain-sensitive tender points mean in fibromyalgia?

Tender points were used to diagnose fibromyalgia. According to the outdated 1990 criteria, at least 11 of 18 points had to be painful on examination when pressure was applied.

In addition to practical weaknesses such as a blurred boundary of the points, it was also shown that tender points can also be conspicuous in other diseases.

These include, among others

  • Myofascial pain syndrome: This is the primary condition associated with trigger points. It is characterised by chronic pain in the musculoskeletal system, particularly in the muscle fascia.
  • Musculoskeletal disorders: Trigger points can result from overuse of muscles, injury or trauma. This can indicate possible underlying problems or diseases in the musculoskeletal system.
  • Mental stress: Chronic stress and psychological problems can contribute to the development of trigger points

In 2010, the American College of Rheumatology (ACR) published updated diagnostic criteria for fibromyalgia. These new criteria move away from the examination of pressure points.

Instead, pain zones are determined in the diagnostic criteria using the Widespread pain index (WPI). In combination with the symptom severity scale (SSS), symptoms that occur and are relevant to the diagnosis are recorded in a structured manner and incorporated into the diagnostic process.

Pressure pain is an unpleasant sensation that is triggered by mechanical pressure. Pressure pain can also occur with fibromyalgia. In the past, pressure pain at defined points, so-called tender points or trigger points, was a diagnostic criterion for fibromyalgia. Today, pain zones are considered instead and assessed in combination with sleep disorders, fatigue and the exclusion of other causes.

[1] Smythe, H. Tender points: Evolution of concepts of the fibrositis/fibromyalgia syndrome. American Journal of Medicine, Volume 81 (3) 1986, Pages 2-6

[2] S3-Leitlinie Definition, Pathophysiologie, Diagnostik und Therapie des Fibromyalgiesyndroms der Deutsche Schmerzgesellschaft. In: AWMF online (Stand 2017) S. 12., 2. Aktualisierung, abgerufen am 20. Mai 2018.

[3] Omar H. Henriquez, Devin Peck: Fibromyalgia Diagnosis. In: Erin Lawson, Mark S. Wallace (Hrsg.): Fibromyalgia. Clinical Guidelines and Treatments. Springer, New York 2015. ISBN 978-3-319-15819-8. S. 26.

[5] Omar H. Henriquez, Devin Peck: Fibromyalgia Diagnosis. In: Erin Lawson, Mark S. Wallace (Hrsg.): Fibromyalgia. Clinical Guidelines and Treatments. Springer, New York 2015. ISBN 978-3-319-15819-8. S. 26.

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