It can be confusing to talk about fibromyalgia tender points and myofascial trigger points, especially since a lot of people (even medical folks) use the term trigger point for both of them. They've typically been regarded as different things, but new research is looking at whether they're actually the same -- at least, in some of us.
First, some quick definitions:
- Tender Point: 18 designated spots on the body (9 pairs) that are abnormally painful when a small amount of pressure is applied. Doctors use them to diagnose fibromyalgia (FMS). (See image, top right.)
- Trigger Point: A small, hard knot of tissue that typically forms after trauma. The knot is often painful, especially when poked, but it may also cause pain in another area (called referred pain.) The electrical activity (from nerves) in trigger points is abnormal.
- Myofascial Pain Syndrome (MPS): People with this condition have chronic pain from trigger points. It's common for people with MPS to later develop fibromyalgia. MPS may also be misdiagnosed as FMS, especially because it can be hard to trace referred pain to its cause.
Research recently published in The Journal of Pain examines whether FMS tender points are actually myofascial trigger points. In 30 people with FMS, they looked at the electrical activity in tender points and found that most tender points actually were trigger points. When researchers pushed on the trigger points, the referred pain mimicked FMS pain.
They're not saying that FMS is the same thing as MPS, but they are saying trigger points are more important than has been thought, and they're saying that trigger points should be treated in people with FMS.
I'm diagnosed with both FMS and MPS, and this research doesn't surprise me. I know first hand how similar the pain is, and how treating trigger points can calm down FMS symptoms. While I was diagnosed with both of them at the same time, the locations of my trigger points correspond to injuries I had as a kid, and I believe the chronic pain they caused was a major cause of my FMS.
Even though tender points are the only diagnostic test we currently have for FMS, only a few doctors actively treat them or check them as markers of progress. This research could make them re-think that (eventually -- it's preliminary and will need to be recreated and validated.)
The good news is that trigger points are fairly easy to treat and can sometimes be eliminated completely. Options include:
- Trigger-point injections with lidocaine (a topical anesthetic)
- Acupuncture
- Myofascial release massage therapy
- Spray-and-stretch physical therapy (therapist blasts the spot with cold air while you stretch -- may not be good if you're temperature sensitive)
I've had a lot of success from acupuncture and trigger-point injections. I started with a lot of trigger points and I seem to make new ones frequently, but with regular treatments I usually see the active ones get smaller and less painful, and sometimes they do go away -- taking the pain with them. As my myofascial pain level has dropped, my FMS symptoms have decreased as well.
- More Information: Tender Point vs. Trigger Point
Have you had these kinds of treatments for tender points/trigger points? Has it worked for you? Have you been diagnosed with MPS, or identified trigger points at non-tender-point locations? Leave your comments below!
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Just to share my experiences (others may be different). I tried acupuncture for about 5 months for my quite severe fibro, and at most I got some very short-term relief (sometimes just a few hours). Some studies have shown that sham acupuncture (used as a control in the study) was as effective as true acupuncture. Studies have not clearly demonstrated the effectiveness of acupuncture for FMS symptoms. One effect I often did find was that I was more energized after acupuncture–but usually an unpleasant hyper feeling. Not something I want with the increased arousal of fibro.
Has anyone else tried the use of near-infrared devices? I use these on tender points and get quite good temporary relief. However, the effects are short lived (about 5 hours), the process must be repetitive and thus can be tedious, and good devices are expensive. Moreover, I find that the relief of tender points doesn’t help my vertigo/balance problems and other symptoms of fibro.
In reading this article about the trigger points I noticed the one part you had about the electrical activity from nerves. In the recent past I would not have had any clue what that meant but I think I do now. Maybe.
About 1 1/2 weeks before Christmas I was at a friends and put a soda on my one leg about 4″ above my knee to open it and in doing so there was just a bit of pressure from me having to push down while popping the top. Needless to say the soda went all over me, those near me and the room around me. Thank God I was at a very good friends house and an understanding ones and those around me wanted to start a drink battle. But I was in so much pain they stopped playing around. The only way I can describe it was in one of two ways, either like I got electrically zapped or like a hot pan touched me real quick. The pain only lasted for a few moments but it was horrible. When I was a child I had an absessed tooth and I can compare it a bit to that also. Whenever the tooth touched silverwear I like hit the ceiling. And this was somewhat like that. I was not in constant pain but each time I pushed a bit I would have that shocking pain. That night I turned over in bed onto that leg and the pain woke me up. In the morning pulling on my jeans and coming to that leg, I of course forgot and again, the pain. Do you or anyone else know what this was? I have all the tender points and then some. I had CFS first for years and then was in a bad car accident 7 years ago and got severe whiplash and it took 2 years of me going to Drs. telling them something was wrong and still getting nowhere. Finally a friend of a friend told my friend, “tell her to look Fibromyalgia up online.” When I did, I almost fell off my chair. There it was right in front of me, everything that was wrong. The Dr. still wasn’t convinced but sent me to a rheumatalogist and she finally agreed. But this pain in the leg…I just don’t know. I have to say it is not as bad and doesn’t last as long now, but has anyone had this or know what it is??? Thanks
Guide Response: Definitely talk to your doctor. It could be an active trigger point — see if you can feel a little hard spot, kind of like a popcorn kernel under your skin. You might also have nerve impingement. It could also be some random fibro-weirdness, but you should let your doctor know in case it’s something else. ~Adrienne
Lynn, I know exactly what you are talking about. I have 3 of these areas and have had them in the same area for approximately 8 years. I refer to them as my ‘hot spots’. When they are acute they become so painful that the slighest touch or movement triggers surges of electrical burning pain. These areas frequently awaken me from sleep and/or prevent sleep. The areas are under my arm, on my back below a shoulder blade and on the outer aspect of a thigh. The areas actually become reddened and swollen when acute.
When the acute phase decreases the areas remain tender to to touch and remain chronically tender until the next acute phase.
I have never been given a medical explanation for these areas just advised to use heat and/or cold. Those giving this suggestion have no idea of the pain & sensations triggered by both of those.
I have attempted massage, acupuncture, reiki therapy, lidocaine injections and physiotherapy all without any success.
I hope that you are able to find some relief Lynn and if you do I would be pleased to hear of your success. Good health.
I have had chronic Myofascial Pain Syndrome since 1983. It took a long time to get a daignosis–about 13 years–and I have had many instances of being told it was all in my head, I was depressed, I was drug-seeking, I was lazy, it was because I am overweight, etc. I do not have fibromyalgia but I have been examined by practitioners who do not know the difference. In fact, I have experienced more harm than good from well-meaning practitioners who didn’t know what they are doing with MPS.
Since my pain began, I have tried just about everything imaginable. It began in my left neck, and has since “spread” to almost everywhere. I use quotes because MPS doesn’t actually spread, but gives that impression because muscle groups interact with each other and spasm begets spasm. It makes it much harder to locate the original trigger points. I have found physcial therapy that employs exercise to be the most destructive attempted treatment. Most PT’s want to have the patient do exercises to strenthen the muscles. They may also do other things, like massage, but always there is the repetitive exercise or weight workout component. There are problems with this: (1) A person with MPS cannot exercise until the trigger points (TPs) are completely resolved. Otherwise, the TP’s are activated and the patient gets much worse, (2) If you strenthen a muscle that chronically spasms (remember I am talking about a chronic condition not a temporary problem), all you have accomplished is making a stronger spasm. This is not to say that people with MPS should let weak muscles atrophy–but I find that exercises and stretches that are more isometric in nature are more effective–if done slowly and carefully. I think this is one reason why I have found gentle yoga so helpful. I have also found Shiatsu massage to be extremely effective. Chiropracty is helpful for me because the spasm pulls my spine out of alignment. I have also been receiving acupuncture for 3 years and it helps a lot. I find it facinating that so many acupuncture points correspond to myofascial trigger points. Finally, today I began receiving Heller body work. I am cautiously optimisitc. This is not something I have tried so far and I have sustained pain relief for appx 10 hours now.
I am having a bad flare right now and can’t even touch most of my trigger points. But I do have tender points too and they feel different. They don’t seem to ever release like a trigger point will. I also have the electrical shooting pains and never thought to see if they were trigger points, would love to get rid of those!
I so self massage with 2 tennis balls in a sock, standing against a wall or leaning against pillows (softer) The technique can be learned from The Trigger Point Therapy Workbook by Clair Davies, NCTMB. I find the illustrations of the various reffered pain patterns and the offending trigger points very helpful. Sometimes pain in one area is actually caused by one of these little knots in another and you can work it out. And laying back against the 2 tennis balls at the base of the skull is great for a migraine or any tension/muscle headache.
Thanks for that infro about the ball. I was usins a stick, but it broke. The sock seem like a real good ideal.
Hometics has a shiatsu massage pillow with heat – this is my savor I have it on right now I have worn thru 2 of them …over the years I use them constantly – my whole body is infested with muscle knots so I know the pain – I have Severe FMA/CFS along with so many other painful illnesses – U can find these on e-bay or in most major stores -I don’t know where ur from But Walgreens usually carries them and around the holidays U can get them on sale for $29.00 a great price -or $39.00 or just look it up on Hometics website Its Much better than tennis balls trust me
Hi .Have had FMS for 12 years now.The latter have been different from my start of FMS.
Does anyone else have the horrible chest wall pain?
This is on the breast bone and is so painful to touch. It makes you feel so unwell.A dreadful feeling in the whole chest area.I have tried the usual, heat, Ibrufen Gel and tablet form.
Just interested to see if anyone else suffers from this.Thanks
Guide Response: It could be costochondritis. I have it too, and it’s a horrible pain. What works best for me is ice, which I know sounds strange, but heat just makes the lump bigger. Check this article: Fibromyalgia & Costochondritis. ~Adrienne
http://www.fibromyalgia-symptoms.org/fibromyalgia_chest_symptoms.html
As the above site notes, your rib pain is very common to fibromyalgics–usually the second rib is the worst. Before I was diagnosed, I thought I had cracked a rib that just didn’t heal. Upon researching fibromyalgia, I found it all came together. I often feel a tightness in the chest also, but your pain seems greater than what I’ve experienced.
Lloyd
Thanks so much for your info on chest pain.
It has really helped me.
Bless You
To those who read and/or responded to my comment on 1/8/10, I just wanted to let you know I have an appointment with my rheumatologist on 1/14/10 and will be bringing up my eletrical pain along with other things and will come back and share with you what I was told. I try not to open minded when I go to the doctor now an try not to think or feel like I am just on the conveyor belt passing on by. I feel like perhaps since my doctor (along with many others) do not know much of anything else to do for me or others that she just wants to get me in and out and does not truly listen to what I am saying to her, but this time some more serious things are happening and I am going to grab her face and ask her if she is really hearing me.
Not really but I will make sure she gets what I am saying and receive information back. There are times I feel like I am a little better and then other things start to happen and I know I am not. And as I have read so much on these comment pages, we all have had to re-learn how to live and that is where I am. I haven’t been too angry about it as of yet as I know the anger will only do more harm to me and I just keep telling myself to keep making lemonade out of the lemons. As you all know there are just some days that even thinking that is a miracle. 
Thanks and I will be back on Thursady.
Hi, I started with a single trigger point (TrP) in my left scapula, and after 15 years and poor treatment options (I live in Mexico) I have widespread chronic myofascial pain, with central sensitization (which means it is or has turned into FMS), and a lot of FMS symptoms. Today I tend to develop TrPs in just about any muscle, and after an abdominal surgery in 2009, I went into a steep decline where FMS symptoms flared up all at once. For me, myofascial pain did evolve into FMS. Literature says widespread CMP is difficult to deal with, I guess I must now cope with the CMP/FMS complex, and wonder whether resolving the most painful TrPs will help; the most difficul set of TrPs involve the deep eye muscles, which when flaring make it impossible to read, drive, or watch TV or work at the computer due to a cascade which involves arm, chest and neck TrPs, bilateral, with a migrane as the outcome most of the time. It is impossible to treat deep eye TrPs. Help!
Hi, I use Lidoderm patches and they help. These are a rx item.
I have an additional pain point inside my upper arm, the very spot my cat likes to knead! I found the trigger point injections too painful to bear. PRESSING, not rubbing, can cause the knots to dissolve. There is an item called a thera-cane on the market that helps to reach the knots. Beware that you can hurt yourself easily with this thing by rubbing or overdoing it (cause it feels so good). You’ll get a delayed pain response next day that you’ll regret.
I have been suffering with FMS for 18 plus years now. Up until… and even after FMS was ‘officially’ recognized I had been yelled at by Dr’s and PA’s who belived I was being lazy, lying, and drug seeking! I was not only bounced from dr to dr; I also ‘fired’ more drs than I care to remember. I have gotten EVERY treatment they could throw at me from intense massages, trigger point injections, accupuncture, and chiropractic adjustments. The different treatments either worked very little or, in most instances they exacerbated the pain to unbelievable levels!! The electrical sensations
I developed Fibromyalgia after being rear ended in a car accident. I wasn’t diagonosed until 1 1/2 yrs later. I had several operations to help with my pain; however, none worked. Any one who has had an accident prior to symptoms, please leave comments. Insurance Co is trying to discredit me; I have lost everything, – job etc, and I am in chronic pain. Little energy,etc. The new drugs ie GABA, no help. I want my life back.
Please go to the social security office and apply for social security disabilty. I struggled for years to keep my jobs, I would have too many sick days and just couldn’t work anymore.
I now get a monthy check, and it helps a lot.
God bless you and good luck.
THANK YOU SO MUCH for all of this information! I was diagnoised with FMS 11 years ago. The information regarding the surges of electrical burning pain, the chest wall and rib pain, and tightness in the chest has plagued me for years. At first I though I was having a heart attack and sometimes still have trouble convincing people that no, I don’t need to go the the hospital, it’s my FMS. I’m still not clear about the “electrical activity from nerves” but this is due to my comprehension problems……….. I’ll get it after reading this a few times or it will come to me in a day or two, lol! Sound familiar?? The acute, recurring pain in my back and shoulder area and below my shoulder blade is excruating. Regarding Di’s referral to the pain on the outer thigh, the pain is indescribeable except to say it feels like someone has ahold of my foot and is twisting it like a pretzel causing the pain to generate up the leg and into my hip. My leg is very weak and often gives out on me. I was trying to describe this pain to my PA once and finally told him, “have you ever cut up a chicken? If you have you know that in separating the leg/thigh you cut until you hit the joint then you SNAP! the joint and continue separating them. Well, that’s how my leg/hip feels!” Since that time we refer to that area as my “chicken leg”! Not only do I have the BEST PA, he has a sense of humor too!
I will be visiting this site often, thank you
Interesting, thank you Adrienne! I may just take a copy of this to my Doc. The place I get my medical has the rheumatologist diagnose FM/CFS (which the insist is the same thing) and the Internist provides the ‘treatment’. I needed my file updated (for SSD) to show how many tender spots I had and my doc didn’t know where to check!! Thank God I had the foresight to sense that and I brought a chart with me, He checked my spots with his right hand while holding the chart in his left… soooo frustrating!
I was diagnosed with fibromyalgia after two years and have had two rounds of the injections of depo-medrol and lidocaine in my back. And they were useless for me. The first set actually made me worse for the first two days. I have spasms,limb jerks, burning pain,dull aching pain in legs, kneck pain,migrains,severe back pain,and fibro fog, some days i can barely walk. And my hands cramp up and i drop stuff frequently. Besides for the shots im not taking any meds. Since im trying to wean my dd. Im thinking about going to a reumatolgist for a second oppinion since i was diagnosed by a neurologist. A second oppinion couldn’t hurt. Also thinking about getting tested for lyme disease.
Does anyone else have the severe fibro pain in their collarbone? My neck, shoulders and inner shoulder blades are in constant agony.