tkgoodspirit

Hey all, I have noticed that there is a bit of confusion between Trigger Points and Tender Points when referring to Fibromyalgia. When first being evaluated for FM we are usually tested for TENDER Points. TENDER Points differ from TRIGGER Points. I have some information on both of these. Some research shows the two terms being used interchangeably, but MOST research shows that these two areas of pain are different, yet similar. Make sense? No. But they are different. You can have both. But usually a dx of only FM has Tender Points. I've tried to define words that I had to look up! The research about the Trigger Points has been paraphrased as best I could. The information about the Tender Points comes from one of Dr. Devin J. Starlanyl's manuals. I know a lot of you have read her books. Tho the info about Tender Points is becoming more and more controversial as far as how many you are "supposed" to have in order to be dx'd with FM. Lately, docs have found that you can have FM w/o having any Tender Points, tho that is rare. But having a specific number of Tender Points to "qualify" is no longer a defining symptom of FM. You can have 2, 4 or 18, also there is no longer a determined amount of how many Tender Points actually exist.

I know this post is long and I know that it is hard for some of you to "take it all in" at one sitting. So don't try. And I can't tell you how much it means to me to be able to share with you and when you DO read these long posts, I'm honored beyond words.

I don't mean to fatigue you, bore you or overwhelm you with information. I just want it to be thourough when I DO share it with you and I want you to see it from BOTH sides, so you can read it and decide for yourself how to interpret it, or whether or not to believe it for that matter. I am by no means trying to force anything on you. I just have noticed a lot of intermixing of these two terms and I want you all to see what the differences are.

Pain is pain no matter how you put it, and we all know what it feels like no matter what it's called! I love ALL of you! Again, sorry for the long post. Take your time.


Trigger Points vs. Tender Points

Trigger Points
Local tenderness, taut band, local twitch response, jump sign
Singular or multiple
May occur in any skeletal muscle
May cause a specific referred referred pain pattern

Tender Points
Local tenderness
Multiple
Occur in specific locations that are symmetrically located
Do not cause referred pain, but often cause a total body increase in pain sensitivity

Tender Points
The Copenhagen official Fibromyalgia Syndrome definition states that you must have at least 11 out of 18 specified tender points to qualify for entry into a clinical study of FMS. Tender points hurt where pressed, but do not refer pain elsewhere -- that is, pressing a tender point does not cause pain in some other part of the body. (Note that when examining yourself for tender points, you must use enough pressure to whiten the thumbnail.)

The official definition for patients to be admitted to a clinical study on FMS further requires that tender points must be present in all four quadrants of the body -- that is, the upper right and left and lower right and left parts of your body. Furthermore, you must have had widespread, more-or-less continuous pain for at least three months.

Tender points occur in pairs on various parts of the body. Because they occur in pairs, the pain is usually distributed equally on both sides of the body.

_On your back, they are present in the following places:
along the spine in the neck, where the head and neck meet on the upper line of the shoulder, a little less than halfway from the shoulder to the neck three finger widths, on a diagonal, inward from the last points

_On the back fairly close to the "dimples" above the buttocks, a little less than halfway in toward the spine

_Below the buttocks , very close to the outside edge of the thigh, about three finger widths

_On the front of your body, tender points are present in the following places:

_On the neck, just above inner edge of the collarbone
Still on the neck, a little further out from the last points, about four finger widths down

_On the inner (palm) side of the lower arm, about three finger widths below the elbow crease

_On the inner side of the knee, in the "fat pad"

The tender point locations are not "written in stone." They can vary from person to person, which can cause further problems with diagnosis. In traumatic FMS, for example, tender points are often clustered around an injury instead of, or in addition to, the 18 "official" points. These clusters can also occur around a repetitive strain or a degenerative and/or inflammatory problem, such as arthritis.

Trigger Points
About 23 million persons, or 10 percent of the U.S. population, have one or more chronic disorders of the musculoskeletal system. Musculoskeletal disorders are the main cause of disability in the working-age population and are among the leading causes of disability in other age groups. Myofascial pain syndrome is a common painful muscle disorder caused by myofascial trigger points. This must be differentiated from fibromyalgia syndrome, which involves multiple tender spots or tender points. These pain syndromes are often concomitant and may interact with one another.

Trigger points are discrete, focal, hyperirritable spots located in a taut band of skeletal muscle. The spots are painful on compression and can produce referred pain, referred tenderness, motor dysfunction, and autonomic phenomena.

Trigger points are classified as being active or latent, depending on their clinical characteristics. An active trigger point causes pain at rest. It is tender to palpation with a referred pain pattern that is similar to the patient's pain complaint. This referred pain is felt not at the site of the trigger-point origin, but remote from it. The pain is often described as spreading or radiating. Referred pain is an important characteristic of a trigger point. It differentiates a trigger point from a tender point, which is associated with pain at the site of palpation only. The word palpation or palpatated used here means the process of isolating the trp by using your fingers to locate the trip and placing them on each side of the trp so that the trp "raises up". This method is used so that the trp can easily be injected or can be manipulated by transversing pressure for release during massage therapy. Papation of a trp simply means "isolating" it and holding it in place.

A latent trigger point does not cause spontaneous pain, but may restrict movement or cause muscle weakness. The patient presenting with muscle restrictions or weakness may become aware of pain originating from a latent trigger point only when pressure is applied directly over the point.

Moreover, when firm pressure is applied over the trigger point in a snapping (snapping as best I can find a definition for means "displacement", like plucking a violin string, you know how those trps "wiggle" when you push them, that's "snapping", far as I can figure ) fashion perpendicular to the muscle, a "local twitch response" is often elicited. A local twitch response is defined as a transient visible or palpable contraction or dimpling of the muscle and skin as the tense muscle fibers (taut band) of the trigger point contract when pressure is applied. This response is elicited by a sudden change of pressure on the trigger point by needle penetration into the trigger point or by transverse snapping palpation of the trigger point across the direction of the taut band of muscle fibers.(this transverse "snapping" is when a therapist "grabs" the trigger point area and runs his/her fingers along the length of the muscle band in order to release the trp. Those of us who have had this trp release therpay knows that this method is very painful and it tends to burn, but it works well ) Thus, a classic trigger point is defined as the presence of discrete focal tenderness located in a palpable taut band of skeletal muscle, which produces both referred regional pain (zone of reference) and a local twitch response. Trigger points help define myofascial pain syndromes.

Tender points, by comparison, are associated with pain at the site of palpation only, are not associated with referred pain, and occur in the insertion zone of muscles, not in taut bands in the muscle belly. Patients with fibromyalgia have tender points by definition. Patients with tender points who have FM may also have trigger points with myofascial pain syndrome. Thus, these two pain syndromes may overlap in symptoms and be difficult to differentiate without a thorough examination by a skilled physician. Many of us here have both FM and MPS (aka Chronic Myofascial Pain Syndrome [CMP])

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