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Old 05-29-2005, 08:14 PM   #1
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Lightbulb Difference between TENDER Points and TRIGGER Points (sorry so long, lots of info)

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])

CONTINUED ON PAGE TWO
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Old 05-29-2005, 08:15 PM   #2
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Re: Difference between TENDER Points and TRIGGER Points (sorry so long, lots of info)

PAGE TWO

Pathogenesis (development of disease)

There are several proposed histopathologic mechanisms to account for the development of trigger points and subsequent pain patterns, but scientific evidence is lacking. Many researchers agree that acute trauma or repetitive microtrauma may lead to the development of a trigger point. Lack of exercise, prolonged poor posture, vitamin deficiencies, sleep disturbances, and joint problems may all predispose to the development of microtrauma. Occupational or recreational activities that produce repetitive stress on a specific muscle or muscle group commonly cause chronic stress in muscle fibers, leading to trigger points. Examples of predisposing activities include holding a telephone receiver between the ear and shoulder to free arms; prolonged bending over a table; sitting in chairs with poor back support, improper height of arm rests or none at all; and moving boxes using improper body mechanics.

Acute sports injuries caused by acute sprain or repetitive stress (e.g., pitcher's or tennis elbow, golf shoulder), surgical scars, and tissues under tension frequently found after spinal surgery and hip replacement may also predispose a patient to the development of trigger points.

Clinical Presentation

Patients who have trigger points often report regional, persistent pain that usually results in a decreased range of motion of the muscle in question. Often, the muscles used to maintain body posture are affected, namely the muscles in the neck, shoulders, and pelvic girdle, including the upper trapezius, scalene, sternocleidomastoid, levator scapulae, and quadratus lumborum. Although the pain is usually related to muscle activity, it may be constant. It is reproducible and does not follow a dermatomal or nerve root distribution. Patients report few systemic symptoms, and associated signs such as joint swelling and neurologic deficits are generally absent on physical examination.

In the head and neck region, myofascial pain syndrome with trigger points can manifest as tension headache, tinnitus, temporomandibular joint pain, eye symptoms, and torticollis. Upper limb pain is often referred and pain in the shoulders may resemble visceral pain or mimic tendonitis and bursitis. In the lower extremities, trigger points may involve pain in the quadriceps and calf muscles and may lead to a limited range of motion in the knee and ankle. Trigger-point hypersensitivity in the gluteus maximus and gluteus medius often produces intense pain in the low back region.

Evaluation and Treatment for Trigger Point pain.

No laboratory test, imaging study, or interventional modality such as electromyography or muscle biopsy has been established for diagnosing trigger points.


Predisposing and perpetuating factors in chronic overuse or stress injury on muscles must be eliminated, if possible. Pharmacologic treatment of patients with chronic musculoskeletal pain includes analgesics and medications to induce sleep and relax muscles. Antidepressants, neuroleptics, or nonsteroidal anti-inflammatory drugs are often prescribed for these patients.

Nonpharmacologic treatment modalities include acupuncture, osteopathic manual medicine techniques, massage, acupressure, ultrasonography, application of heat or ice, diathermy, transcutaneous electrical nerve stimulation, ethyl chloride Spray and Stretch technique, dry needling, and trigger-point injections with local anesthetic, saline, or steroid. The long-term clinical efficacy of various therapies is not clear, because data that incorporate pre- and post-treatment assessments with control groups are not available.

The Spray and Stretch technique involves passively stretching the target muscle while simultaneously applying dichlorodifluoromethane-trichloromonofluoromethane (Fluori-Methane) or ethyl chloride spray topically. The sudden drop in skin temperature is thought to produce temporary anesthesia by blocking the spinal stretch reflex and the sensation of pain at a higher center. The decreased pain sensation allows the muscle to be passively stretched toward normal length, which then helps to inactivate trigger points, relieve muscle spasm, and reduce referred pain.


Okay, Done! Go rest now! LOL Thanks guys for always "bearing" with me and my long posts.
Love you,
TK
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Old 05-30-2005, 10:11 AM   #3
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Re: Difference between TENDER Points and TRIGGER Points (sorry so long, lots of info)

Goodmorning TK, you are so ''up'' on all this fibro information, it
amazes me. My daughter is a history teacher and she received
$3,000 for one chapter in a new history book. It took her only a
couple of days to write the whole thing. You could write a ''first
hand account'' of what our daily lives are like. Even though we are
different in so many ways, the confusion and pain of firbomyalgia
makes us all kindred souls. I'm not joking about you writing an article
for a nursing journal; you can do it!
This is a rainy day in Alabama and I'm sure achy today. Wishing the
best to all of you,
Bilij

 
Old 05-30-2005, 10:16 AM   #4
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Re: Difference between TENDER Points and TRIGGER Points (sorry so long, lots of info)

Oh my gosh TK, I had been wondering about the difference for awhile, just haven't had the time to go look it up. You are awesome!

Bilij, sorry about the rainy day, just hold in there.
It's actually mid 70's and mostly sunny here with a slight breeze. My favorite weather, and I still feel especially icky today. Horrible headache too. Would be quite wonderful weather to go out in and just relax though, we have some chairs on our front porch, I might just do that. But I do wish I felt better and could go do more... oh well, maybe another day.
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Old 05-31-2005, 09:35 AM   #5
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Re: Difference between TENDER Points and TRIGGER Points (sorry so long, lots of info)

TK, Thanks for all your work, I know we need sometimes to get clarification. My foggy brain gets confused sometimes and I'm sure others do to.

GodsGirl, I hope you did get some rest in our beautiful weather. It will be hot and humid before we know it and we will all be staying in the A/C.

Thanks again TK

Glojer

 
Old 05-31-2005, 02:42 PM   #6
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Re: Difference between TENDER Points and TRIGGER Points (sorry so long, lots of info)

Hey TK,
Nice stuff. I am glad that someone took so much effort to write all this.
I am in a miserable state right now. I know for a fact that this is Fibro/MPS. I havent been diagnosed but its very very very obvious. You tell me if i am mistaken. I am seeing my PCP on 13th. He did mention Fibromyalgia last time but i am certain its both. Tell me TK, am i correct?!
Here's the deal...
Started with right back lower rib pain. That was for close to 4 months. I figured i damaged it during exercise. So, i did not get any treatment. UNTIL... The pain was excruciating and next thing i know my back and abdominal muscles hurt sooooo bad...
The symptoms were so vague that doctors kept wondering.
One day i woke up with extremely sore calf. Another day i woke up with extremely sore glutes and knees. Walking, climbing etc. were so painful. There was no obvious reason for this. I did not work out those muscles. I got a migraine attack for 2-3 weeks which was new. I never had migraines before. It hurts alone the spine and in the back and front rib areas. I also got a lot of abdominal muscle pain. Worst on the right oblique. It was hard and hurt a lot. They checked for gall bladder and it was negative.
They did an abdominal CT scan and heat CT scan. Negative. They sent me to a Rheumatologist and everything came negative. I started getting chest pain (muscle twitches) along with abdominal twitches and leg spasms. I get a lot of random pains. All of a sudden some part will begin to hurt for few seconds or minutes.
I may also have IBS. Having that checked as well... Everytime my stomach bloats and i have gas, i get terrible heartburn and abdominal discomfort. That bloating makes my trigger points worse... Yes, i said trigger points.
I have trigger points. I have identified it. I have millions, not all are active. I abdominal muscles, buttocks and outer thights all feel fibrous. I feel the rope like texture. In addition to that, i have many tiny nodules. There are times it begind to hurt randomly out of the blue. The minute i touch the spot where it hurt, i can feel the nodule. Besides, someof them are very very active. They are mainly near the lower rib and in the abdominal area. It feels like some insects in my flesh eating me. Almost feels like someone started poking me from inside. Its painful.
Now, clothes (jeans, bra etc) hurt. My scalp hurt when my hair moves even in bed. When i sit down. The groves of my tummy or abdominal muscle contractions hurt. I get red patches on my legs when i put my hands or the other leg on top of it. I have so much going on. And lately i burp every 2-3 seconds. This maybe related to IBS or some kinda GI issue.
I have been given Amitriptyline for my migraines. Its really good. It helps me sleep through the nights. I had trouble falling asleep and sleeping well. Now, thats not a big deal. Thanks to this medication.
However, my husband has to be very careful around me. He does the cooking, cleaning etc. I do nothing. Any amount of work aggravates it. I feel like a Zombie. I have absolutely no sex drive. I feel so bad for him. But he's amazing. The least i can do for him is keep smiling So i try.
Now, does this sound like Fibromyalgia with MPS ? Please let me know. I get these sharp pains at random times along with the sensitive areas that hurt when touched. The nodules that hurt the most are one under my left breast, few (3 or 4) in the abdominal area and one just below my right rib.
Any help and suggestions. I dont think i have the tender points. Atleast not 11. And the ones i have, dont happen simultaneously. Besides the fibrous nodular stuff on the glutes and knees cause pain with movement but not otherwise. Yeah, sometimes they also hurt when pressed. I dunno what it is. Hope there is a way out of this. My husband can also feel the nodules and there are tons of them.
Does anyone else has similar issues. I am looking forward to hearing from everyone not just TK.
Thanks ya all...
God bless.
LibertyGirl

 
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Old 05-31-2005, 06:09 PM   #7
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Re: Difference between TENDER Points and TRIGGER Points (sorry so long, lots of info)

Hi Liberty,

I just want to let you know that I have read your post and I will be answering it soon. I don't want you to think I'm blowing you off. I've had an early day, with only a few hours of sleep. One of those, "I can't sleep nights", plus I am reading a really good book! On top of that, I woke up with awful diarreha. Took nearly 2 hours for it to finally pass and have my cramp subside. So, I'm a little weak! Part of IBS!

Right now, what I want you to do is go to the new part of the Healthboards. The one about "Research", there is a thread there about how to ask a question during a search. I have a post there. Follow the directions on the RESEARCH board on how to ask a question to search with. K? Then use your "tools" you have right there, and find out as much as you can about the symptoms of what you are feeling. Use your "tools" to learn about CMP or MPS (the same), see what you find. And I will definately give you my "unprofessional" advice. I can only tell you what I believe you may be experiencing, it is only my opinion from my own experience.

First, I'm going to tell you to start a pain diary. You can learn about those also using your "tools". It will help you better narrow down times or pattersn when your painhits you.

I'll be back to your post, hon, I won't forget. Let me also see what I can find in all my "stuff".

"I'll Be Back!"
tk
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Old 06-01-2005, 07:26 AM   #8
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Re: Difference between TENDER Points and TRIGGER Points (sorry so long, lots of info)

Hey TK...
Sounds good... thanks for the advise..I will look into it... Great to hear back from ya...
Talk to you soon...
Take care... I hope you feel better.
LibertyGirl

 
Old 06-02-2005, 11:36 PM   #9
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Re: Difference between TENDER Points and TRIGGER Points (sorry so long, lots of info)

Quote:
Originally Posted by LibertyGirl
Hey TK...
Sounds good... thanks for the advise..I will look into it... Great to hear back from ya...
Talk to you soon...
Take care... I hope you feel better.
LibertyGirl

Hey you!

Thanks for understanding. I've had a lot of tests this week. 2 MRI's on the same day, and EMG and an Ultrasound of my Carterol(sp?) Artery. I have no idea how you spell it, but it was an Ultrasound on the big artery in your neck that you hear your heartbeat in.

I have NO appts. tomorrow! Yippee, so I'll try and get back here tomorrow. Meantime, try to find out as much as you can about what your feeling using the resources you have at your "finger tips."

Talk to you soon. I'm sleeping 'til Noon tomorrow! Oh Yeah!

Hugs,
tk
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Old 06-04-2005, 12:02 AM   #10
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Re: Difference between TENDER Points and TRIGGER Points (sorry so long, lots of info)

Okay LibertyGirl, I'm ready!

First of all, I'm going to "bump up" the thread here on the FM board called "The List". This list is a symptom "guide" for FM and Chronic Myofascial Pain Sydrome aka MPS. Keep in mind that many of FM symptoms mimic other conditions and they also cross over into other conditions like Chronic Fatigue Syndrome. You do not have to have ALL of these symptoms and a lot of these symptoms can be experienced by folks who don't have and never will have Fibro. K? It is meant to be a "guide".

Next, IBS. You said you are being tested for this? What kind of test? I never knew there WAS a test. I've heard of other folks getting tested for IBS, I guess they didn't do that when I was first dx'd. I had IBS way before I was dx'd with FM. IBS means just as it sounds. Irritable Bowel Syndrome. Your bowels are "irritable" kinda like some of us when we have PMS! Typically someone with IBS will go from acute diahrrea(sp?) to acute constipation. The diahrrea will come on all of a sudden and for no apparent reason. Just WHOOSH! It can be quite debilitating, cuz, you will become bloated and have cramps so bad that you can't button your pants. Then next week you'll suffer from constipation and you'll need to break down and use a laxative. Sometimes you can go from constipation to diahrrea in one day. I kept an account of all my "episodes" on the calander for two months. On days when I had diahrrea I would put a big "D" on that date, constipation, a big "C". There would be times when I'd have like 4 "D's" in a row, followed by 3 "C's". On a normal day, I'd just put "N", meaning I went to the bathroom that day without "incident". The "C's" on the calander meant I did not have a bowel movement and I was experiencing the symptoms of constipation (bloating, pain, nausea). I remember driving to work and having to pull over into the nearest gas station and RUN to the bathroom hoping I would make it. IBS also had a tendency to dehydrate you, and make you feel weak and exhausted. It's like after an episode of diahrrea you feel like you just swam in the Olympics. Same thing with the constipation, you feel like you just gave birth!

Also, you may have GERD, acid reflux. Just my opinion because of your burping so often. I'm suprised your gall bladder is okay, cuz some of your abdominal pain sounds like gall bladder pain. Gall bladder pain is similar to "ulcerous" pain, it is a "burning" pain, in your side. Which ever side the gall bladder is on, I can't remember.

You sort of described your pain, but not in enough detail for me to know more than you have pain. Is it burning pain, numbing, tingling? What about your motor functions? Can you lift things, sit for long in one position, hold onto things without fumbling, walk straight? What about after you get moving for awhile, do the muscles seem to release? Have you tried any OTC creams for muscle pain? How about some Ibuprofen? Aleve? Any of those help? You mentioned medication. What are you using? I may have missed it. Okay, I see it, the meds for migraines. Good that it is helping.

When you say you have pain along your spine and in your back and front ribs. Where exactly along the spine? Upper, midsection, or lower? I would like to know if that muscle pain in your abdominal area is a burning pain. What about your sternum area? Is it sore to touch? Does it feel like there is a lot of "pressure" on it? You also have pain in your calves? Burning?

Okay, these nodules. Are they knots? When you locate the nod can you do like it said in my post, grab it between two fingers and raise it up? What does it feel like when you transversely massage one of the nodules? Does it burn? It should. If you, or your husband finds the nodule then runs pressure along the length of the fiberous pressing on that nodule the whole time to get it to release it should feel like your skin is on fire. This is because of the neurons in the skin tissue reacting to the neurotransmitters that are responsible for your pain. The nerve endings in your skin are very sensitive, more so when you have inflammed trigger points.

Are you seeing your Rheumy on a regular basis? When is your next appt? Have they suggested an EMG? This tests the nerves in certain areas for damage.

I gotta say, I'm not sure about the type of pain you are experiencing mostly because of where it is, like your calves and your abdominal muscles. While trigger points can occur most anywhere you have muscle tissue, most common areas are the upper back, neck and shoulders.

Your rib pain puzzles me also. I have rib pain from a condition called Chostochondritis. You can find information at your finger tips about this condition. But it is basically an inflammation of the cartiledge between your ribs and around your sternum. The pain is awful. It can best be described as sore, achey, tender to the touch (extremely), causing pain when you breathe or wear a bra. The sternum is sore to touch, like a big bruise. Chosto is often mistaken for a heart attack. There are a lot of folks here who have posted that they went to the ER because they felt like they were having a heart attack, only to find it was Chosto. Chosto normally is worst when you get it the first time, it can last for a couple weeks to a few months. Most times it goes away and doesn't return, or if it does return, it isn't as intense and lasts for a couple days. However, chronic Chosto will recurr more often and will last for more than a few days, usually a couple weeks. The only help for Chosto is anti-inflammatory meds. There are some safe ones out there that can be rx'd by your doc. I use Arthotec, but Aleve works well on the inflammation if all you have to deal with as far as an inflammatory condition is the Chosto. No need for a med if you can do with an OTC med. Also, if you do a board search for Chostocondritis you will pull up all the threads and posts that have the word Chosto in it. I remember we did a pretty long thread on it awhile back. Just use the "search this board" feature on the Fibromyalgia board. The search tool for each individual board is located on the page that lists all the threads, it's in the blue area located right under "NEW THREAD", it's on the right hand side right under the listed pages, you know the 1 2 3 Last, etc. It's next to Board Tools and says "Search This Board". Just click on the arrow and the diaglogue box will open and type in Chostochondritis. See what pops up.


CONTINUED ON PAGE TWO:

Last edited by tkgoodspirit; 06-04-2005 at 12:06 AM.

 
Old 06-04-2005, 12:05 AM   #11
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Re: Difference between TENDER Points and TRIGGER Points (sorry so long, lots of info)

PAGE TWO:
Reply to LibertyGirl


Has your Rhuemy run all the blood tests to rule out all the "other" conditions, like Lupus, RA, thyroid problems and similar autoimmune diseases? There is no blood test for FM, although they can test for Substance P in your spinal fluid by doing a spinal tap, but that's normally not done, good for us! Having FM, we have an elavated level of Substance P.

I can't say that your muscle soreness sounds like FM. FM is a musculalskelatal (sp?) disorder that causes inflammation of the connective tissue. It doesn't really cause inflammation of the muscles themselves. I don' know, honestly, what would be causing the inflammation and soreness of those muscles you mention. FM is not an inflammatory condition. CMP, well, I'm still learning about that. So far, I know that CMP, or MPS causes the inflammation of the trigger points, and is a widespread condition. Breaking down the definition of Myofascial goes like this: Myo = muscle
Fascia (fascial) = A sheet or band of fibrous connective tissue enveloping, separating, or binding together muscles, organs, and other soft structures of the body.

Please do me a favor and do not dx yourself with FM. Reason being, you may have something completely different that needs much different treatment than FM does. You said you sleep okay? You up and down during the night? What about your legs at night, do they "jerk" or twitch?

I have to say that yes, you most likely have some nasty trps (millions? maybe not ). Have you ever had a massage? See if you can find a good massage therapist that does Trigger Point Release. Ask them. It's basically deep tissue massage, but ask the facility if some one there is trained in Trp Release Massage Therapy. You need someone who know's what they are doing or you could end up injured. What about a pool near you? An indoor heated pool? Usually you can look in the yellow pages to find "Aqua Therapy" or "Water Aerobics". The YMCA is good, cuz you aren't paying the physical therapy prices. I would try some sessions of pool therapy, it's great for MPS, and FM, heck, it's just GREAT! (I sound like Tony The Tiger) What about stretching exercises, have you tried them? Have you gone to any kind of PT? Maybe get your Rheumy to rx you PT for a month. Get some Ultrasound Heat Therapy on those muscles. Also a TENS unit might give you some relief on those muscles. Again, use the tools at your finger tips to learn about TENS. I can't recall right here what the initials stand for, sorry. But it's a set of electronic stimulators that you stick onto the affected area and it sends out little electric charges at a certain rate, which strengthens these muscles while at the same time "releasing" them. You control it. Some docs will order the unit for you and you purchase it over time, or you can get it done at PT. This way you don't have to buy it if it doesn't help you. They are somewhat expensive, but if you have an ongoing condition and the TENS helps you, I would purchase one, your insurance covers most of it and you just pay the rest to the TENS supplier on a monthly basis. Like when I bought my wheelchair. If the script for TENS is written for you by your doc, then you can usually buy it. They'll give it to you after a rep from the TENS supplier shows you how to use it, and you take it home with you and use it as prescribed. It would be worth the cost if it's something that helps you.

Okay, I know I didn't give you much there. I just don't want you to dx yourself with FM. You can certainly determine that you possibley have FM, but wait for a doc's dx. Or you will have a dickens of a time when you see any other doc, cuz, unless you have an official dx of FM, and you see a doc and tell them you have FM, they won't treat you correctly. Has your doc suggested that you may have FM? You can find another Rheumy. I've been through 2 already and I'm currently on my 3rd, so far so good. See if you can't find a doc in your area that specialized in FM. Call around to clinics, hospitals, or, again, use your "tools" to look up a FM doctor/specialist in what ever area you are in. Neurologists sometimes dx and treat FM. Sometimes even Ortho's dx and treat, but not too often. Is there any chance of your doc referring you to a Pain Management doc or clinic? A good PM doc or clinic will use all modalities to dx and treat your FM, including PT, tests like EMGs and injections of anti-inflammatory agents, as well as medications.

I would ask your Rheumy about writing you an rx for Lidoderm/Lidocaine patches. These are WONDERFUL for muscle and trp pain. You just stick 'em right where the pain is and they numb the nerve endings and slowly release into the skin to the affected area to numb and decrease swelling. I love 'em. I told my Pain doc that last month and he handed me five patches and wrote me a script for 3 boxes! LOL You can cut them, or if you are having neck and upper shoulder pain, you can cut just a small slit in the patch to "butterfly" it so it shapes your neck better. Ask your doc for some samples first. Maybe he/she will hand you a few patches to try out. They last for 12 hours and only work where they are put. They are a localized treatment for pain. They only give relief where you stick 'em.

LibertyGirl, it's your muscle pain that puzzles me. Please ask your doc about FM and see if she will do all the tests that may indicate FM. Also, when you see your Rheumy next, try as best you can to describe your pain in great detail. Like stabbing, throbbing, grabbing, tingling, weakness, sharp, dull, achey. Use words to describe how it affects you. Like "I feel sharp pains in my ribs when I inhale" or "I feel like my calve is in a vice grip". Be as detailed as possible. Get that pain diary going, like I said you can find them on your computer. Use that thing! You'll learn a lot. Find something you think describes your pain, copy it, get it on paper to show your doctor. Try those heated pads you can get OTC, get some anti-inflammatory creams, also use ice packs. Though heat feels better, ice is good to reduce the swelling. Use a pack of frozen veggies! Stretch, stretch and stretch! You have one of those big "balls"? Use it to lay back on and stretch out those abdominal muscles, calve muscles: you know how to stretch those right? Lean against the wall, hands spread out on the wall, heels to the floor with your feet as far back as possible without you fallng. Find a slight incline, like a wedge, and put your feet on it so that your heels are touching the floor and your toes are pointed up towards your shins. Be careful when doing any kind of stretching, do it slowly, very slowly, and ask your doc if it's okay before you start. Definately ask your doc to get you into some PT. They may actually find a definate dx of what is going on with those muscles.

***Sigh*** I'm whooped! LOL I know I didn't help you much, I'm sorry. I will bump up that list. It's titled "The List" and I think it says something about "for all the Newbies" ( something like that). It's a whole thread, so look for it. I'll just bump it up so, it should be on the first page. Check it out, print it out, highlight any symptoms you are feeling, take it to your doc, and go from there. But definately ask your Rheumy about the possibilty of you having FM. And let us know how it goes.

Get those trps worked on! They are only going to get worse w/o any kind of treatment. And as you alread know, the pain from those buggers are pretty awful. Trp release massage therapy is really effective. I just had it last month and will have it again as soon as I catch up on paying for all these new medical bills. It hurts like the dickens the first couple times you get it done, but it will give good relief. Bluelakelady gets trp release massage and she, like me, feels relief through the tears! LOL It will bring tears to your eyes, but it feels so much better after 2-3 sessions. You will be sore the nextg day, but it goes away, and you aren't having it done every day. It doesn't work if you have it done every day. You gotta let 'em rest a day!

Good luck hon, I know my reply to you is going to be excrutiatingly long and I'm sorry, but I felt I owed you a thorough reply. I'll break it up into two pages, take your time reading it, don't overwhelm yourself in one sitting.

Please Please let me know how you progress. Let me know what you find out. Get to your doc. Also I'd like to know about any kind of tests they order for you. Particularily an EMG.

Don't give up, it will take time, but we'll get you there! Next time I'll tell you about my great journey with some of my "other" conditions, and about my numerous and costly tests. You are not alone.

Look for that thread "THE LIST".

Here's wishing you a good spirit!
tk
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"We must be the change we wish to see in the world"
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Last edited by tkgoodspirit; 06-04-2005 at 12:10 AM.

 
The Following User Says Thank You to tkgoodspirit For This Useful Post:
whatswronghere (04-01-2011)
Old 06-06-2005, 10:21 AM   #12
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LibertyGirl HB User
Re: Difference between TENDER Points and TRIGGER Points (sorry so long, lots of info)

Hey TK... Thanks for the detailed message. I really appreciate your efforts. It helps a great deal... As far as the pain and exams and all those descriptions... I will write as soon as i get time... This time, its gonna be long post with as much details as possible. I may need some time so i will get back to it soon... I just had my wisdom teeth pulled out... All four of them... My face is all swollen. Besides, i am seeing the GI specialist today and also the eye doctor... I am so busy with work and hospitals... But i will surely take time to write a detailed message ASAP.
Thanks again. I did learn a lot of new things from you today. I will talk to my Rhuemy about it... Seeing her next monday... Also seeing my PCP next monday and a Infectious diseases guy too ... All next monday.. My life's exciting now... But the oxycodone for the dental surgery is also keeping the body pain away
Talk to you soon.
I will post the details of the exams and stuff soon... Thanks TK... Take care...
LibertyGirl.

 
Old 06-17-2005, 04:16 PM   #13
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tkgoodspirit HB Usertkgoodspirit HB User
Re: Difference between TENDER Points and TRIGGER Points (sorry so long, lots of info)

Bumping Up!
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"We must be the change we wish to see in the world"
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Old 06-21-2005, 12:29 PM   #14
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LibertyGirl HB User
Re: Difference between TENDER Points and TRIGGER Points (sorry so long, lots of info)

Hi TK... sorry it took so long. I have been lining up so many appointments with doctors. I also had wisdom teeth extraction. Now i need to get the TMJ taken care of. I am seeing a PT today for my rib pain and restricted motion. Life's not fun.

I saw the GI specialist and he is going to do an abdominal x-ray and sigmoidoscopy. If things dont improve with prilosec and high biber diet, he shall do an endoscopy. I have a bunch of GI issues also as i mentioned before.

You have been very helpful but i have had really busy weeks and weekends. Between house, work and hospitals. Also planning on vacation to India next month. I feel so bad for the delayed response.

Anyways, i did find your email very very helpful... Infact, i took your input and copied on a word document i often use to catalogue info about treatments and tests. So, thanks for that...

My doctors, PCP as well as Rheumatologist together have done the following exams:
Blood work including CBC, ESR, CPK, Thyroid, ANA, Lyme etc.

Everything came negative. All are in normal ranges.

My doctor "thinks" I may have Fibromyalgia. He never examined the tender points. He just said since the blood work is all negative and i have widespread pain, its Fibromyalgia. You gave me better reasoning than my doctor did. I am seeing a PT today to see if he can check for the tender spots.

Following is a detailed list of the symptoms i have...

SYMPTOMS
PAIN PAIN PAIN PAIN PAIN PAIN PAIN PAIN PAIN !!!

§ Excruciating burning pain wraps along the abdomen, obliques and the ribs. Extremely tender to touch. Clothing hurts too on certain days. Feels like the pain is in the flesh or on the surface of the skin. I can feel the fibrous/nodular nature of muscles/tendons. Sounds like musculoskeletal pain or pain in the soft tissues. Can you or someone explain how they feel when you move your hands over our abs, muscles. For me, the muscle tissues and tendons under the skin can be felt as rope like fibers and nodules. When touched, hurt immensely.
§ Extreme pain along the spine, ribs and shoulder blades. Especially the should blades.
§ Burping– constant burping (every 2 to 3 seconds). Perhaps related to IBS or other GI issues.
§ Chest pain.
§ Shortness of breath/Difficulty breathing through nose (sometimes). Irregular heartbeats (sometimes)
§ Pressure in the front and top head and upper Chest- Usually happens if I bend forward, wake up from a sitting position, move suddenly, start walking or exhale. I can feel the heartbeat rhythms or beats throbbing in the forehead and upper chest. It feels like a lot of pressure. Its a weird feeling that is tough to put in to words.
§ Extreme headache with crushing pressure like feeling. The head becomes very sensitive to touch especially on the right side. The head muscles also hurt all over. I also have neck and shoulder pain. Shoulder blades are the worst. My shoulders hurt all the time.
§ Blurry Vision. Pain in and around the eyes (forehead, temples etc) and photosensitivity. Eyes are also very dry and red. Had eye inflammation (irisitis), which was treated with steroidal eye drops.
§ Temporomandibular Joint disfunction (TMJ)
§ Severe headaches – Result of TMJ. Hurts the most in temporal area above the cheek.
§ Bowel issues- Constipation, Painful bowels and Bloody stools. Gas, bloating and cramping.
§ Knee pain- both knees inthe fat pad. Not necessarily tender. Bad with movement especially after a hot shower
§ Muscle pain all over the body- Neck, shoulders, upper back, around ribs, lower back, abs, hips, thighs. Persistent back pain along the spine.
§ Hormonal changes – mood swings, loss of sex drive altogether, irregular periods with excessive bleeding or very little bleeding etc.
§ Weakness and fatigue – get exhausted too quickly. Always tired and sleepy. Inability to perform simple things. Fall asleep while driving even in the mornings. Just cant feel fresh even after a hot morning shower.
§ Numbness – arms and legs- especially during sleep. Have to sleep straight to ensure blood circulation.
§ Deep, intense stabbing pain that comes in various random locations – abs, spine, chest, head etc. Lasts for few seconds to a few minutes. Have gotten better in the past month.
§ Had red raised burning rashes on abdomen and shoulders in April for a week. Have some redness on my hands and feet. Have blotchy skin. Those rashes in april are perhaps unrelated but i dont know. There were no signs of infection as per the blood work.
§ Muscle twitching – especially in the abdomen and chest area. Have gotten much better.
§ Any amount of work and movement aggravates the rib and spine pain – can’t bend or lift anything. Exercise and stretching only make things worse. Can’t even bend to wash hands or brush in the sink. Some days I can’t even shower, open a door.
§ No vomiting. No stress or depression. No noticeable swelling. No weight loss. No crazy fever. Have swollen nodes in the neck but they've been there for 6 months.
§ Waking up with extreme headaches, joint and muscle pain for no obvious reason- for e.g., hips, glutes, calves etc.

Does any of this make sense or sound like Fibromyalgia. I do not have all those tender points. Atleast not at once. I have noticed today that point#6 is very tender. It hurts a LOT when i press the spot. However, other spots like the fatpad in the knee are painful but not necessarily on application of pressure. They are not tender to press. They just hurt when i move it. Also the muscle pain in not tender to touch. They just hurt. On the other hand, my abdominal wall, oblique, sides of the rib etc are very tender to touch. They hurt so much. I have pain in the soft tissues and thats why my doctor thinks it is Fibromyalgia. Does this sound right? I also have slight morning stiff ness in the neck and fingers but nothing significant.

TK, I am so not convinced with my doctor's approach. He doesnt think anything is required to be done. He just sent me home saying there is no apparent reason and nothing serious from the blood work. He also said since there is no deterministic cure, the best thing for me is to exercise and that i will be good in 2 months. It hurts even if i bend a little to brush my teeth let alone exercising. One day i tried little bit of walking and streching and i was crying for 2-3 days.

I am seeing a PT today who has decent knowledge about Fibromyalgia and MPS. This is a session to evaluate everything. Anything i should discuss with him in particular. I will surely ask about TENS, ultrasound etc. that you mentioned in your reply.

I dont know why are women between 20 to 50 are in high risk categories for all these painful diseases. Why not men!?! Unfair !!!

I will also ask my doctor for Lidoderm/Lidocaine patches. Are they similar to heat patches?

You spoke about EMG in your reply. I will ask my PCP about it although he is adamant that i do not need any more exams. But, i will certainly ask him about it.

Chostochondritis- yes, even i thought about it. I could not even move. Movement would bring tears... Its better now... However, the ESR does not show that i have any inflammation. Its so weird coz my eyes were definitely inflammed! The eye doctor found it. I dont believe that ESR test.

I have so much pain. I have pain in the soft tissues on my abdominal wall, obliques, ribs (under breast and on the sides under the arms). It hurts so bad when touched. Its so bad. I dont think its gall bladder. Although you were right because initially it only hurt on the right side and they did an ultrasound to determine it wasnt the gall bladder. Now, its on both sides. everywhere on my trunk. Even my breasts are sore on some days.

I have a lot of back pain, headache and shoulder pain also. The shoulder blades really are very tender. I also am always tired !!!

TK, thanks for all you help. It's helping a lot. I am again sorry to have been so late with the reply. Its just been very very busy and painful lately. The teeth extraction made the TMJ worse, which made the headaches worse and so on... Every monday i am seeing doctors so i work on Saturdays instead. There goes my work. After we return from vacation, i am probably gonna quit and get my health straightened out !!!

I am really interested in leaning if Fibromyalgia patients get sensitive to even slight touch just like i do. Also interested to find out how your muscles feel as far as the texture is concerned. Is it rope-like fibers with nodes/nodules. The tiny nodes are what cause pain. They are in clusters and there are many of them. Its more prominent on realllllly bad painful days and less to on other days. I wish i could touch someone else and feel it if this is normal... Unfortunately all my family is in India and most in my husband's family are very overweight so i cant feel anything. I cant rub and feel on my husband because he has lipomas and it would hurt him. Also, mean are so hairy and have thicker skin. Its impossible to find out. I dont know if the way my soft tissues feel is normal or not.

Thanks. Take care.
LibertyGirl

(To lazy to do spell checks on long posts, please ignore the mistakes )

 
Old 08-10-2005, 02:41 AM   #15
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sunshine70 HB User
Re: Difference between TENDER Points and TRIGGER Points (sorry so long, lots of info)

Thank you so much, TK, for taking the time to type all that. I almost cried when I read about tender points b/c all I ever heard about were trigger points. I obviously must suffer more from the tender points and feel so much better being validated. Thanks!

 
Closed Thread

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