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Tender points are one of the main features of fibromyalgia, while trigger points are associated with myofascial pain syndrome. What are their differences?

What are tender points? How do they differ from trigger points?

So-called tender points are one of the main features of the chronic functional pain disorder fibromyalgia, which also tends to cause widespread pain, fatigue, disordered sleep, and even affects your ability to think straight. "Trigger points", meanwhile, are linked to chronic myofascial pain. People sometimes mix the two up, but the main difference between the two is that:

  • Tender points lead to pain or discomfort at the site of the point
  • Trigger points cause referred pain — pain felt in other areas

Tender points can strike in your muscles, fat pads, muscle-tendon junctions, or bursae (fluid-filled, cushioning, sacs), and having them is required for a fibromyalgia diagnosis. Because some patients with fibromyalgia also suffer from myofascial pain syndrome, however, they may have trigger points too. 

Fibromyalgia trigger points aren't any bigger than a fingertip, and though they're located around joints, the pain doesn't originate there. They're bilateral, occurring on both sides of your body, and though their locations tend to shift, more common areas in which people with fibromyalgia experience tender points include:

  • The upper chest
  • The base of your neck
  • Over the inner knees
  • Over the inner elbows
  • At your shoulder blades and upper back
  • At the back of your head
  • Over your hips
  • Around your buttocks
Fibromyalgia symptoms don't follow a neat pattern — the pain may be severe one day, and nearly gone the next, and individual tender points will disappear only to spring up in a new place. This is something doctors are getting better at taking into consideration during the diagnostic process. 

Patients should be aware that tender points and similar symptoms can also result from other medical conditions, like:

  • Polymyalgia rheumatica, an inflammatory disorder that leads to pain and stiffness and tends to affect the same areas of the body where fibromyalgia tender points also spring up.
  • Rheumatoid arthritis
  • Lyme disease
  • Lupus, an autoimmune disease

These and other conditions all need to be ruled out before a person is first diagnosed with fibromyalgia.

Fibromyalgia tender points and their role during diagnosis

Physicians used to use fibromyalgia diagnostic criteria that had them look for 18 different tender points; in order to "qualify" for a fibromyalgia diagnosis, the patient needed to have at least 11 of them. Today, your doctor will still look for tender points, but new diagnostic criteria look at the wider symptomatic picture of fibromyalgia more, and your doctor will verbally ask you to describe your past tender points rather than just testing to see which ones are "active" at the moment. 

What are trigger points?

Myofascial pain syndrome, which usually strikes after you make repetitive motions, during work for example — leads to sore spots within muscles that cause pain. (Before you ask, the "fascial" refers to your muscles' connective tissues, and has nothing to do with your face; the pain can affect many different parts of the body.) These sore spots, known as trigger points, can produce:

  • Pain when palpated
  • Referred pain  pressing the trigger point will cause pain in another area of the body. This is the main difference between trigger points and tender points. 
  • Involuntary movements and twitches
  • Reduced range of motion in the affected areas
  • Aches and pains not associated with current touch
  • Trigger points contain muscle or fiber that feels harder than their surrounding tissues
  • Tension headaches and migraines, temporomandibular joint pain, and tinnitus (a ringing in your ears) are all possible symptoms that aren't obviously connected to myofascial pain. 

Trigger points can be active or latent, with active trigger points being painful when you're resting, causing extra pain when touched, and leading to referred (radiating) pain that can be felt far from the original site. Latent trigger points, meanwhile, don't continuously hurt, but they may still reduce your mobility or be linked to weakness within the surrounding muscle. You may not know you have a certain latent trigger point until it is directly touched. 

Keep in mind that having trigger points does not mean you cannot also have tender points — fibromyalgia and myofascial pain syndrome can co-occur, in which case you'll suffer from both. 

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