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tender points
14 Replies
tnichel - September 7

I was diagnosed 2 months ago with fibromyalgia by a rheumatologist. He doesn't treat it so I went to another rheumatologist a month later. During that waiting period I began using a tennis ball on the tender points in my shoulder and back. Now the 2nd doctor I saw said he's not sure I have it or not b/c I didn't react to the tender point test. My question is... do tender points get less painful when you consistently massage them. ?When I was first diagnosed I hadn't been using the tennis ball massage. I'm wondering this may have confused the 2nd doctor b/c I was doing almost every night for a month before I saw him.


JJ1 - September 7

I do not have the tender points but still have been diagnosed with fibromyagia do to my other symptoms (which include pain, but not trigger point pain).


islandguy - September 7

The medical profession has made it quite clear that you must have 11 out of the 18 tender points to be diagnosed with fibromyalgia. You may find that on a flare up you have more than 11 tender points but on a good day you may have under 11.
Regardless if you do not have at least 11 points you do not fall into the category of fibromyalgia and there may be some unlying problems to cause these pains be it arthritic or something else. All the medical people I see are very specific on this matter and will not deviate from the pressure point count.
Possibly some of the doctors do it differently. Possibly that's where we get so many misdiagnosis problems.
In saying that I have recently been put on 400mg of Zytram XL which has helped me with the pain by 40 percent.
It is not a mind altering drug but a pain killer. Ask your doctor and see what he thinks of it to reduce your pain. 400mg is the maximum dose you can take and it works well for me so far.
Good luck.


tnichel - September 9

Thanks for the answers. I also forgot the add that I DID have several tender points but not 11 the day I saw the 2nd doctor. He also touched spots the other doctor didn't and his touch was very light. Now near those points where I didn't respond to his touch were very tender areas. It's just frustrating to be told you have one thing, look up the symptoms and realize you've had them all for the past 7 years and feel hope things will change and then another doctors tells you he's not sure whether you have the condition.


JJ1 - September 9

My doc told me that the tender points were needed to be considered in FMS clinical trials but it is not the only basis of diagnosis.....From the National Fibromyalgia Research Association --- "The American College of Rheumatology bases the diagnosis of FM upon two major criteria: 1) widespread, diffuse pain lasting at least three months and 2) a minimum of 11 (out of 18 possible) specified tender points throughout the body. This is the strict definition for being included in a clinical study of fibromyalgia, but tender points may change from time to time, and may worsen or get better in the cyclical way that this syndrome seems to work.

These tender points will hurt when pressed, but the pressure will not cause pain in any other part of the body. The physician applies a standardized amount of pressure, about 4 kg (enough to turn the thumbnail white). Remember, a tender point has to be painful at palpation, not just "tender." When pressed, these areas tend to feel like bruises in various stages of healing.

Also, a tender point is different from what you may know as a trigger point. Tender points hurt, trigger points hurt and refer pain to other body parts. Trigger points cause myofascial pain syndrome, which often coexists with fibromyalgia, but can be treated with massage, physical therapy, or gentle stretching. When muscles feel hard and pressing on them causes a response elsewhere in the body, or even nausea, trigger points are responsible. Tender points are caused by an unknown mechanism, and their severity is often cyclic. Tender points do not generally respond to physical therapy, often becoming more painful with pressure.

Widespread pain is defined as having pain in both sides of the body and pain above and below the waist. In addition, pain must also be present in the cervical spine, anterior chest, thoracic spine or lower back. "


JJ1 - September 9

Also, from "Diagnosing Fibromyalgia
under "Diagnoses and Tests" on the blue side bar of this website....."Why Eleven Points?
Some experts believe that a person does not need to have the required 11 tender points to be diagnosed and treated for fibromyalgia. This criterion was originally intended for research purposes. A diagnosis of fibromyalgia may still be made if a person has less than the 11 of the required tender points so long as they have widespread pain and many of the common symptoms and associated syndromes connected to fibromyalgia, such as sleep disorders and irritable bowel syndrome. "


islandguy - September 9

Well done and researched JJ1.

You have covered it very well and have also pointed out that the widespread pain needs to be in all four corners of your body. Well done. I totally agree with your post.
"Widespread pain is defined as having pain in both sides of the body and pain above and below the waist. In addition, pain must also be present in the cervical spine, anterior chest, thoracic spine or lower back. "


skidoo - September 14

The tender points were developed initially for diagnosis and to identify potential candidates for clinical trial studies. It is still used to identify those candidates but it is also recognized that all fibromyalgia patients do not have these tender points.


Robin1237 - September 20

I think we actually have Lyme diseae, a bacterial infection, generally gotten from an infected tick bite, but can also get it from other insects and human tramsmission as well. Go read at and see what you think. They can help you find a doctor who's knowledgeable in recognizing Lyme symptoms, doing the testing and treating. In general, we need antibiotics, but there are also lots of treatments people are trying. When I did clindamycin antibiotic 150 mg 4x/day, all the fibro pain went to zero in one week.


Tallulah - November 22

The 18 tender points are only the most common ones, there are up to 50 possible tender points and they may vary in sensitivity from day to day, perhaps you just don't have them in the most common places where they check.


gimmeemo - November 28

Good job with detail Island guy! Also, Tallulah..Or you know where I can see all 50 tender spots, because I swear, I counted over 20 spots just around my pelvic region, hips, thighs, knees, lower back. I lost count and it has spread and increased in severity that I have so many spots around my stomach, ribs, upper back, sternum, chest arms....Any where there's a muscle, there's a spot....Even on my head and behind my ears...Jeez...I'd like to make sure I'm not just being a hypochondriac!


Tallulah - December 3

I haven't found a list or diagram of the other tender spots anywhere, but I get them on my head, temples, upper arms and other places too and I was confused as they weren't in the usual places on the diagrams. Then I read that there are up to fifty different ones in a book maybe or a website, can't remember where.


JJ1 - December 4

The typical diagrams that you see with only 18 tender point locations are used to determine candidates for use in clinical trials and studies. They need to have a set of criteria to use so they can tell if a drug or therapy is working. In the real world, there can be much more or less tenderpoints for those suffering from Fibromyalgia.


Tallulah - December 12

I read about the other tender points in ' The First Year, Fibromyalgia' by Claudia Craig Marek, p.27. This book is recommended by the Fibromyalgia Association UK. It says that the tender points aren't important except for research purposes and it isn't helpful to focus on their importance, most of the rest of the body can be tender as well. You don't need someone else to tell you where you hurt!


tnichel - December 13

UPDATE: Thanks for your answers guys. The 2nd doc now believes I do in fact have FMS. I'm searching for a new doctor now b/c I don't think he has much experience with it. Right now I'm pretty much on a wait and see program with him and still have so many questions. he recommended using ice massages for the tender points. have you ever heard of this? that would be fine but since I live by myself it's kind of hard to do self ice-massages. what about pain patches, ben gay, or other alternatives? I don't want steroid shots not that the doc suggested it .. i've just been doing a lot of research. I no doubt have a lot of knots in my back , well all over really.



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