If you hurt all over and feel worn out, you may have fibromyalgia or chronic fatigue syndrome. Both are serious chronic illnesses that have specific criteria for diagnosis, but may be overlooked because blood tests are typically normal. Also, the distinction between fibromyalgia and chronic fatigue syndrome is rather fuzzy, with up to 70 percent of patients meeting the diagnosis for both.1

Fibromyalgia Tender Points

Routine lab tests do not detect the widespread pain of fibromyalgia. Instead, the diagnosis is made by a physical exam of pressure points that takes about five minutes. When light pressure is applied to the surface of the muscles throughout the body, patients with fibromyalgia find this painful, especially at the specific tender point areas used for diagnosis.

Tender point diagram used for the fibromyalgia diagnosis, based on the CDC's 1994 guidelines.To meet the fibromyalgia criteria for diagnosis, patients must have:

A. Widespread pain in all four quadrants of the body for a minimum of three months

B. At least 11 of the 18 specified tender points (see diagram2)

The 18 sites used for the fibromyalgia diagnosis cluster around the neck, shoulder, chest, hip, knee, and elbow regions. The finger pressure that your doctor must apply to these areas during an exam is just enough to cause the nail bed to blanch or become white.

While many chronic pain syndromes mimic certain aspects of fibromyalgia, the 1990 American College of Rheumatology criteria identifies fibro patients with an 88 percent accuracy.3 This is just as accurate as blood tests for other medical conditions, so you and your doctor should not view fibromyalgia as a wastebasket diagnosis.

Tender Points vs. Trigger Points

What is the difference between tender points and trigger points, and how will it impact your treatment? For starters, 90 percent of the 18 predetermined tender points are actually myofascial trigger points.4 Trigger points are firm nodules that you can often feel in your tight, rope-like muscles. Pressing on a trigger point hurts in the area and also shoots pain to other regions, while pressing on a tender point is believed to only cause discomfort to the local area.

The finding that most of your tender points are actually trigger points is good news because it opens up your treatment options. There are specific therapies for relieving the painful knots in the muscles where the trigger points are located, and research shows that relieving the pain of just one trigger point can have a significant on reducing your body-wide pain. One of the more popular approaches is therapeutic massage, which involves working out the trigger points to try to get the muscles to relax. In fact, anything that eases muscle tension, such as a hot shower or soaking in a hot tub, will reduce the impact of the trigger points. Unlike tender points, trigger points cause a restricted range of motion (muscle tightness) and they radiate pain to other areas of the body.

Is your tender point count under 11?

If you don’t quite meet the tender point criteria, the diagnosis of fibromyalgia may still apply to you. The tender point diagnosis was developed for selecting fibromyalgia patients for research studies. However, patients in the general community are often diagnosed with fibromyalgia using less strict guidelines.

New Fibromyalgia Criteria Proposed

In April of 2010, a group of rheumatologists acting on behalf of the American College of Rheumatology (ACR) published new preliminary criteria on how doctors should diagnose fibromyalgia. There are pros and cons of these new criteria. Tender points have been tossed out the window and they have been replaced with a symptom checklist. Learn more and take a survey that will tell you if you meet the fibromyalgia diagnosis.

Do you meet the diagnosis for fibromyalgia?

If the answer is yes, visit our Latest News section for information about drug and nondrug treatment options – we post new articles about studies that may be helpful for you. If you stay current on the latest news about fibromyalgia, you give yourself the best opportunity to return to a more enjoyable quality of life. Symptoms can be both frustrating and overwhelming when other people in your life cannot see your pain or trivialize your diagnosis. Find out more about the symptoms and learn about your treatment options, including various methods to relieve painful trigger points.

Could you have chronic fatigue syndrome?

Doctors usually order tests to make sure you don’t have an easy to treat condition or one that needs can destroy tissues so it needs to be caught early (such as rheumatoid arthritis or lupus). If nothing shows up on your tests and you really don’t have the widespread pain required of fibromyalgia, you and your doctor may want to consider the diagnosis of chronic fatigue syndrome.


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