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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.
These tender points are located at:
- Occiput (2) - at the suboccipital muscle insertions (near the
base of the skull)
- Low cervical (2) - at the anterior aspects of the intertransverse
spaces at C5-C7 (the lower vertebra of the neck)
- Trapezius (2) - at the midpoint of the upper border (the neck,
mid back and upper back muscles between the shoulder blades)
- Supraspinatus (2) - at origins, above the scapula spine near
the medial border
- Second rib (2) - upper lateral to the second costochondral junction
(the insertion of the second rib)
- Lateral epicondyle (2) - 2 cm distal to the epicondyles (the
side of the elbow)
- Gluteal (2) - in upper outer quadrants of buttocks in anterior
fold of muscle (the upper and outer muscles of the buttocks)
- Greater trochanter (2) - posterior to the trochanteric prominence
(the upper part of the thigh)
- Knee (2) - at the medial fat pad proximal to the joint line
(the middle of the knee joint)
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