Q: There’s a disagreement in our new fibro & ME/CFS support group. Some of us think “tender points” and “trigger points” are really the same thing. And some think they may be different things. Could you clarify, please?
A: In fibromyalgia, the main findings on physical examination are the tender points. Tender points are areas in the soft tissue (the muscles, tendons, and/or ligaments) that are very sensitive, and painful when pressed (with enough pressure to make my thumbnail blanch).
Tender Points - Indicative of FM
These tender points are found in distinct locations of the body. They do not move around and can be found in multiple locations… These are “signature” areas that distinguish individuals with fibromyalgia from those with chronic muscle pain from other causes….
Trigger Points – Anyone Can Have Them; Often a Result of Muscle Trauma
If pressing on a particularly painful tender area causes pain, numbness, or tingling to radiate or spread to another area, this spot is called a trigger point. A trigger point is another typical finding in patients with fibromyalgia and was first described by Dr. Janet Travell.
If I were to press on an area in your mid-trapezius muscle and you felt numbness radiating down your entire right arm into the hand, that area in the trapezius muscle would be called a trigger point. (It could also be a painful tender point as well.)
These trigger points can cause confusion since they may mimic a pinched nerve. Rather, the trigger areas in the muscles are causing radiating symptoms to distant locations.
Trigger points arise from shared neurological links between seemingly unrelated body parts.
These seemingly unrelated parts actually shared a common tissue during the body’s early fetal development. After these tissues divided and formed specialized parts, a common sensory neurological link remained and could “communicate” (refer pain) in certain situations.
For example, if a man is having a heart attack, he may experience numbness in the left arm. There is no problem with the left arm, per se. Rather, the heart muscle is being damaged, and because it has sensory connections to the left arm, it sends referred symptoms down the left arm. The injured heart muscle acts as a trigger point in this situation.
The human body has hundreds of potential trigger points.
They can develop wherever fibromyalgia pain develops and are very common after trauma to muscles. Trigger points can cause numbness, headaches, dizziness, ringing in the ears, jaw pain, sciatica, and many other symptoms.
If trigger points are spontaneously irritated, they may cause constant symptoms. If pressing on these trigger points during the exam causes them to be “activated,” the physician may be able to reproduce some of the patient’s subjective complaints such as referred pain and numbness.
This information is excerpted with kind permission from Dr. Pellegrino’s very popular book, Fibromyalgia: Up Close & Personal. For much more detail, see Chapter 5, "Clinical Evaluation of Fibromyalgia."
Note: This material is presented for general informational purposes only and is not meant to be a substitute for proper medical care by your doctor.