Tender Points Reexamined

The American Fibromyalgia Syndrome Association is funding some promising research on myofascial trigger points and their wider connection to fibromyalgia. Researchers believe that this is a neglected field of study that demands exploration. Fibromyalgia is diagnosed through applying pressure to eighteen designated tender points. If the patient has a minimum of 11 out of 18 of these tender points, he is diagnosed with the condition. Myofascial pain, on the other hand, is caused by trigger points that bring on referred pain in nearby areas of the body.

Erroneous Belief

David Simons, M.D. and the late Janet Travell, M.D. were early believers that there was a strong link between the tender points of fibromyalgia and myofascial trigger points (MTPs) and did pioneering work on the topic. Simons feels that a mistaken report back in the beginning days of fibromyalgia research led to an ironclad, yet erroneous belief that tender points could not be MTPs because they do not cause referred pain.

Even so, it’s surprising that the role of MTPs has been so long neglected by researchers since studies have proven that MTPs predispose affected muscles for lowered pain thresholds in response to pressure. This means that these trigger points cause the muscles to become more sensitive to pain. Also, it is known that there is hyperactivity in the nervous systems of fibromyalgia syndrome patients. This is the cause of the fibromyalgia patient’s greater sensitivity to pain as well as more intense pain in those fibromyalgia patients who suffer from MTPs. As many as 70% of all fibromyalgia patients suffer from head pain and this symptom has been found to be rooted in MTPs located nearby.

Referred Pain

In the first of the two studies to be performed on the role of myofascial trigger points in fibromyalgia syndrome, Hong-You Ge, M.D., Ph.D., and his team of colleagues based at Denmark’s Aalborg University will evaluate 30 fibromyalgia patients along with 30 healthy control subjects to study active and latent MTPs. Latent MTPs are present in even healthy subjects and cause pain when pressure is applied. Both groups will be assessed for the presence of MTPs and their MTP referred pain patterns. The pain thresholds of the subjects will be calculated as well. The presence of the MTPs will be confirmed through the use of electromyography (EMG).

Next, the patients will be tested for sensitivity at the 18 tender points for fibromyalgia. The researchers will look for latent or active MTPs at and near these points. Ge will also be looking for tender points that are situated in the referred pain area as generated by the presence of an MTP.