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The pain of Fibromyalgia (FM) is present in the soft tissues throughout the body. Pain
and stiffness concentrate in spots such as the neck and lower back. The tender spots
don't seem to be inflamed, nor do they display the typical signs of discomfort, such as
heat, redness, or swelling. Most tests show nothing out of the ordinary in the anatomy
of people with FM.
The anatomy of FM is rather straightforward: there are 18 tender points (often confused
with trigger points, which are associated with
chronic myofascial pain) on your body that doctors
have identified. These tender points become painful when pressed on (that's part of the
American College of Rheumatology diagnostic process for fibromyalgia). According to the
ACR criteria, FM is present when a patient suffers widespread pain for at least three
months and feels pain in 11 or more of the 18 pressure point sites.
Doctors measure these tender points in one of two ways:
- By pressing the site with a finger or
- By using a slightly higher-tech method called dolorimetry
In the dolorimetry method, the examiner presses a rubber endplate, attached to a
spring-loaded force gauge, into the tender point site with increasing force. Patients are
then asked to say when they stop feeling pressure and start feeling pain.
These tender points are very small, about the size of a penny. All of them are
around joints, but FM pain has nothing to do with the joints themselves. Instead,
FM pain affects the soft tissues of your body, mainly the muscles. The 18 Tender
Points of FM exist at these nine bilateral muscle locations:
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