The terms tender point and trigger point are often used interchangeably; however, they are different from each other.
At first glance, the medical community appears divided over whether they in fact are the same thing. You can even find a lot of websites and books, written by healthcare professionals (but we know how much help they can be!), who talk about diagnosing FM with trigger points and treating it with trigger-point injections.
Nonetheless, the scientific literature makes it clear that, while tender points and trigger points both appear to play roles in FM, they are not the same thing. Some of the confusion may be because it’s extremely common for people with FM to also have myofascial pain syndrome (MPS), which is a diagnosis of chronic pain from multiple trigger points. (Some doctors also question whether FM and MPS are different illnesses.)
- Tender Point: One of 18 specific places on the body that are used to diagnose widespread pain and tenderness in FM. The presence of widespread tender points helps your doctor diagnose FM.
- Trigger Point: Also called myofascial trigger point (TrPs or MTrPs), a trigger point is a small, hard knot in the muscle (myo) or connective tissue (fascia) that won’t relax. TrPs are painful when pressure is applied. In the absence of pressure, they may cause pain in the immediate area and/or cause pain in a different area. This is called a referred pain pattern. Chronic pain from multiple TrPs is called myofascial pain syndrome.
Tender Points in FM
Trigger Points in FM
Multiple studies show that TrPs can in fact play significant roles in FM, as a cause of significant pain, and possibly even in a causal role.
In one study, researchers were able to fully reproduce FM pain by manipulating the TrPs. They also found that the participants with more active TrPs had more intense spontaneous pain. What they concluded was that pain from TrPs may help lead to something called central sensitization, which is believed to be an underlying mechanism of FM. Essentially, central sensitization means that the central nervous system (the brain and spinal cord) are hypersensitive to pain and other stimuli, such as light, noise and temperature (hypervigilence). Central sensitization is also believed to play a role in migraines, osteoarthritis and chronic fatigue syndrome.
A review of literature on tender points and trigger points states that confusion between the two and the interchangeable use of the terms can lead to misdiagnosis, which in turn leads to ineffective treatment.
BUT 90 per cent of the 18 predetermined tender points are actually TrPs. 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. During my time at the rehabilitation pain clinic, my physio spent her time teaching me ways to de-sensitize my trigger points – which in time, would help to reduce pain. This mostly involved self-massage regularly. 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.
Despite all of this, FM requires different treatment than MPS. For the many people who have both, it’s essential to treat both in order to alleviate symptoms and regain function.