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These two conditions are frequently confused by both patients and medical providers. Many patients suffer from both of these conditions at the same time.
Fibromyalgia is defined by the American College of Rheumatology as a condition with widespread pain lasting over 3 months, with no other medical explanation for symptoms (citation below).  The definition also used to include certain tender points located in specific places on the body, but this requirement was removed in 2010 because many fibromyalgia patients don’t have the specific tender points, or they only have them during flares, or they have them in different locations from the “classic” locations.

Fibromyalgia tender points map from
Fibromyalgia tender points map from
Tender points are basically areas of the skin that are extremely tender to light or moderate touch, that most people wouldn’t perceive as tender at all. There is nothing physiologically wrong with these tender regions, they are simply tender because the nervous system misinterprets the signals when these points are touched. The important thing is not specifically which areas are sensitive to touch, but the fact that there are multiple areas that are sensitive, with no known reason for them to be tender. In addition to the widespread pain and unusually tender areas, fibromyalgia patients also have fatigue, unrefreshing sleep, and a variety of other symptoms. These symptoms tend to wax and wane in flares. Sleep and central pain amplification are key factors  in fibromyalgia, and addressing these issues is the mainstay of most fibromyalgia treatments.

Myofascial Pain Syndrome is a condition in which the patient has abnormal clumps of muscle fibers or knots or bands known as trigger points. (Not to be confused with tender points, more on this in a future post….) These trigger points “trigger” or “refer” pain to other locations in the body.

Trigger point - NOT a fibromyalgia tender point!
Trigger point – NOT a fibromyalgia tender point!
Trigger points can be felt in the muscle tissue, and the muscle fibers can be gradually remodeled or “released” using a combination of pressure, massage, stretching, and sometimes more invasive measures like electrotherapy, acupuncture, and injections. If you’ve ever had a knot in a muscle that “hurt so good” when it was massaged and sent pain into a distant area that was then relieved by the massage, then you know what a trigger point feels like. Trigger points are common causes of headaches, including migraines, sciatica, plantar fascia pain, and TMJ pain, among many other painful conditions.

Classic SCM trigger points (the
Classic SCM trigger points (the “X’s”) radiate pain into the head and eye, causing migraine symptoms.
The good news is that once the trigger points are identified they are fairly simple to treat. The bad news is that trigger points are frequently missed because most medical providers aren’t trained to recognize them. So the two conditions both cause severe pain, but the reasons for the pain are very different. This was a very brief and oversimplified introduction to these challenging conditions, and in the next post I will go into more detail about the differences between tender points and trigger points and the different approaches needed to manage them. Stay tuned!

  1. Fibromyalgia and Chronic Myofascial Pain: A Survival Manual (2nd Edition). Jun 30, 2001. by Devin J. Starlanyl and Mary Ellen Copeland. This is my desert-island resource book, I keep copies at home and at my office. (FYI: This is an affiliate link, which means we get a small percentage of money if you purchase this book or any other product through this link, thank you in advance!)
  2. Devin Starlanyl MD’s website at
  3. and Measurement of Symptom Severity”, published in Arthritis Care & Research Vol. 62, No. 5, May 2010, pp 600–610 DOI 10.1002/acr.20140 © 2010, American College of Rheumatology.
  4. Muscle Trigger Point Anatomy app for smartphones and tablets. The trigger point image above is from this app, and it has wonderful graphics with multiple views of the muscles and common trigger points, and their typical pain referral patterns.