General Health

Why Are Fibromyalgia Tender Points Significant?

Fibromyalgia is not an easy condition to diagnose. In the past, doctors tried to narrow down a diagnosis of fibromyalgia by exerting pressure on 18 small spots on the body to elicit sensations of tenderness and pain. These points were referred to as ‘tender points. In 1990, the American College of Rheumatology identified 18 spots that are often tender in people with fibromyalgia. Before 2011, the criteria for diagnosing fibromyalgia emphasized at least 11 out of 18 points to test positive before diagnosing fibromyalgia.

However, the diagnostic criteria have changed, and tender points are no longer considered a mandatory diagnosis tool. Fibromyalgia is now diagnosed through laboratory tests that rule out other causes of pain, fatigue, and sleep disturbances. These techniques have identified many people with fibromyalgia that don’t meet the tender points criteria.

Diagnosing people with tender points

Although the presence of tender points is not considered mandatory criteria to diagnose fibromyalgia, it is essential to know them for historical purposes.

Fibromyalgia tender points are located on both sides of the body, above and below the waist. A few examples of areas are the neck, chest, shoulders, elbows, hips, and knees. For the point to be classified as tender, localized pain should be elicited when the doctor presses it with his fingers. A point classified as tender should test positive for tenderness every time the spot is packed.

One of the defining characteristics of fibromyalgia is that the pain usually fluctuates. It varies in intensity from day to day. However, a tender point test is still helpful for physicians to diagnose these conditions. Once the diagnosis is confirmed, your doctor may be able to find the aetiology of the pain.

How can you cope with tender points?

People with fibromyalgia are more concerned about full-body aches and tenderness than specific tender spots. Some fibromyalgia symptoms include morning stiffness, difficulty in moving, pain during handshakes, and painful knots in muscles.

Trigger points are hard lumps that form in skeletal muscles. Unlike tender points, which only produce localized pain, trigger points produce localized and referred pain.

Trigger point injections for fibromyalgia

Injections at the trigger points can deactivate a painful trigger point, providing pain relief in certain areas. A trained person should give injections at the trigger points with specialized equipment. Injections contain saline, steroids, or local anaesthetic like lidocaine.

Acupuncture is an ancient Chinese practice of inserting needles into specific points on the body. This method has been used to relieve pain for thousands of years.

Manual lymph drainage therapy is a massage that moves the fluid away from areas where lymph vessels are blocked or damaged. Connective tissue massage is a technique that focuses on manipulating myofascial tissue.


Fibromyalgia tender points are areas where you experience pain when pressed. Trigger points can cause localized and radiating pain. It would help if you discussed with your healthcare provider about the potential therapies that you can try to get relief from pain due to fibromyalgia.


Tuhina Mishra

Dr. Tuhina Mishra completed her MBBS from Grant Government Medical College in the year 2021. She has published several research papers in Indian and international journals. She is a recipient of the ICMR-STS award in the year 2019. She is a staunch believer in making research an integral part of the medical curriculum. She has volunteered in several NGOs, healthcare startups, and awareness programs.

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