Tender points are
specific sites on the body that cause pain when pressed. The pain may
spread when a tender point is pressed and cause pain in a larger area
(for example, down the leg, arm, or back).
There are 9 pairs of
tender points. Each pair has one point on each side of the body, for a
total of 18 points. These pairs are located:
- Just behind the ear
where the neck muscles attach to the base of the skull.
- About halfway
between the base of the neck and the tip of the shoulder.
- At the spot where
the back muscles attach to the shoulder blade, just below the second
tender point.
- On the front of the
neck above the collarbone.
- Just to the right
and left of the breastbone (sternum) about 2 in.(5.08 cm) below the
collarbone.
- On each forearm
just below and to the outside of the crease of the elbow.
- Just above and to
the outer right and left of each buttock.
- On the outer upper
leg just behind the bony part of the hip (this point is easier to find
when standing).
- On the inside of
each knee.
To clearly diagnose
fibromyalgia, a person must have pain at 11 or more of the 18 tender
points. In practice, however, many people with fibromyalgia have fewer
than 11 tender points. |
The variety and severity of
symptoms caused by
fibromyalgia
vary from person to person. Widespread, chronic pain is the
most common symptom. It usually develops gradually.
Other symptoms that commonly
occur in addition to pain include:
- Fatigue that interferes
with work and daily activities.
- Sleep problems (difficulty
falling or staying asleep, waking up feeling tired).
Less commonly people with
fibromyalgia may have:
- Morning stiffness lasting
less than an hour.
- Headaches.
- Constipation or
diarrhea related to irritable bowel syndrome.
- Memory problems and
difficulty concentrating.
- Numbness or tingling in the
hands and other parts of the body. The skin may be ultrasensitive,
reacting to a firm touch with tingling, numbness, or a "pins and
needles" sensation.
- A circulatory problem
that affects the small blood vessels of the skin (Raynaud's
phenomenon).
- Anxiety or depression.
No one has a clear
understanding of what causes
fibromyalgia.
There are theories as to what may cause it, but there is not enough
evidence to support any single theory. Since fibromyalgia is a
syndrome of many symptoms, it has been difficult to find a specific
cause for the combined symptoms. It has been recognized as a medical
disorder only since the 1980s.
Some theories suggest that
fibromyalgia may be:
- Associated with
oversensitive nerve cells in the spinal cord and brain.
Oversensitivity may occur as a result of changes in chemicals in
the brain or spinal cord that regulate pain. As a result, the
person senses pain more easily, and widespread muscle pain occurs.
- Linked to an imbalance in
brain chemicals that control mood, which results in a lowered
tolerance for pain and may also cause an unrestful sleep cycle and
fatigue. Once this occurs, a person becomes less physically
active, and the muscles and tissues become more sensitive and
painful and more easily irritated.
- Caused by an
imbalance of hormones such as cortisol and growth hormone. Their
release is controlled by the pituitary gland
and the hypothalamus. Imbalances
of these hormones can result in fatigue, mood changes,
concentration and memory difficulties, a lowered tolerance for
pain, and other symptoms.
Currently, there is no cure
for
fibromyalgia.
Treatment is focused on managing pain, fatigue, depression, and
other symptoms common in fibromyalgia in an attempt to break the
cycle of increased sensitivity to
pain and decreased physical activity.
Treatment may include:
- Medications to help
you sleep better, such as tricyclic antidepressants,
SSRIs, or cyclobenzaprine (Flexeril).
- Medications to
relieve muscle and joint pain, such as tricyclic antidepressants,
cyclobenzaprine (Flexeril), or,
less often, nonprescription pain relievers.
-
Exercise therapy
to relieve sore muscles and increase energy.
Other Treatment
A variety of other
treatments have been used to treat conditions that cause chronic
pain. Most of these complementary or alternative therapies are
not proven treatments for
fibromyalgia,
but they may be helpful when symptoms flare up and may improve
quality of life. Safe complementary therapies such as
acupuncture or massage, for instance, may help relieve stress,
ease muscle tension, and help you feel better and healthier.
Other Treatment Choices
Other treatments that may
be used to treat fibromyalgia include:
-
Physical therapy.
-
Massage therapy.
- Injection of
tender points with a numbing
drug (anesthetic).
-
Cognitive-behavioral therapy
and other forms of counseling.
Those treatments should be
coordinated through a Physiatrist who has extensive training and
experience with this disorder
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