Fibromyalgia Tender Point - what are the Trigger and fibromyalgia pressure point
Fibromyalgia Tender / Trigger Point
The ACR Multicenter Committee defined tenderness as pain evoked by pressure stimulation at relatively low-intensity levels (<=4 kg). The ACR identified 18 anatomic sites or tender points that best distinguished patients with fibromyalgia from patients with various other chronic pain syndromes, specifically, low back pain, RA, and SLE. These 18 Fibromyalgia Tender Point are:
(a) the left and right occiput, at the insertion of the suboccipital muscles;
(b) lower cervical spine, at the anterior aspect of the intertransverse spaces between C5 and C7;
(c) trapezius, at the midpoint of the upper border;
(d) supraspinatus, at the origin of the muscle, above the scapular spine near the medial border;
(e) second rib, at the second costochondral junction;
(f) gluteal muscles, at the upper outer quadrant of buttocks;
(g) epicondyle (lateral), 2 cm distal to the epicondyle;
(h) greater trochanter, posterior to the trochanteric prominence; and (i) knee, at the medial fat pad, proximal to the articular line.
The locations of these Fibromyalgia Tender Point are indicated with pictures. During the evaluation of patients for fibromyalgia, pressure is applied with a force of approximately 4 kg with either the thumb (in the clinical setting) or a calibrated dolorimeter (in the research setting). Tenderness is defined by a verbal report of faint pain in response to the pressure stimulus. Okifuji and colleagues have published a manual and videotape that provide standardized instructions for identifying the ACR tender points and control points and for evaluating pain thresholds at these points.
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It has not been possible to establish normative values for the responses to tender point examinations of patients with fibromyalgia and healthy individuals. Independent laboratories have published different values, probably due to variations in evaluation procedures and dolorimeters. For example, pain sensitivity may vary as a function of time of day (i.e., circadian rhythm), menstrual cycle phase, medication usage, or cognitive errors in labeling sensory events. We have reported that the average Chatillon dolorimeter (Chatillon Instruments, Kew Gardens, NY, U.S.A.) pressure required to elicit faint pain at tender points is approximately 1.9 kg in patients who meet ACR criteria for fibromyalgia, compared with about 5.4 kg for healthy controls.
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Fibromyalgia Tender Point