Significance of trigger points and tender points

An article has been e-published ahead of print in the German publication 'Zeitschrift fur Rheumatologie' discussing the significance of the differences between tender points and trigger points.

Tender points (TPs) are part of the American College of Rheumatology criteria for the diagnosis of Fibromyalgia Syndrome (Fibro), whereas trigger points (TrPs) are typically found in Myofascial Pain Syndrome, also known as Chronic Myofascial Pain (CMP). [1]

The main difference until recently was that tender points could only be defined in terms of their local position, whereas trigger points can be found upon palpation which may cause a specific referred pain pattern. [1]

However, analysis of trigger points by microdialysis demonstrated elevated levels of pro-inflammatory substances at these sites. [1]

Chronic Myofascial Pain and TrPs are even more under-diagnosed than Fibro, despite myofascial pain being probably the most common cause of musculoskeletal pain in medical practice. A doctor or healthcare provider in almost any field will see some patients with Fibro and/or TrPs. [2][3]

These conditions often, but not always, occur in the same patients although TrPs, which are thought to develop after trauma, overuse or prolonged spasm of muscles, can occur in otherwise healthy patients. [4]

It is important that in patients with Fibro and CMP, both conditions be diagnosed, as their treatment is very different and they may be affecting and/or amplifying and perpetuating each other. [2][4]

Fibro is a central disorder, with an increasing body of evidence relating it to Central Nervous System Dysfunction. [5] It often requires a multidisciplinary treatment, utilising medications that target the nervous systems - local treatment applied to TePs is ineffective. [4]

However, local, specific treatment of TrPs, either by manipulative therapy or injection, is often dramatically effective with prompt relief of symptoms. [2][4]

For more information on tender points and trigger points, please see the FibroAction patient article 'Tender Points, Trigger Points and Pressure Points'.

References:

1. Brezinschek HP. [Mechanisms of muscle pain : Significance of trigger points and tender points.] [Article in German] Z Rheumatol. 2008 Nov 19. [Epub ahead of print]
2. Starlanyl DJ, 2003. Fibromyalgia and Chronic Myofascial Pain: Keys to Diagnosis and Treatment [website]. Available at: http://www.sover.net/~devstar/physinfo.htm
3. Pongratz DE, Späth M. [Myofascial pain syndrome--frequent occurrence and often misdiagnosed] [Article in German] Fortschr Med. 1998 Sep 30;116(27):24-9.
4. Schneider MJ. Tender points/fibromyalgia vs. trigger points/myofascial pain syndrome: a need for clarity in terminology and differential diagnosis. J Manipulative Physiol Ther. 1995 Jul-Aug;18(6):398-406.
5. Kuchinad A, Schweinhardt P, Seminowicz DA, Wood PB, Chizh BA, Bushnell MC. Accelerated brain gray matter loss in fibromyalgia patients: premature aging of the brain? J Neurosci. 2007 Apr 11;27(15):4004-7.