Tender points are spots that hurt when touched by an examiner and occur in the original tender point model which was never meant to be the diagnostic tool, but has been adopted as one.
Unlike other disease processes, the symptoms of fibromyalgia affect all four quadrants of the body equally. In other words, tender points are found on both sides of the upper body (above the waist) and both sides of the lower body (below the waist). If there is a tender point in the left elbow, there will be another tender point in the same spot on the right elbow. Painful tender points are consistent and are considered chronic because they persist for a period of at least three months. (Cooper and Miller, pg. 9, 2010)
An exact description and tender point model can be found at http://www.thesethree.com/fibromyalgia/tender-points.php (cut and paste the link into your vrowser). Be sure to browse the site for more important information.
Since the adoption of the tender point model as a diagnostic tool, it has met much criticism. Some patients have tender points in other areas of the body, more than 18 or less than 18, but still meet other criteria that have continued to evolve as we learn more about fibromyalgia. As a matter of fact there are those that think the tender point model should go by the wayside. The new preliminary proposed criteria only considers a WPI, wide-spread pain index. This concerns me because it is a reported complaint and the examiner will not have to put their hands on the patient at all. A physical exam has always been the greatest diagnostic tool the physician or nurse practitioner has.
Other considerations of the tender point model is the suspicion these are not tender points per se, but myofascial trigger points or pain in the MTrP/MTP referral pattern of pain including neuralgia and other consequences. This has been shown in several studies. Read more about this at http://www.thesethree.com/cmp/chronic-myofascial-pain.php (cut and paste the link into your browser.)
All blogs, posts and answers are based on the work in Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection by Celeste Cooper, RN, and Jeff Miller, PhD. 2010, Vermont: Healing Arts press and are not meant to replace medical advice. http://www.thesethree.com.
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