Pain,
the primary fibromyalgia symptom, is necessary for an
official diagnosis. According to the American College of
Rheumatology, fibromyalgia is characterized by
widespread pain of three months duration or more and
pain in 11 of 18 “tender points”.
A fibromyalgia trigger point is an area of pain to the
touch, but without redness, swelling or heat in the
surrounding joints or muscles. These trigger point
areas, also referred to as a tender point or pressure
point, feel sore when pressed. A tender trigger point is
considered “positive” if you feel pain with an
approximate pressure of 4kg, which is roughly the amount
of pressure needed to change the color of the skin.
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The most accurate fibromyalgia diagnosis is a trigger
point examination, which determines the presence of
tender pressure points on certain spots of the body. For
an accurate application of pressure to the tender point
areas, your health care provider might use an instrument
called an algometer. The tender trigger point
examination is based on the standardized American
College of Rheumatology criteria. To receive a formal
fibromyalgia diagnosis, your doctor must find at least
11 of these 18 tender points of pressure. The 18 trigger
point sites used for fibromyalgia diagnosis are (see
diagram below):
_
On the fat pad over the knee.
_ On the outside of the hip.
_ At the top of the hip.
_ Over the shoulder blade.
_ On the outer edge of the forearm, directly below the
elbow.
_ On the breastbone.
_ On the top of the shoulder toward the back.
_ At the base of the neck in the back.
_ At the base of the skull.
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These tender pressure point areas occur symmetrically on
both sides of the body. The trigger point pain must also
appear in all four quadrants of their body for a minimum
of three months. Trigger point pain is considered
widespread when present in the left and right side of
the body, above and below the waist and in the neck,
front of chest, mid-back, or low back.
However, a trigger point that is tender on one day may
not be on another. Typically, fibromyalgia pain varies
day-to-day and from person-to-person. The fibromyalgia
tender point pain can range from mild discomfort to
intense, disabling pain. Most healthy people might have
only two or three trigger point areas.
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