Thursday, January 26, 2012

Does 2+2=3? The tender point model of fibromyalgia.

This is a great question and one that has always confused me too. First, the tender point model was never meant to be the diagnostic hallmark which has evolved. It was originally developed as a tool to be used for analyzing participants for a study.

Most likely the tender points were paired to indicate that the tenderness and pain of fibromyalgia occurs on both sides of the body. I doubt there was any other significance because the criteria actually says one must have at least 13 of the 18 tender points for a diagnosis of FM. Thirteen tender points would mean that at least one of the pairs was broken up.

Excerpt ©
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 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 (MTPs) or pain in the MTP referral pattern of pain and neuralgia and other consequences. This has been shown in several studies. Read more about this at

Other helpful information can be found at In with the New, Out with the Old: Fibromyalgia diagnostics


Helping your doctor diagnose fibromyalgia

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.

This blog is based my answer to the question “Why are all of the fibromyalgia tender points paired?” as fibromyalgia expert at

Monday, January 16, 2012

Sleep oh sleep, where art thou? Could your fibromyalgia medications be causing insomnia?

Yes, fibromyalgia medication could be causing your insomnia.

Cymbalta® (Duloxetine) and Savella® (milnacipran) which have been approved for treating fibromyalgia are in a class of drugs called selective serotonin and norepinephrine reuptake inhibitors (SNRIs) and insomnia is a side effect for both medications.

Also note worthy is that many fibromyalgia patients have migraine headaches as a comorbid condition. Selective serotonin and norepinephrine reuptake inhibitors (SNRIs) and selective serotonin reuptake inhibitors (SSRIs) can have serious, even life threatening interactions when combined with triptans such as zolmitriptan and sumatriptan used to treat migraine. If you are a migraineur, be sure to remind your doctor, close monitoring is suggested. If you have frequent migraine that requires abortive medications, I would certainly think twice before taking an SSRI or an SNRI. We are in an era where we must be our own best advocate.

Neurontin® (gabapentin) and Lyrica® (pregabalin) are anti-seizure drugs and are also used to treat the pain of fibromyalgia. Neither was found to have an insomnia effect in the studies except during the withdrawal process. However, there have been anecdotal complaints, which could suggest a paradoxical (opposite) reaction. When you have fibromyalgia, just about any reaction or sensitivity is possible. The important thing is to report any untoward effects to your doctor.

Because cognitive deficit and fatigue are common complaints by the fibromyalgia patient, medications to treat ADHD have been used to improve vigilance. This particular group of medications has a higher incidence of insomnia. With that said, there is also a group of patients that these type of medications help in slowing the brain response down.

We are each different, with different co-existing conditions and different responses to various medications. It is important to check with your pharmacist regarding your medications, any potential interactions, and side effects. Always report reactions to your pharmacist and healthcare provider and seek immediate help if you have an allergic reaction, swelling of the mouth, tongue or throat, which can block your airway.

This blog is based on my original answer at ShareCare, Could my fibromyalgia medications be causing my insomnia?

(Signature line appended, April 2018)

In healing,

Celeste Cooper, RN / Author, Freelancer, Advocate

Think adversity?-See opportunity!

~ • ~ • ~ • ~ • ~ • ~

Learn more about Celeste’s books here. Subscribe to posts by using the information in the upper right hand corner or use the share buttons to share with others. 

Sunday, January 8, 2012

Jack Backwards, Fibromyalgia, the stress response what you can do about it.

Follow the link to my Share Care blog site.

Chest wall pain mimic costochondritis in fibromyalgia: Successful treatment

The muscles between the ribs are formed in such a way to allow our chest to expand and relax with breathing. It performs its job many times a day. The average adult breaths about 20 times per minute, that is a lot of work. Many fibromyalgia patients and some chronic fatigue (ME/CFS) patients complain of chest wall pain and restriction of movement. Often this restriction and pain is misdiagnosed by the health care provider as costochondritis, which is inflammation of the muscles between our ribs, usually seen when there is a viral or infectious process present.

I want to make this very clear; fibromyalgia is not considered an inflammatory disorder. It is a disruption in the central nervous system that is hyper-sensitized by the presence of peripheral pain generators such as chronic myofascial pain.

More often than not FM patients have comorbid myofascial trigger points (MTPs) of, , chronic myofascial pain (AKA, myofascial pain syndrome). These MTPs shorten the muscle involved cause pain and dysfunction, radiate pain (in some cases neuropathy and other symptoms) in a consistent pattern for the location of that specific trigger point. It is my belief and the belief of other experts that the chest wall pain found in FM is from intervertebral (between the ribs) myofascial trigger points, which restrict the motion of the chest wall during inspiration. This restriction then leads to ineffective breathing.

The treatment for chest wall pain found in FM is not medications for inflammation unless there is a known inflammatory condition present, (MTPs are not inflammatory in nature either). The treatment is trigger point therapy. If you can feel the tender painful knot apply 80% pressure with stroking motion for 30-60 sec. There can be many, because the rib cage is a lush environment because of the muscle complexity necessary to operate effectively. Myofascial trigger points can be behind bone or other large muscles, the rib bone in this case. This make it difficult to treat them, however, also helpful is deep breathing exercises such as Qi Gong.

Cellular oxidative stress has been indicated in fibromyalgia, even better reason to get that chest wall moving. We explain deep breathing techniques in our book and the comorbid condition, chronic myofascial pain at length, the dos and don’ts, therapies that can help, and what to avoid.

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.

Saturday, January 7, 2012

December '11 Blogs for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain

Following is a recap of my blogs on FM and CFID (ME/CFS) at both my profile as expert for Dr. Oz on Sharecare, and blogger. Please feel free to disseminate the information as you see fit for the better good of all FM and ME/CFS patients. In healing, harmony and hope for awareness.

A years worth of blogs can be found in the archives of the right column at Google Blogger. There might be something of particular interest there for you.

December 2011
These Three, Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain.

In a word – What we know about terms and fibromyalgia

Ironic, the P in Substance P: The Relationship of Pain in Fibromyalgia

Ups and Downs; unpredictability of FM and CFID. How can I avoid a flare?

Nerve to Muscle and the Role in Fibromyalgia

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

Celeste's Website

Celeste's Website
Click on the picture