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distressed woman at doctor's surgery after having her fibromyalgia tender pain points examined

The Agony of Tender Points with Fibromyalgia

Reading time | 3 mins
Although no longer used to diagnose fibromyalgia, many patients with the condition will experience flare-ups in specific places on the body (“tender points”).
Sarah Alexander-Georgeson remembers asking her doctor about fibromyalgia, and pain like no other when she was examined. Since that first appointment, various specialists have given advice on pain-management.


In the 1990s, eighteen symmetrical "tender points" were said to be on the body when checking for fibromyalgia. These were located on the following:

  • Front of the lower neck
  • Upper chest
  • Near the elbow
  • Knee
  • The base of the skull
  • Hip bone
  • Upper outer buttock
  • Back of the neck
  • Back of the shoulder

Before 2010, you had to experience tenderness in 11 out of 18 of these points to get a fibromyalgia diagnosis.

However, as our understanding of the condition has improved, this testing method has been deemed wildly inaccurate. Although diagnostic guidelines used to say, "Push on the point until your fingernail turns white," the amount of pressure used could vary from doctor to doctor.

And, with many fibro patients, the pain fluctuates (usually referred to as flares). For example, someone may feel tender at all pressure points when making an appointment. But on the examination day, the same person may only feel tenderness in four or five.

This doesn't mean that any pain in those tender points doesn't exist. It just means the old diagnostic criteria were too rigid and didn't consider variable factors.

I found out about my tender points the hard way

When I discovered my tender points, the pain was like something I had never felt before. I remember the first time I went to my doctor and spoke to her about fibromyalgia. It was an experience I will never forget. Honestly, this is odd as my mind is often clouded by fibro fog nowadays.

We discussed my symptoms, and she decided she wanted to touch some of the pressure points on my body. I had never heard about the pressure points before, so I was not expecting much.

I stood in front of my doctor. She was about the same height as me, a petite, 5'3" woman. She then informed me that she was about to press into the base of my skull. I thought absolutely nothing of it. I had suffered from chronic pain since childhood, so I wasn't a novice when it came to examinations.

It was like the doctor had whipped out a blade and had stabbed me in the neck. I jerked forward, catching myself on a nearby chair. The doctor apologised but continued onto my shoulders. Another flash of pain ricocheted across my shoulders and down my arms.

My hips were the worst. I had to sit down afterwards because I was heaving, trying not to be sick. My hips and knees have always caused me the most discomfort. When poked, the doctor's short, sensible nails felt penknives. There was no way I could cope with the doctor touching me there again.

I learned more about my body and pain-management

She gave me a break and explained that she had to press on these tender points on my body to assess my pain sensitivity. I got it, I understood, but my hips were on fire. As I listened to her, I started doing some prodding of my own, poking at parts of my hand, wrist, and arm. That same searing pain made me gasp when I got to my elbow. It felt like I'd just punched a deep bruise.

We talked about pain management, and I was referred to a specialist. The experience wasn't the best meeting I'd had with a doctor, but I came away knowing more about my body. The specialist also gave me some pain-management advice for fibro flare-ups. It was trial and error, but I soon found that heat worked best on my knees, hips, and shoulders, but massaging was better for the base of my neck.

Relief isn’t consistent, but I must keep going

I cannot bear massage or any slight touch on my hips (what a shocker) or my shoulders. Bracing, splinting, and compression are also great for my knees and elbows. Sometimes (conversely), ice packs work on my shoulders and elbows too.

Many options are available to help ease the pain of these pressure points. They might not work for every single one, and you might have to change it daily, but find what works for you and give it a go.

My routine constantly changes, and I'm still switching up my combinations regularly. Still, I know my pain is not going anywhere. If I must find new ways to ease my discomfort every day until the end of time, then so be it.

NPS-IE-NP-00478 August 2022