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Pain and Tender Points
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Widespread pain and tenderness are the hallmark symptoms of FMS. According to the 1990 American College of Rheumatology requirements for diagnosis of fibromyalgia, pain must be present in all four quadrants of the body (upper, lower, right and left). Today it is understood, however, that many persons with more localized pain, affecting only the upper or lower half of the body, for example, also suffer from FMS. In fact, people with fibromyalgia frequently describe their pain as moving to different areas of their body. Stiffness in the morning or after remaining in one position for a long period of time is common, and patients frequently will note that weather changes, physical activity, stress, and menstruation can worsen the pain. Although patients often report swelling in the regions of pain, the swelling typically cannot be detected by others.
A "tender point" is defined as a site that is painful when 4 kg (approximately 9 pounds) of pressure is applied, about the amount that makes your fingernail turn white when you press on it. The presence of tender points on physical examination is one of the diagnostic requirements for FMS. However, several studies have suggested that persons with fibromyalgia are more sensitive to pain throughout the body, not simply in areas recognized as tender points. Greater sensitivity to pain is a distinctive feature of fibromyalgia, which is likely influenced by other factors including poor sleep and depression. |
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