What’s Driving Your Pain?
… Myofascial Trigger Points in Fibromyalgia
The 18 tender points once used to diagnose fibromyalgia are more than sore spots on the body. According to an AFSA-funded study by Hong-You Ge, M.D., Ph.D., of Aalborg University in Denmark, 90 percent are myofascial trigger points (MTPs).1 These trigger points matter because they can make your fibromyalgia pain worse.
Why MTPs Matter
Why does Ge’s finding matter? Tender points and myofascial trigger points are not the same thing. Tender points relied on a patient’s feedback during an exam, so doctors viewed them as subjective. They also did not consider them a treatable physical problem.
MTPs are different. They are objective findings in the muscle. They contain pain-sensitizing chemicals, generate electrical activity, and clinicians have ways to treat them.2
MTPs feel like hard nodules in tight, ropy bands of muscle. These knots form when muscle fibers stay contracted, which can shorten the muscle and restrict movement. However, finding MTPs depends on a provider’s training and skill.
To confirm MTP locations, Ge used intramuscular electromyography (EMG). MTPs generate a strong electrical signal, and the EMG needle detects this activity. When the needle reaches the center of the MTP, it can force the contraction to release and the electrical signal drops.
Active vs. Latent MTPs
MTPs come in two forms: active and latent.
Active MTPs hurt even at rest and are most likely to need treatment. Latent MTPs may restrict movement or hurt when pressed, but they usually do not cause ongoing pain. Overusing a muscle can turn latent MTPs into active ones.
Ge found that MTPs at the old tender point sites caused most—but not all—of the pain reported by fibromyalgia patients. This means active MTPs in other muscles can also contribute to your symptoms. Many active MTPs also appeared in the mid-back region and upper arms.
The diagram below shows where Ge found the most common MTPs. The black dots overlap with the 18 old tender points. The red dots show additional MTP locations, including the low back—the most common MTP site in the study.
Active MTPs also mattered most for pain severity. The more active MTPs a patient had, the worse their fibromyalgia pain. Latent MTPs did not affect pain ratings.
Why the difference? Active MTPs contain pain-producing chemicals that can irritate nerve endings, and blood flow through these trigger points is reduced.3
How MTPs Affect Your Nervous System
MTPs are not just muscle knots. They generate electrical signals that travel to the central nervous system and may keep it “fired up.”
Once the nervous system becomes overly sensitive, it can amplify pain and spread it beyond the original trigger point. This may help explain why pain spreads beyond the original trigger point, causing widespread discomfort.
Ge’s study shows that muscle tissue plays an important role in fibromyalgia pain. Active MTPs may provide a steady source of electrical input that helps maintain a dysfunctional central nervous system state.
This creates a troubling cycle. Active MTPs may keep the nervous system irritated, and the nervous system may send signals back to the muscles that encourage more MTPs to form.
Muscle Cramps and Weakness
Fibromyalgia may make you more prone to muscle cramps. Pain increases the odds that a muscle will cramp, especially when active MTPs are present.4
If leg cramps disrupt your sleep, try the following:
- Gently stretch your leg and foot muscles in warm water before bedtime.
- Take a calcium and magnesium supplement in the evening.
- If a Charlie horse occurs, pull your heel toward the cramped muscle. This further shortens the fibers so they can relax.
Muscles with MTPs also wear out faster. Repetitive use or overload may increase fatigue, promote more nearby MTPs, and add to your sense of weakness.5 Still, fibromyalgia fatigue is complicated because the central nervous system also plays a major role.
Treatment Tips for Patients
“Active MTPs are important pain generators in fibromyalgia,” says Ge. “Targeting active trigger points should significantly relieve fibromyalgia pain and represents a promising treatment potential.”
Because active MTPs may appear in areas other than the original 18 sites, Ge recommends checking all painful muscles. Ge adds, “Examining physicians should check active MTPs in all muscles according to a patient’s pain drawing.”
Clinicians have several ways to treat trigger points. Dry needling by a highly skilled practitioner, usually a physical therapist, may be one option.
Patients can also use self-help techniques to identify and treat trigger point pain. The more troublesome, large MTPs feel like hard rocks in the muscles and with a little practice patients can learn to treat them.
“Relief of active MTPs will decrease fibromyalgia pain intensity and significantly reduce the input that maintains the dysfunctional nervous system,” says Ge.
Long-term relief may require regular MTP therapy and attention to factors that keep trigger points active, such as acute or chronic muscle overload.
A daily home program may also help. Warm water, moist heat, or an electric massager with a long handle may reduce tightness and pain.
The goal is to keep your muscles as healthy and functional as possible.
Start with Your Trapezius
If active MTPs can drive widespread fibromyalgia pain, where should treatment begin? One good place to start is your trapezius, the large shoulder muscle in your upper back. Many fibromyalgia patients report pain or tightness there.
In Ge’s AFSA-funded study, each fibromyalgia patient had almost five active MTPs on each side of the trapezius.6 Healthy subjects had no active MTPs in this region.
These MTPs referred pain to the head, neck, shoulders, back, upper chest, and arms. This means your trapezius muscles may contribute to much of your upper body pain.
Bottom line: Treating upper trapezius MTPs is a good place to start. Also, try to avoid overstraining your shoulder muscles because this can activate MTPs. One simple step is to limit how often you lean your head forward.
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Read more about myofascial trigger points (MTPs) in our section on Muscle Pain Relief or learn about other Symptoms. For different approaches to target your fibromyalgia, see our sections on Medications, Alternative Therapies, and Diet & Nutrition.
References for What Makes Fibro Worse
- Ge HY, et al. J Pain 11(7):644-651, 2010. AFSA-funded Study Article
- Pradeep A, et al. BMC Musculoskelet Disord 24(1):624, 2023. Free Article
- Shah JP, et al. PM & R 7(7):746-761, 2015. Free Article
- Serrao M, et al. Exp Brain Res 187:623-629, 2007. Abstract
- Ge HY, et al. Pain Med 13:957-964, 2012. Free Article
- Ge HY, et al. PAIN 147(1-3):233-40, 2009. AFSA-funded Study Abstract