Fibromyalgia, a chronic pain disorder, is often characterized by pain in multiple tender points. These tender points are sometimes confused with trigger points, which are associated with chronic myofascial pain. The primary difference between tender points and trigger points is that trigger points can produce referred pain (that is, they can cause pain in other parts of the body).

Making things all the more confusing is that chronic myofascial pain often accompanies fibromyalgia, so it's possible that you may experience pain from tender points (due to fibromyalgia) and trigger points (due to chronic myofascial pain).

The fibromyalgia tender points are symmetrical; they occur on both sides of the body. The trigger point locations are:

• Front lower sides of your neck
• Upper chest
• Inner elbows
• Just above inner knees
• Back of your head
• Top of the shoulders
• Upper back (at shoulder blades)
• Upper buttock
• Hips

These tender points are very small—the size of a penny. All of them are around joints, but fibromyalgia pain has nothing to do with the joints themselves. Instead, fibromyalgia pain affects the soft tissues of your body, mainly the muscles.

These tender points are not the only places it's possible to feel fibromyalgia pain; you can also have general muscle fatigue and widespread chronic pain.

When it comes to tender points, it's important to understand that fibromyalgia is not a consistent syndrome. What that means is that you may feel intense pain in some areas one day and in other areas the next. (Fortunately, there are days when you may not even experience pain at all.)