Health Conditions A-Z Chronic Pain 9 Fibromyalgia Pain Points These tender points on the body can help diagnose fibromyalgia. By Health Editorial Team Updated on January 6, 2023 Medically reviewed by Cara Beth Lee, MD Medically reviewed by Cara Beth Lee, MD Cara Beth Lee, MD, is the current Assistant Medical Director in the Medical Affairs department at Comagine Health. learn more Share Tweet Pin Email Fibromyalgia tender points are nine pairs of penny-sized spots hypersensitive to touch. Those pain points, spread throughout the body, from the base of the skull down to your knees, often help healthcare providers diagnose fibromyalgia. Fibromyalgia is a chronic disorder that causes muscle pain and fatigue. Other symptoms include sleep issues, fatigue, and emotional and mental distress. People with fibromyalgia may also be more sensitive to pain overall. Here's what you should know about the nine pain points and how they may signal fibromyalgia. 13 Conditions That Mimic Fibromyalgia PrathanChorruangsak/Getty Images What Is Fibromyalgia? The cause of fibromyalgia, which affects about four million adults in the United States, is unknown. However, factors that may increase your risk of fibromyalgia include: Age Stress Traumatic events Other autoimmune conditions There's no cure for fibromyalgia. But you can manage the condition with medication and lifestyle changes. The hallmark symptom of fibromyalgia is widespread pain. People with fibromyalgia tend to have common tender points—specific areas of pain near their joints but not the joint itself. The pain points are about the size of a penny and hurt when pressed. Those spots, known as the 18 pain points of fibromyalgia, are located above and below the waist. The pain points are symmetrical, on both sides of the body, with nine locations per side. There's no specific test to diagnose fibromyalgia, so it may take time to identify the condition correctly. Before 2010, healthcare providers used those points to diagnose fibromyalgia and required pain in 11 of 18 points. However, updated clinical practice guidelines by the American College of Rheumatology (ACR) removed a specific number of tender points from the criteria. Talk to a healthcare provider if you experience tenderness in the following areas. 01 of 09 Back of the Neck Tender points at the back of the neck, where the base of the skull and the neck meet, are common among people with fibromyalgia. In addition to those specific pain points, fibromyalgia may cause a stiff neck. You may notice muscle tension, cramping, and a limited range of motion that makes it difficult to turn your head. Keep in mind neck pain is not exclusive to fibromyalgia and can be caused by arthritis, injuries, over-exertion, poor posture, or just sleeping on it funny. 02 of 09 Elbows Fibromyalgia tender points on the forearms are found just below the elbow crease toward the outside of the arm. These pain points can occur on one or both elbows. In addition to pain at the elbow tender point, fibromyalgia is associated with lateral epicondylitis (tennis elbow) and medial epicondylitis (golfer's elbow), both of which are forms of tendinitis. Both can cause pain and tingling that radiate down the forearm to the hands and fingers, according to a study published in 2015 in the British Journal of General Practice. Injuries or illnesses unrelated to fibromyalgia, including arthritis, gout, and lupus, may also cause elbow pain. 03 of 09 Front of the Neck Fibromyalgia pain points on the front of the neck are located above the collarbone, on either side of the larynx. People with fibromyalgia can also have a sore neck from muscle strain due to poor posture or sleeping in an unusual position. Outside of fibromyalgia, pain in the front of the neck can be due to arthritis, injury, or swollen glands. A healthcare provider will likely order blood work to rule out rheumatological conditions before diagnosing fibromyalgia. 04 of 09 Hips The hip tender point in fibromyalgia is located just below the hip bone, around where the buttock muscles curve to join the thigh muscles. In addition to the tender point, people with fibromyalgia can experience muscle soreness and decreased range of motion in the hip area. Osteoarthritis, muscle strains, and other injuries can also cause hip pain. X-rays and other imaging tests can sometimes rule out other conditions when trying to narrow down a diagnosis. Imaging tests help distinguish between pain caused by joint damage, osteoarthritis, or myalgia (muscle pain). The Reality of Fibromyalgia 05 of 09 Lower Back Fibromyalgia pain points in the lower back are found near the top of the buttocks, where the gluteus maximus and gluteus medius muscles meet. In addition to those two spots, fibromyalgia can cause muscle pain, spasms, and stiffness across the lower back and buttocks. Lower back and butt pain is prevalent outside of fibromyalgia, as well. More than one in four adults in the United States experience low back pain. Problems with vertebral disks, spinal misalignment, repetitive stress injury, or an autoimmune disease can cause it. 06 of 09 Knees Knee tender points are located on the interior side of the leg. Also known as medial knee pain, the specific pain point is just above the side of the knee near the bottom of the vastus medialis muscle. Joint stiffness and cracking may accompany fibromyalgia-related knee pain. Joint swelling, however, is not typical with fibromyalgia. If your knee is also swollen, another condition, such as knee osteoarthritis, a meniscus injury, bursitis, or autoimmune disease, may be causing your condition. 07 of 09 Upper Back Fibromyalgia pain points in the upper back are located where the trapezius muscles meet the scapula, just below the shoulder blades. In addition to the spot being tender to the touch, you can often feel fibromyalgia pain throughout the trapezius. In fact, a 2013 study showed that people with fibromyalgia experience significant trapezius muscle tension when faced with mental stress compared to others. Pain in that area can also be due to a spinal disk problem, arthritis, or an injury. 08 of 09 Shoulders Shoulder tender points are found where the supraspinatus muscles connect to the shoulder blades, which are about halfway between the shoulder's edge and the neck's bottom. In addition to feeling pain when pressed, people with fibromyalgia may experience a burning or throbbing pain in this area and shoulder stiffness. Tendonitis, a rotator cuff tear, or adhesive capsulitis (also known as frozen shoulder) can cause pain in the supraspinatus muscles, which are part of the rotator cuff. 12 Reasons You Have Shoulder Pain–and What to Do About It 09 of 09 Chest Fibromyalgia pain points on the chest are located on either side of the sternum (also known as the breast bone) near the second rib. A few inches below the collarbone, that tender point is felt at the costochondral junction, the cartilage that connects the rib to the sternum. Some people with fibromyalgia may experience severe pain that starts at that tender point and spreads across the chest, also known as costochondritis. A Quick Review The nine pain points (located on both sides of the body for a total of 18 pain points) can help a healthcare provider diagnose fibromyalgia. But remember: Pain in those areas is not a definitive fibromyalgia diagnosis. So, it's essential to consult a healthcare provider for an accurate diagnosis. Was this page helpful? Thanks for your feedback! Tell us why! Other Submit Sources Health.com uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Fibromyalgia. Centers for Disease Control and Prevention. Fibromyalgia. American College of Rheumatology. Fibromyalgia. Ahmed S, Aggarwal A, Lawrence A. Performance of the American College of Rheumatology 2016 criteria for fibromyalgia in a referral care setting. Rheumatol Int. 2019;39(8):1397-1403. doi:10.1007/s00296-019-04323-7 American College of Rheumatology. 2010 Fibromyalgia Diagnostic Criteria (excerpt). National Library of Medicine. 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