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June 20, 2018  |  Login
by James F. Balch, M.D. and Mark Stengler, N.D.

The tender points for fibromyalgia exist in pairs (one on the right side of your body and one on the left) at the following locations:

  • Base of the skull
  • Base of the neck
  • Upper chest, a little more than an inch below the collarbone
  • Along the top of the shoulder
  • Upper back, close to the spine and about an inch below the preceding set of points
  • Inside of the elbows
  • Lower back, close to the dimples above the buttocks
  • Upper outside edge of the thigh
  • Inside of the knees

If you are testing yourself for a reaction to these points, you must touch them with enough pressure to whiten your fingernail. A doctor who is knowledgeable in the diagnosis of this condition can test these points for you


Fibromyalgia is the name given to chronic, widespread muscular pain that has no obvious cause. The pain-usually described as aching, stiff, burning, or throbbing-may appear in any location of the body, but for a diagnosis of fibromyalgia to be made, you must have pain in at least eleven of eighteen specific "tender points." The pain from tender points and elsewhere in the body usually feels most severe upon waking and gradually lessens as the day goes on.

Although the pain of fibromyalgia alone can be so severe as to render its victims disabled, the disease can be complicated by any of several other problems. Fibromyalgia is closely linked to chronic fatigue syndrome, and many of its sufferers experience symptoms similar to those of CFS (see the symptom list). Irritable bowel syndrome, premenstrual syndrome, palpitations, and temporomandibular joint syndrome (TMJ) may also be present.

As with CFS, there is currently no one agreed-upon cause for this disease. In most cases, many factors combine to produce the varied components of fibromyalgia.

Disordered sleep is a very common problem with this condition. The length and the quality of sleep must be improved for long-term success in most cases of fibromyalgia. Also, hormone imbalance is quite common. Particularly, low thyroid function and imbalances in estrogen/progesterone, as well as in the stress hormones DHEA and cortisol. Digestive function and detoxification usually need improvement to help people with fibromyalgia. Along with this digestive weakness come leaky gut syndrome and candida overgrowth, as well as general dysbiosis. Chronic infections that include viruses can be a factor. Food allergies are a significant contributor for some people, especially allergies to wheat, sugar, and cow's milk.

As well, nutritional deficiencies, of magnesium, B vitamins, coenzyme Q10, L-carnitine, and several others, are very common. We have also found that many people with fibromyalgia have a brain chemistry imbalance. Using natural therapies to balance serotonin and other neurotransmitters results not only in a better mood but in less muscular pain. Toxic elements, such as lead, mercury, arsenic, and others, can also be one of the root contributors to fibromyalgia. These toxic elements interfere with the normal enzyme and cell function in the body. In addition, blood-sugar imbalances worsen pain and inflammation.

Many people develop symptoms of fibromyalgia after a car accident, and thus structural abnormalities must be addressed through physical therapies. Chiropractic, osteopathic, and craniosacral therapy; physiotherapy; and sometimes massage are very helpful in reducing pain.

In essence, all of these potential imbalances lead to a defect in how the cells produce energy. Normally, the "energy-producing plant" of the cells, known as the mitochondria, produces efficient energy for the cells of the body. When a defect occurs in mitochondrial metabolism, it can lead to a shortage of energy for the muscle cells and other tissues of the body, resulting in fatigue and pain. Mitochondria require organic acids that are intermediaries in metabolic pathways in the body that create energy. Researchers have found that people with fibromyalgia often have imbalances in these organic acids. To correct this problem, one must address the root causes, as have been described. more

Next: What are the Symptoms of Fibromyalgia

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