Tender Points

Tender points are discrete areas - classically at the neck, shoulders, chest, elbows, hips and knees - that produce disproportionate pain when moderate pressure is applied. They were once used as formal diagnostic criteria for fibromyalgia; current criteria focus instead on widespread pain, fatigue, unrefreshing sleep and cognitive symptoms, but tender points remain a useful clinical observation. The underlying mechanism is thought to be central sensitisation: amplified pain processing rather than damage at the tender spot itself, which is why local imaging is usually normal. Because several treatable conditions mimic or worsen this picture, evaluation matters - vitamin D deficiency, hypothyroidism, inflammatory arthritis, sleep apnea and depression all deserve consideration before settling on a diagnosis. Management with the best evidence is unglamorous but effective: graded aerobic exercise started well below tolerance, cognitive behavioural therapy, and sleep improvement, with medications such as duloxetine, pregabalin or low-dose amitriptyline for some. On supplements, vitamin D correction helps where deficiency exists, magnesium has small and inconsistent trial support, and coenzyme Q10 has preliminary evidence in fibromyalgia. None replaces exercise and sleep work, and effects reported are modest.