As previously mentioned, fibromyalgia is generally difficult to diagnose, it can mimic other diseases, including Lyme disease, HIV disease, degenerative spine diseases, low thyroid conditions, and certain types of cancer, and it is really a matter of ruling out these types of conditions.

According to the American College of Rheumatology, a diagnosis of fibromyalgia requires the experience of nearly constant pain on all four quadrants of your body. This includes having pain on both sides of the body as well as pain localized above and below the level of the waist. Additionally, the criterion requires tenderness in at least 11 of the 18 listed tender points exhibited by people who have fibromyalgia. 

Tender Points

• The Neck – The back of your neck is considered to contain major points of pain. The tender points could be at the base of the skull or where your shoulders meet your neck and anywhere in between. With the neck area, there is also a strong likelihood of referred pain, which means the real area of pain is causing pressure on nerves. This will result in a sensation of pain in a seemingly unrelated area. Your doctor will probably check for various related points in the neck muscles.

  The front area of the neck is also strongly related to pain, so the whole neck can become very painful in this condition. The muscular points of pain at the front of the neck are the big muscles at the sides of your head. These are called the sternocleidomastoid muscles and are involved with a wide range of neck movements. This is one of the major reasons fibromyalgia causes such intense neck pain, possibly frequent headaches and sleep problems.

• The Elbow – Elbow pain also seems to be common in fibromyalgia. Keep in mind this is also a common site of injuries. Just because your elbows are aching doesn’t mean you have the condition in question. If you do a lot of lifting and twisting motions with your arms on a regular basis, this can cause a condition known as tendonitis and the elbows are a common area for this type of injury. With fibromyalgia, the elbow pain will be persistent and usually felt on the outside and the center of the arm.
• Hips – The hips are another major pain point in fibromyalgia. Hip pain is also often of major concern when it comes to osteoarthritis and rheumatoid arthritis. Fibromyalgia pain in this area is not felt in the joints. Instead, it is centered in the gluteus maximus and gluteus minor muscles. What does this mean in plain English? It means your butt muscles hurt most of the time. Sitting can become excruciating and standing may also hurt at times. Pain in the butt is a major contributor to sleep problems associated with fibromyalgia.
• Lower Back – As if hip pain were not enough to deal with, the next major point is the lower back. There are multitudes of physical problems, which can cause lower back pain. Sitting for lengthy periods can cause pain here. Standing too much can also do the same. A lack of exercise and being overweight can cause this pain. Injuries are a culprit too. How is it experienced when people are dealing with fibromyalgia? How is it different? There are usually two distinct trigger points right at the top of those butt muscles. Even gentle pressure on these little indentations above the hips will induce severe pain.
• The Knees – The knees hurt and this is another point, which requires some clarification yet is usually involved with fibromyalgia points. There are many potential knee problems and your physician will most likely need to run some tests to determine if you might have an untreated injury or serious issues, which require different treatment. The distinct nature of fibromyalgia pain in the knees is that pain and sensitivity is focused on the back of the knees, on the soft side. Mechanically, this is a bundle of nerves and tendons related to the support of the buttocks and lower back. Are you starting to see the pattern?
• Upper Back – So far, all of these points of pain are related to bodily support muscles or muscles, which hold you up and make you functional in general life activities. The upper back is a point of fibromyalgia pain related to shoulder and neck support. Actual pressure points will be located between the spine and shoulder blades. This is the area we often see people rubbing in states of fatigue. The difference is, with fibromyalgia, these muscles called the trapezius muscles will hurt almost all of the time, contributing to neck pain, displacing the shoulders, and leading to balance issues and, ironically, neck pain.
• Chest – Chest muscles are checked for pain by doctors to make a diagnosis. Sudden chest pain is not the same as what is being described here. If you have sudden chest pain and / or shortness of breath, dial 911 immediately. Any regular chest pain must be addressed by a physician. Otherwise, the pain with fibromyalgia will have focused pain on one or both sides of the sternum. The sternum is the long bone down the center of your chest, so the pain points would be close to this bone and all its connections to the ribs. In addition, the pain is localized, not connected with side chest muscles or breathing muscles.

You may not be counting a full eighteen points, but when you consider each of these points to be bilateral, occurring on both sides, you start to get an idea of how fibromyalgia pain can extend itself. In the neck, there are at least eight potential points alone.

The hips and lower back comprise four to six potential points. It is the distribution of pain along the planes of the body, which involve areas of focal balance. Neck, shoulders, lower back, hips, elbows, and knees.