by Catharine L. Shaner, M.D., FAAP Ah yes, medical school -- where doctors-to-be study many things from basic science to cutting-edge technology. Along the way, they learn how to speak "doctor talk" - that mystical Latin/Greek language that allows doctors to communicate clearly and succinctly with one another. It is very handy and very precise. At times, medical-ese becomes so convenient that doctors forget to speak to their patients in plain English. In addition, patients are sometimes too confused or embarrassed to ask for clear explanations. If you want to be better prepared, then arm yourself with knowledge of some basic terms that are used frequently in regard to fibromyalgia. Grab some coffee - school's in session. Let's learn the lingo! Primary vs. Secondary -- Primary fibromyalgia (FM) is just FM all by its little own self. It is not caused by or related to any other condition. Secondary FM is found in association with another condition such as lupus or in FM following a car accident, for example. Trigger point vs. Tender point - Unfortunately, some articles and even some doctors use these words interchangeably. They do not mean the same thing. It is possible, even common, for a FM patient to have both tender points and trigger points. Treating a trigger point as a tender point can worsen the pain, so it is important that you and your practitioner know the difference. A trigger point refers to a tight band in muscle or supporting structures, such as skin, ligaments, and fascia (tough linings that support and separate internal body parts). Trigger points are often described as lumps, bumps or ropes. When compressed, these points can make a muscle jump or twitch. Pain from a trigger point can be experienced at the site of the trigger or referred to a distant part of the body. Trigger point activity can be continuous or just occur when touched. Even when it is not actively painful though, a trigger point causes trouble. The tight contraction squeezes blood vessels, lymph vessels, and nerves causing symptoms that might not be recognized as coming from a trigger point. Because they involve muscles (myo) and the lining supporting a muscle (fascia), trigger point pain may be referred to as myofascial pain. One can have Myofascial Pain Syndrome (MPS) alone or in addition to FM. Fibromyalgia causes generalized soreness or pain spread over many places in the body. When touched even lightly, a body part might feel very tender. These hypersensitive spots are called tender points. Tender points hurt where they are touched, but do not cause pain elsewhere. They often occur in pairs with a matching tender point on both the right and left side of the body. In FM, tender points can occur anywhere, however the American College of Rheumatology (ACR) has identified 18 tender points that are most consistent among fibromyalgia patients. These 18 points are helpful in the diagnosis of FM and in fact, 11 out of 18 points are necessary to be included in a scientific study involving fibromyalgia patients. A specific amount of pressure (4 kg, or about 9 pounds, per unit area of force) must be applied when testing tender points. Pressing with a thumb until the fingernail blanches white produces the correct force. A special instrument called a doliometer can measure the pressure with greater accuracy. The name doliometer comes from the Latin dolor, meaning pain. Although tempting, referring to your pesky little brother as a "dolor" however, is not strictly correct. Muscles vs. Tendons vs. Ligaments - The short answer is: muscles contract to move things, tendons attach muscles to bones, and ligaments attach bones to bones. Intrigued? Read on for the long answer: The word muscle is from Latin meaning "a little mouse." Muscles are the contractile tissues in the body. Human bodies have over 600 different muscles. No wonder we hurt so much! There are three different kinds of muscle tissue: skeletal muscle (to move our body parts voluntarily, for example gripping a cup), cardiac muscle (to make our heart beat), and smooth muscle (to move body parts without conscious effort, for example intestinal contractions). One end of the muscle is fixed in place and the other end is moveable. Tendon is from the Latin tendo meaning to stretch out or extend. Tendons connect the moving ends of a muscle to your bones. Usually, tendons are just at the far end of a muscle, but sometimes they run alongside or even through the center of a muscle. The Achilles tendon is familiar to most people. It is the thick cord attaching your calf muscle to your heel. Do you notice how it stretches out from the bottom of the calf muscle to reach the heel? The word ligament is Latin meaning a band or bandage. Ligaments connect bones, cartilage, and other structures and serve as support for fascia or muscles. Strain vs. Sprain - You strain a muscle (strained back), but you sprain a ligament (sprained ankle). The terms are not interchangeable. Strain implies an injury from overusing the muscle. Sprain refers to a stretching of a ligament past its normal limit. These surely are not the most important terms to tell apart, but it is neat to know something that your friends don't know, isn't it? Signs vs. Symptoms - Signs are what can be detected physically in an examination. We can measure fever with a thermometer, we can feel enlarged lymph nodes, and we can see a rash. Symptoms are what you experience in how you function or what you feel. Examples of symptoms include fatigue, pain, and stiffness - things that cannot be measured and cannot be seen by another person. Only you know how your pain feels, but doctors sometimes get a clue by asking you to rate your pain on a pain scale. "Subjective swelling," a term often used in reference to fibromyalgia patients, refers to the symptom of feeling swollen. However, no swelling can be seen or felt by an examiner. Cognitive Dysfunction (Fibro-fog) - Dysfunction means something is not working right. Cognition refers to knowledge and the process of knowing. It encompasses: perceiving, recognizing, conceiving, judging, sensing, reasoning, and imagining. Cognitive dysfunction is commonly called fibro-fog. (Quick, what's the difference between sprain and strain? Just kidding!) Syndrome vs. Disorder vs. Disease - Fibromyalgia: a syndrome, a disorder, or a disease? Today, fibromyalgia is generally termed a "syndrome." Syndrome derives from Greek and means "running together." Together, the symptoms you experience and the physical signs your body exhibits give a picture of "fibromyalgia." A disorder is defined as a disturbance of function (how your body works) or structure (how you body is formed) or both. Disorder can result from a genetic cause or from an external cause, such as trauma. The word disease is English and means the opposite of ease. Previously, classification as a disease required two of three criteria, namely: a recognized cause of the disease, a group of signs and symptoms, and consistent changes/damage to your body or body parts. An example of a disease would be measles. It is caused by a specific virus and has characteristic symptoms and physical signs. Recently, the definition of disease has been under revision. Perhaps the best current definition emphasizes the failure of a system to adapt to a stress, such as poison, bacteria, or negative emotions. In short, anything that prompts one to visit a doctor could be considered a disease. Acute vs. Chronic - The word acute comes from the Latin acutus meaning sharp. It refers to a short and sharp course. An acute pain might be a stomach virus for example. Suddenly, you have stomach cramps, you throw up, but in a day or two you feel better. The pain is gone. Chronic is from the Greek chronos meaning time. It refers to a disorder of long duration and slow progress. Sound familiar? Diabetes, MS and fibromyalgia are examples of chronic disorders. Diagnosis of Exclusion and Rule Out - Diagnosis of exclusion means that for a particular condition, there is no straightforward way to make a definite diagnosis. The doctor must exclude other similar disorders before concluding that you have the suspected ailment. Pain, fatigue, and muscle stiffness, the main symptoms of FM, occur in many conditions. For example, FM in children may be initially suspected of being juvenile rheumatoid arthritis (JRA). If the doctor orders tests to prove that it is not JRA, then she has ruled out JRA as the cause of the child's symptoms. When all other reasonable conditions have been eliminated as potential diagnoses, then the doctor can state that her patient most likely has FM. It is a little unsettling not to have a test that proves you definitely do have FM, but it is sometimes reassuring just to know what you do not have! Okay, school's out. I hope you enjoyed learning the lingo. I know it's not as much fun as learning the tango, but it is much more useful than dancing at the doctor's office.