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The association between tender points, psychological distress, & adverse childhood experience: a community-based study - fibromyalgia research

  [ 62 votes ]   [ Discuss This Article ] • June 5, 1999

OBJECTIVE: To examine the hypothesis that characteristics of
somatization and illness behavior, and their childhood
antecedents, are associated with the presence of multiple
tender points.

METHODS: Two hundred eighty-nine subjects who
had demonstrated psychological distress (General Health
Questionnaire score > or =2) had a tender point examination
and in-depth psychological evaluation. In addition, subjects
were interviewed about a number of adverse childhood
experiences. The 99 subjects with 5 or more tender points were
compared with the remaining 190 subjects.

tender point count (> or =5) was associated with low levels of
self-care (odds ratio [OR] 2.4, 95% confidence interval [95%
CI] 1.1-5.0), reports of a greater number of somatic symptoms
(OR 2.2, 95% CI 1.0-4.9), high levels of fatigue (OR 3.3, 95%
CI 1.7-6.3), and a pattern of illness behavior characterized
by increased medical care usage (OR 4.2, 95% CI 2.1-8.4).
Those with high tender point counts were substantially more
likely to report adverse childhood experiences, including loss
of parents (OR 2.1, 95% CI 1.1-3.9) and abuse (OR 6.9, 95% CI
2.0-24.6). These results were not explained by the presence of
chronic pain.

CONCLUSION: These data add further weight to the
hypothesis that tender points, as part of the fibromyalgia
syndrome, are strongly associated with specific components of
psychological distress as well as characteristics of
somatization and its antecedents. It is possible that these
features contribute to the development of the syndrome of

McBeth J, Macfarlane GJ, Benjamin S, Morris S, Silman AJ

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