What use are fibromyalgia (FM) control points?
By Wolfe F •
March 26, 1998
OBJECTIVE: To investigate the relationship between control
points and symptom and distress severity in fibromyalgia (FM).
METHODS: Eighty- four new patients with FM seen at an
outpatient rheumatology center from December 1994 through
August 1996 underwent tender point and dolorimetry
examinations at 18 active and 4 control sites. All completed
the assessment scales for fatigue, sleep disturbance, anxiety,
depression, global severity, pain, and functional disability,
and a composite measure of distress constructed from scores of
sleep disturbance, fatigue, anxiety, depression, and global
severity -- the Rheumatology Distress Index (RDI).
Control point positivity was common in FM (63.1%) and was
associated with somewhat more severe FM symptoms and general
distress, yielding an increase in the RDI of 9.2 units or 0.55
standard deviation units. There was no evidence of
particularly worse disease in patients with high counts of
control tender points, and increasing numbers of tender points
beyond the first positive control point were generally not
associated with, or were only weakly associated with,
increasing symptom severity. Many patients with positive
control points had only mild levels of symptom severity.
Finally, we found no clusters of patients with very severe
symptoms associated with control points, or with dolorimetry
scores, or with ratios of dolorimetry scores from different
body regions of varying pain thresholds.
control points are a common feature (63%) in FM, and appear to
be a marker for a generally low pain threshold rather than a
disproportionate increase in severe symptoms or distress.
Control point positivity should not be used to disqualify a
diagnosis of FM. Control point measurements do not add much to
FM diagnosis or assessment and, perhaps, should be abandoned.
At the least, they should be designated "high threshold"
points rather than control points. Dolorimetry is considerably
less useful in FM assessment than the manual tender point
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