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Population study of tender point counts & pain as evidence of fibromyalgia (FM)

  [ 81 votes ]   [ Discuss This Article ] • September 17, 1994

OBJECTIVE--To determine the relation between tender points,
complaints of pain, and symptoms of depression, fatigue, and
sleep quality in the general population.

DESIGN--Two stage
cross sectional study with an initial questionnaire about pain
to classify those eligible for an examination of tender

SETTING--Two general practices in north west England.

SUBJECTS--Stratified random sample of adults from age-sex
registers. Of the responders, 250 were selected for
examination of tender points on the basis of their reported
pain complaints; 177 subsequently participated.

MAIN OUTCOME MEASURES--Tender point count (0 to 18) grouped into four
categories with the highest (> or = 11) corresponding to the
criteria of the American College of Rheumatology for
fibromyalgia. Assessment of pain (chronic widespread,
regional, none). Measures of depression, fatigue, and
difficulty with sleeping.

RESULTS--Women had a higher median
tender point count (six) than did men (three). Counts were
higher in those with pain than in those who had no pain and in
those with widespread compared with regional pain. Mostsubjects with chronic widespread pain, however, had fewer than
11 tender points (27/45; 60%). Two people with counts of 11 or
more were in the group reporting no pain. Mean symptom scores
for depression, fatigue, and sleep problems increased as the
tender point count rose (P value for trend < 0.001). These
trends were independent of pain complaints.

CONCLUSIONS--Tender points are a measure of general distress.
They are related to pain complaints but are separately
associated with fatigue and depression. Sleep problems are
associated with tender points, although prospective studies
are needed to determine whether they cause tenderness to
develop. Fibromyalgia does not seem to be a distinct disease

Croft P, Schollum J, Silman A

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