More pain, more tender points: is fibromyalgia (FM) just 1 end of a continuous spectrum

OBJECTIVES: To investigate the hypothesis that fibromyalgia

represents one end of a spectrum in which there is a more

general association between musculoskeletal pain and tender


METHODS: The subjects studied were 177 individuals

selected from a population based screening survey for

musculoskeletal pain. All subjects completed a pain mannikin

and were examined for the presence of tender points at the

nine American College of Rheumatology bilateral sites.

RESULTS: There were moderately strong associations (odds

ratios range 1.3-3.1) between the reported presence of pain in

a body segment and the presence of a tender point within that

segment. Further, there was evidence of a trend of increasing

number of tender points with increasing number of painful

segments. The reporting of non-specific pain, aching, or

stiffness, was also associated with high tender point counts.

CONCLUSION: This study illustrates that the association

between tender points and pain is not restricted to the

clinically defined subgroup with chronic widespread pain.

Given that widespread pain and tender points have previously

been linked with distress, this might reflect lesser degrees,

or earlier phases of the somatisation of distress.

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