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

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

1 Star2 Stars3 Stars4 Stars5 Stars (81 votes, average: 3.00 out of 5)

Leave a Reply