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

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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