The relation between tender points & fibromyalgia (FM) symptom variables: evidence that FM is not a discrete disorder in the clinic

OBJECTIVE: To investigate the relation between measures of pain

threshold and symptoms of distress to determine if

fibromyalgia is a discrete construct/ disorder in the clinic.

METHODS: 627 patients seen at an outpatient rheumatology

centre from 1993 to 1996 underwent tender point and

dolorimetry examinations. All completed the assessment scales

for fatigue, sleep disturbance, anxiety, depression, global

severity, pain, 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).


regression analyses, the RDI was linearly related to the count

of tender points (r2 = 0.30). Lesser associations were found

between the RDI and dolorimetry measurements (r2 = 0.08). The

RDI was more strongly correlated with the two measures of

pain threshold than any of the individual fibromyalgia

symptom variables. In partial correlation analyses, all of

the information relating to symptom variables was contained

in the tender point count, and dolorimetry was not

independently related to symptoms.

CONCLUSION: Tender points

are linearly related to fibromyalgia variables and distress,

and there is no discrete enhancement or perturbation of

fibromyalgia or distress variables associated with very high

levels of tender points. Although fibromyalgia is a

recognisable clinical entity, there seems to be no rationale

for treating fibromyalgia as a discrete disorder, and it

would seem appropriate to consider the entire range of

tenderness and distress in clinic patients as well as in

research studies. The tender point count functions as a

‘sedimentation rate’ for distress, and is a better measure

than the dolorimetry score.

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