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The reliability of examination for tenderness in patients with myofascial pain, chronic fibromyalgia (FM) & controls

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OBJECTIVE. To establish the reliability with which tenderness
could be evaluated in patients with chronic myalgias, using
dolorimetry and palpation.

METHODS. Three blinded examiners
using pressure dolorimetry and digital palpation compared 19
paired tender points and 8 paired control points in 4 matched
groups of 6 patients with fibromyalgia (FM), myofascial pain,
pain controls, and healthy controls.

RESULTS. Good interrater
and test-retest reliability were found for dolorimetry scores.
There were significant differences in tenderness ratings by
dolorimetry between the diagnostic groups, with the patients
with FM and myofascial pain having the greatest tenderness,
the normals having the least tenderness, and the pain controls
having tenderness levels midway between the patients with FM
or myofascial pain and the normals. In all patients, control
points had higher pain thresholds than tender points.
One-third of patients with localized pain complaints
demonstrated a significant relationship between region of
clinical pain complaint and measured tenderness thresholds by
dolorimetry. In ratings of tenderness by digital palpation,
there was very good intrarater reliability over 26 of 27
paired points, and good interrater reliability at 75% of the
points. One-half of patients with localized pain complaints
demonstrated a significant relationship between region of
clinical pain complaint and number of tender points by
palpation.

CONCLUSION. Both dolorimetry and palpation are
sufficiently reliable to discriminate control patients from
patients with myofascial pain and FM, but may not discriminate
patients with myofascial pain from those with FM. Neither
method appears to correlate well with the location of the
clinical pain complaint, regardless of diagnosis.

Tunks E, McCain GA, Hart LE, Teasell RW, Goldsmith CH, Rollman GB,
McDermid AJ, DeShane PJ

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