The Relationship between Mechanical Hyperalgesia Assessed by Manual Tender Point Examination and Disease Severity in Patients with Chronic Widespread Pain: A Cross-Sectional Study
The clinical utility of tender point (TP) examination in patients reporting chronic widespread pain (CWP) is the subject of contemporary debate. The objective of this study was to assess the relationship between mechanical hyperalgesia assessed by manual TP examination and clinical disease severity. 271 women with CWP were recruited from a clinical setting. Data collection included patient-reported symptoms, health-related quality of life variables, and observation-based measures of functional ability, muscle strength, 6-minute walk, and pressure pain thresholds measured by cuff algometry. TP examination was conducted according to ACR-guidelines. Relationships between disease variables and TP count (TPC) were analyzed with logistic regression in a continuum model, allowing the TPC to depend on the included disease variables and two regression models carried out for a TPC threshold level, varying between 1 and 17. The threshold analyses indicated a TPC threshold at 8, above which a large number of disease variables became consistently significant explanatory factors, whereas none of the disease variables reached a significance level in the continuum model. These results support the premise that the presence of mechanical hyperalgesia influences symptomatology in CWP and that the severity of clinical expression is related to a threshold of TPs, rather than being part of a continuum. 1. Introduction Fibromyalgia is a characterized subgroup of patients presenting with chronic widespread pain (CWP) and widespread mechanical hyperalgesia. These characteristics are enshrined in the 1990-ACR criteria [1] that have been the cornerstone for research studies of the past 2 decades. Contemporary research in subjects fulfilling 1990-ACR criteria has provided persuasive evidence for augmented central pain processing in terms of sensitization of nociceptive neurons and ascending spinal tracts accompanied by dysfunction of descending pain inhibitory pathways [2]. The underlying pain mechanisms in subjects with CWP with fewer than 11 tender points (TP) are less well described [2]. Mechanical hyperalgesia is a clinical manifestation of central sensitization and, although an imperfect measure, the manual TP examination has been considered a primary identifier of pain hypersensitivity [3–6]. In the development of the 1990 ACR classification criteria for fibromyalgia, TPs were found to be the most powerful discriminator between fibromyalgia and control subjects; the best separation occurred at about the 13 TPs for mild tenderness (the subject state that palpation is painful)
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