Abstract
Multiple tender points are common in the population and, in studies of mid-life adults, are strongly associated with high levels of psychological distress. Whether this relationship occurs in older adults is unclear.This cross-sectional study investigated whether high levels of psychological distress would be associated with a high tender point count and whether the relationship would be moderated by age. Three thousand three hundred and seventy-nine individuals were mailed a questionnaire which included the Hospital Anxiety and Depression (HAD) scale, the Pain Catastrophising Scale (PCS), the Brief Illness Perception Questionnaire (Brief IPQ), and the Pittsburgh Sleep Quality Index (PSQI). A random sample of approximately 10% of subjects who returned the questionnaire undertook a physical assessment, including a manual tender point count assessment.A total of 2385 (71%) subjects completed the questionnaire, of whom 798 (33%) were invited to take part in the physical assessment and 290 (12%) participated. Of the 290 participants the median age was 64 years (range 34–97) and 63% were female. The median HAD score was 9 (IQR 5–14) and the median number of tender points was 3 (range 0–7).Increasing HAD score was positively and significantly associated with tender point count, but this relationship was not moderated by age. In a final multivariable model, sex, HAD score and PSQI score were independent predictors of multiple tender points.Psychological distress was associated with multiple tender points independent of age. Psychological distress and trouble sleeping were important, potentially modifiable factors associated with the outcome.
Highlights
Tender points are body sites where pain is commonly induced on the application of firm pressure
A threshold number of tender points has been part of the American College of Rheumatology definition of fibromyalgia (Wolfe et al, 1990), they are common in the general population, with one study finding a median of 4 tender points (Croft, Schollum, & Silman, 1994), and another finding that the mean number of tender points was 1.8 in participants with no pain and 6.2 in those with chronic, widespread pain (Wolfe, Ross, Anderson, Russell, & Hebert, 1995)
It can be seen that only osteoarthritis in the hands and medication count varied significantly between the age groups (p < 0.05), whereas the other variables did not
Summary
Tender points are body sites where pain is commonly induced on the application of firm pressure. As well as being more common in people with more widespread pain (Croft, Burt, Schollum, Thomas, & Macfarlane, 1996), a high tender point count is associated with greater disability. Tender point count was found to correlate significantly with physical disability in female care workers (Lundberg & Gerdle, 2002). In older people multiple tender points have been found to be associated with mobility limitations. A population-based study of older participants (aged 70–97 years) found that higher tender point count was significantly associated with poorer mobility (Eggermont, Shmerling, & Leveille, 2010)
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