Tender Point Score Research Articles

Serum paraoxonase activities, nitric oxide, and malondialdehyde levels are altered in patients with primary fibromyalgia syndrome.

Fibromyalgia patients who are exposed to extreme oxidative stress may face more severe clinical features or oxidative stress may be increased by the severity of the disease. The purpose of these investigation were to determine serum paraoxonase activities (PON-1) and nitric oxide (NO) activities and malondialdehyde (MDA) level in fibromyalgia and whether there were any associations between these enzymes activities, MDA level, and clinical parameters. The study groups were consisted of 30 primer fibromyalgia patients and 30 healthy subjects. Clinical findings, pain severity, functional disability, general health status, anxiety, and depression assessed, and serum PON-1 activity, MDA, and NO levels were measured. The primer fibromyalgia group had significantly higher MDA, low density lipoprotein-cholesterol (LDL-C), and decreased PON-1 activity, NO, and high density lipoprotein-cholesterol (HDL-C) with respect to controls. The paraoxonase activity was negatively correlated with MDA, LDL-C, Visual Analog Scale (VAS), Fibromyalgia Impact Questionnaire score (FIQ score), tender point score, age, and BDI score, while positively correlated with NO and HDL-C. MDA level was positively correlated with VAS, FIQ score, tender point score, age, and negatively correlated with NO level. These results suggest that FMS patients have an alteration in levels of MDA, NO, and PON-1 activities. We think that impaired oxidant/antioxidant status may affect the symptoms of the disease. Also, they may be of importance in the complex physiopathologic mechanism behind the development of FMS.

Elevated Serum Levels of Monocyte Chemotactic Protein-1/Chemokine C-C Motif Ligand 2 are Linked to Disease Severity in Patients with Fibromyalgia Syndrome

Background:Elevated levels of monocyte chemotactic protein-1/chemokine C-C motif ligand 2 have been identified in fibromyalgia patients.Aims:To examine the potential association among serum levels of monocyte chemotactic protein-1/chemokine C-C motif ligand 2 with disease severity of fibromyalgia.Study Design:Cross-sectional study.Methods:Seventy-nine female patients with fibromyalgia and 75 healthy normal controls were included in our study. Serum levels of monocyte chemotactic protein-1/chemokine C-C motif ligand 2 were detected by enzyme-linked immune sorbent assays. The existence of tender points was evaluated based on the standardized manual tender point examination. Pressure pain thresholds at the knees, and bilateral trapezius muscles were measured with an algometer. A visual analog scale and the Revised Fibromyalgia Impact Questionnaire were utilized to assess the degree of pain and functional abilities.Results:Serum levels of monocyte chemotactic protein-1/chemokine C-C motif ligand 2 were significantly greater in patients with fibromyalgia compared with healthy controls (151.6±31.9 pg/mL vs 103.3±25.2 pg/mL, p<0.001). Patients with severe fibromyalgia had significantly higher serum levels of chemokine C-C motif ligand 2 than patients with mild and moderate fibromyalgia (173.1±21.9 pg/mL vs 151.0.0±35.1 pg/mL, p=0.01). Patients with moderate fibromyalgia revealed markedly augmented serum levels of chemokine C-C motif ligand 2 compared with patients with mild fibromyalgia (151.0±35.1 pg/mL vs 133.3±23.9 pg/mL, p=0.03). Serum levels of chemokine C-C motif ligand 2 were positively associated with tender point scores (r=0.455, p<0.001). In addition, serum levels of chemokine C-C motif ligand 2 were positively associated with pressure pain thresholds in both knees and bilateral trapezius muscles (knees: r=-0.349, p=0.002; trapezius muscles: r=-0.318, p=0.004). Finally, we found elevated serum levels of chemokine C-C motif ligand were also positively associated with the visual analog scale (r=0.368, p=0.001), and the Fibromyalgia Impact Questionnaire score (r=0.401, p<0.001).Conclusion:Elevated serum levels of monocyte chemotactic protein-1/chemokine C-C motif ligand 2 are linked to disease severity of fibromyalgia. Therapeutic interventions inhibiting monocyte chemotactic protein-1/chemokine C-C motif ligand 2 in fibromyalgia deserve additional studies.

Dyspareunia in Female Fibromyalgia patients

Objective: To evaluate tender points number, pressure pain threshold and incidence of fibromyalgia in women with dyspareuniaPatients and Methods: Married women dyspareunia were compared to 35 healthy controls. Females were asked if they encountered sexual intercourse throughout the preceding month and dyspareunia was rated from zero to 3 by usingMarinoff Dyspareunia Scale (MDS). Dolorimeter (pressure algometer) was employed to assess pressure pain threshold. Diagnosis of Fibromyalgia was based on the 1990 American College of Rheumatology (ACR) criteria. Depression status of was assessed using the Beck Depression Inventory (BDI).Results: No significant statistical difference was found among both patients and control groups in relation to age, body mass index (BMI). Myalgic score and total tender point score was significantly lower in the dyspareunia group. Tender points score among dyspareunia patients was significantly higher. Themean score of Beck Depression Inventory (BDI) was 18.1±6.7 among dyspareunia group diagnosed with fibromyalgia compared to 11.3±4.1 in the dyspareunia group without fibromyalgiaConclusion: fibromyalgia is a contributing factor to dyspareunia

Effectiveness of 2 Osteopathic Treatment Approaches on Pain, Pressure-Pain Threshold, and Disease Severity in Patients with Fibromyalgia: A Randomized Controlled Trial

Objective: To assess the effectiveness of osteopathic intervention (OI) and general osteopathic treatment (GOT) in individuals with fibromyalgia syndrome (FMS). Methods: The trial was designed as a randomized controlled trial with 2 osteopathic interventions and 1 untreated control group. The patients in the two osteopathic groups received 10 osteopathic treatments (OI or GOT) within a time period of 12 weeks. The control group did not receive any osteopathic treatment. The primary outcome was the average pain intensity (API) assessed by visual analog scale (VAS). Secondary outcomes were the pressure-pain threshold rated by means of a tender point score, and disease severity, assessed by the Fibromyalgia Impact Questionnaire (FIQ). Results: 50 patients were randomized. The primary outcome parameter API decreased from 7.2 to 4.7 in the OI group, from 6.3 to 4.3 in the GOT group, and increased slightly in the control group from 6.2 to 6.6. There were significant differences for the change in API between the OI group and the control group (VAS: 2.9, 95% confidence interval (CI) = 1.12-4.52), and between the GOT group and the control group (VAS: 2.4, 95% CI = 0.65-4.11), but no significant differences between the OI group and the GOT group. There were no significant differences for the secondary outcome parameters between the groups. Conclusion: A series of osteopathic treatments might be beneficial for patients suffering from FMS.

GH Responsiveness to Combined GH-Releasing Hormone and Arginine Administration in Obese Patients with Fibromyalgia Syndrome.

Reportedly, fibromyalgia (FM) is frequently associated with reduced IGF-1 levels and GH hyporesponsiveness to different GH stimulation tests. Since there is a high prevalence of obesity in FM, and obesity itself is characterized by hyposomatotropism, the aim of this study was to assess IGF-1 levels and GH responsiveness in sixteen severely obese women suffering from FM, who, subdivided into two subgroups on the basis of their age-dependent IGF-1 values (> or <−2 SDS), underwent the combined GHRH plus arginine test. Four out of 16 obese women with FM (25%) had low IGF-1 SDS values, 2 cases of this subgroup (12.5%) failing also to normally respond to the test. Among patients with normal GH responses, 4 showed a delayed GH peak. The subgroup with low IGF-1 SDS values had higher BMI than that with normal IGF-1 SDS. GH peak and area under the curve were not correlated with CRP, ESR, or tender point score, while significant correlations were found with fat-free mass and fat mass. In conclusion, this study shows the existence of a high prevalence of GH-IGF-1 dysfunction in patients with both FM and obesity, presumably as a consequence of the obese rather than fibromyalgic condition.

Functional limitations in children and adolescents suffering from chronic pain: validation and psychometric properties of the German Functional Disability Inventory (FDI-G).

Our objective was to translate the Functional Disability Inventory (FDI) into German, to evaluate its validity and to assess functional limitation in a large cohort of children and adolescents with juvenile fibromyalgia syndrome (jFMS). We administered several questions (e.g., sociodemographics, school-related issues) and questionnaires to 329 patients and one parent. The questionnaires included, among others, a German version of the FDI, the CHAQ (parent report), KIDSCREEN, tender point score (TPS), Depression Inventory for Children and Adolescents (DIKJ) and others. Patients were asked about the severity of pain today (NRS=numerical rating scale) and other symptoms. Internal consistency was evaluated with Cronbach's alpha. Construct validity of the FDI was evaluated by correlating the FDI with the questionnaires as well as with the pain and other variables, e.g., days missed school. An exploratory factor analysis (EFA) was also performed. Mean age was 13.9years (SD ±2.48). Means were for pain today 5.37 (±2.39) and for the TPS 39.71 (±21.56). Internal consistency was α=.90. Low-to-moderate correlations were obtained between the FDI and the CHAQ (ρ=.51**), KIDSCREEN (e.g., physical well-being ρ=-.62**; peers and social support ρ=-.28**) as well as the pain variables (NRS ρ=.24**; TPS ρ=.38**). Psychological variables were also correlated with the FDI (e.g., DIJK ρ=.28**). An EFA suggested a two-factor solution. The FDI is a valid instrument for measuring functional limitations in German children and adolescents with jFMS.

Joint Hypermobility: A Common Association with Complex Functional Gastrointestinal Disorders

To evaluate the prevalence of joint hypermobility (JH) and comorbid conditions in children and young adults referred to a tertiary care neurogastroenterology and autonomic disorders clinic for functional gastrointestinal complaints. This was a retrospective chart review of 66 new patients aged 5-24 years who fulfilled at least 1 pediatric Rome III criteria for a functional gastrointestinal disorder (FGID) and had a recorded Beighton score (n = 45) or fibromyalgia tender point score (n = 45) based on physician examination. Comorbid symptoms were collected and autonomic testing was performed for evaluation of postural tachycardia syndrome (POTS). The median patient age was 15 years (range, 5-24 years), 48 (73%) were females, and 56% had JH, a significantly higher rate compared with population studies of healthy adolescents (P < .001; OR, 10.03; 95% CI, 5.26-19.13). POTS was diagnosed in 34% of patients and did not correlate significantly with hypermobility. Comorbid conditions were common, including sleep disturbances (77%), chronic fatigue (93%), dizziness (94%), migraines (94%), chronic nausea (93%), and fibromyalgia (24%). JH and other comorbid symptoms, including fibromyalgia, occur commonly in children and young adults with complex FGIDs. POTS is prevalent in FGIDs but is not associated with hypermobility. We recommend screening patients with complex FGIDs for JH, fibromyalgia, and comorbid symptoms such as sleep disturbances, migraines, and autonomic dysfunction.

THU0316 The Symptom Severity in Korean Patients with Fibromyalgia is Associated with Socioeconomic Status, but not with Obesity

BackgroundFibromyalgia (FM) is a chronic pain disorder characterized by widespread pain, tenderness, and various associated symptoms including sleep disturbances, chronic fatigue, depression, and other somatic symptoms. Several longitudinal and cross-sectional...

SAT0393 The Effects of Coexisting Fibromyalgia on Disability of the Computer Users with Cumulative Trauma Disorders

BackgroundThe effects of coexisting fibromyalgia syndrome (FS) on disability of computer users with cumulative trauma disorders (CTD) hasn’t been studied previously.ObjectivesTo evaluate the existence of FS in computer users with...

AB1095 Study on factors associated with chronic fatigue syndrome (fibromyalgia) in patients with systemic lupus erythematosus

ObjectivesTo examine the relation between chronic fatigue syndrome (fibromyalgia), disease activity, and quality of life measures in patients with systemic lupus erythematosus (SLE).MethodsConsecutive 40 patients attending king fahad hospital, Jeddah...

Structural alterations in brainstem of fibromyalgia syndrome patients correlate with sensitivity to mechanical pressure

Fibromyalgia syndrome is a chronic pain disorder characterised by widespread pain and tenderness in muscles and deep tissues. Current theories regarding the pathophysiological origins of fibromyalgia syndrome point towards central sensitisation and a decreased capacity of descending nociceptive controls. Morphological alterations to subcortical brain regions may contribute to such pathophysiological mechanisms, and to pain and other symptoms seen in fibromyalgia. Therefore, we evaluated geometric differences in subcortical structures in fibromyalgia patients relative to healthy people using a novel method of shape analysis. Sixteen female fibromyalgia patients and 15 age and sex matched, healthy control subjects underwent high-resolution T1-weighted magnetic resonance image scanning. Data was analysed using shape analysis of 15 subcortical regions and standard voxel-based morphometry analysis.Fibromyalgia syndrome patients, relative to healthy control participants, exhibited alterations to the shape of the left lateral aspect of the lower brainstem (medulla). The mean total volume of the brainstem was also found to be significantly reduced in the patient group compared to healthy control subjects, and this brainstem volume reduction in patient group significantly correlated with clinical manual tender point scale scores. Voxel-based morphometry analysis revealed that patients also demonstrated decreased local grey matter volumes in the brainstem (pons) and left precuneus, and increased grey matter volumes in bilateral primary somatosensory cortices.Results suggest that the volume reduction and associated geometric shape alterations seen in the brainstem of the patient group may contribute to sensitivity to pressure pain in fibromyalgia syndrome. This finding may be due to structure-related deficiencies in regions subserving descending nociceptive control.

Identification of the Clinical Features Distinguishing Psoriatic Arthritis and Fibromyalgia

To identify the clinical features that can help to distinguish between psoriatic arthritis (PsA) and fibromyalgia (FM). Our cross-sectional study was carried out in 10 Italian rheumatology centers between January and September 2009, and enrolled all consecutive patients with PsA and FM who agreed to participate. Standard clinical and laboratory data for PsA and FM were collected from all patients. Records were made of somatic symptoms, response to nonsteroidal antiinflammatory drugs (NSAID), self-evaluated pain, general health, disability, and responses to the Fibromyalgia Impact Questionnaire. Data were statistically analyzed by univariate and multivariate analyses, and receiver-operating characteristic curves. The analysis concentrated on the clinical features shared by the 2 conditions. Two hundred sixty-six patients with PsA (mean age 51.7 yrs; disease duration 10.2 yrs) and 120 patients with FM (mean age 50.2 yrs; disease duration 5.6 yrs) were evaluated. Univariate analysis showed that patients with FM had higher mean tender point and enthesitis scores, more somatic symptoms, and responded less to NSAID. Multivariate analysis showed that the presence of ≥ 6 FM-associated symptoms and ≥ 8 tender points was the best predictor of FM. The shared clinical features of PsA and FM that had the greatest discriminating power for FM were the number of FM-associated symptoms and tender point count.

α1‐Antitrypsin in Fibromyalgia: Results of a Randomized, Placebo‐Controlled, Double‐Blind and Crossover Pilot Trial

To assess clinical effect of a human plasma-derived alpha-1 antitrypsin (AAT) concentrate in reducing pain severity of patients with fibromyalgia (FM). Thirteen subjects with FM completed a randomized, double-blind, placebo-controlled, crossover study which consisted of 9 weeks trial of AAT or placebo with a washout period of 6 weeks. Primary efficacy endpoint was change on pain severity score, assessed by a daily visual analogue scale (VAS) for pain. Other outcome measures included a tender point score, the Fibromyalgia Impact Questionnaire, (FIQ), the Medical Outcomes Study Short Form 36 (SF-36), the Health Assessment Questionnaire Disability Index (HAQ-DI), the Hospital Anxiety and Depression Scale (HADS) and tiredness score evaluated by VAS. No statistically significant differences were observed in either pain severity or other secondary outcome measures in either of the treatment groups, or between treatment groups in either of the treatment periods. No carryover or order of intervention effect was observed from one treatment to the other. Both investigational interventions were generally well tolerated, and vital signs during the drug infusions were within the respective normal ranges. Treatment with a human plasma-derived AAT concentrate did not demonstrate significant improvement over placebo on reducing pain severity and other symptoms of FM. Further research should examine other FM subpopulations and drug doses.

A clinical study on treating lumbar disc herniation with different electroacupuncture dose

Objective The therapeutic effectiveness of different electroacupuncture dose on lumbar disc herniation was studied. Methods 200 cases with lumbar disc herniation, who were also diagnosed of blood stasis and qi stagnation, and obstruction of collaterals by TCM syndrome differentiation, were randomly divided into a control group and a treatment group (100/group) by tail number of cases. Both groups were cured with electroacupuncture, while receiving treatments of Qd, 20 minutes/time in the control group; Bid, 20minutes/time in the treatment group. Effects were analyzed after the treatment(35days/course). Results After treatment, control-markedly rate was 91％ in the treatment group, and 68％ in the control group; There was significant difference of control- markedly rate between the two groups (Z=-3.5480, P＜0.05). According to the analysis of the symptoms and signs: low back pain (0.65±0.03) score, tender point (1.12±0.11) score, lumbar activity (0.75±0.12) score, dysbasia ( 1.01 ±0.06) score, straight leg raising test (0.37±0.12) score,radioactive pain in the legs (0.61 ±0.09) score, strengthening test (0.29±0.08) score, toe strength (0.29±0.09)score in the control group, those improvements of both groups existed obvious statistical difference (P＜0.05).There was also significant difference of average effective time between the two groups (P＜0.01) [ (3.86±2.106)d in the treatment group, (5.12±3.125)d in the control group]. Conclusion Electroacupuncture Bid group was superior to electroacupuncture Qd group for treating lumbar disc herniation. Key words: Electroacupuncture; Different acupuncture dose; Lumbar disc herniation

Fibromyalgic rheumatoid arthritis and disease assessment

We evaluated fibromyalgic RA to determine its clinical impact, identification using core clinical assessments and influence identifying active disease using disease activity scores (DAS-28). We examined the impact and identification using core clinical assessments (tender minus swollen joint counts) of fibromyalgic RA (> or =11 tender points) in initial (105 patients) and replicate (100 patients) cohorts. Receiver operator characteristic (ROC) curves optimized the cut-off points using tender minus swollen joint counts; their validity was confirmed in a routine practice cohort (321 patients). We evaluated whether fibromyalgic RA affected the identification of active disease using DAS-28 (> or =5.1) and the clinical disease activity index (CDAI). A total of 18/105 and 12/100 patients in initial and replicate cohorts, respectively, had fibromyalgic RA. This was identified by > or =7 tender minus swollen joint counts with 83% sensitivity and 80% specificity in the initial cohort (72 and 98% in replicate, respectively) and ROC area under the curve 0.80 (0.94 in replicate). 'Fibromyalgic' RA (tender point scores in initial and tender minus swollen joints in clinical practice cohorts) had higher DAS-28, pain, fatigue and HAQ scores. More fibromyalgic RA patients had active disease by DAS-28 (odds ratio 14.3; 95% CI 5.5, 37.1; and CDAI 17.2; 95% CI 6.1, 48.5); conventional assessments (three or more tender joints; three or more swollen joints; ESR > or =28 mm/h) showed no difference (1.75; 95% CI 0.72, 4.3). Fibromyalgic RA affects 12-17% of RA outpatients and results in worse functional outcomes. DAS-28 scores over-interpret active disease in fibromyalgic RA.

Serum hyaluronic acid levels do not explain morning stiffness in patients with fibromyalgia

To investigate the serum levels of hyaluronic acid (HA) in Korean female patients with fibromyalgia (FM) and correlate these levels with variables of disease severity including morning stiffness, we measured HA serum levels in 69 FM patients, 72 rheumatoid arthritis (RA) patients, and 71 healthy controls by enzyme-linked binding protein assay. The serum levels of HA in FM patients did not differ from those in the age-matched controls, whereas HA levels were significantly higher in RA patients than in FM patients and controls (both P < 0.001). With a cut-off value of 75 ng/mL, the prevalence of seropositivity was higher in RA patients (59.7%) than in FM patients (26.1%) or controls (14.1%; both P < 0.001). There were no differences in seropositivity between FM patients and controls, or between FM patients with severe symptoms and those with mild symptoms. The HA levels in FM patients were significantly correlated with age, age at diagnosis, age at symptom development, disease duration, symptom duration, and level of education. There were no correlations between HA levels and morning stiffness, tender point counts and scores, or Fibromyalgia Impact Questionnaire, State-Trait Anxiety Inventory, and Beck Depression Inventory scores. In our patients, the serum HA levels were not increased and did not reflect disease severity. These results suggest that serum HA is not a useful laboratory marker for diagnosis and assessment of FM.

Evaluation of the efficacy and safety of terguride in patients with fibromyalgia syndrome: Results of a twelve‐week, multicenter, randomized, double‐blind, placebo‐controlled, parallel‐group study

To assess the efficacy and safety of terguride, a partial dopamine agonist, in patients with fibromyalgia syndrome (FMS). In a 12-week, multicenter, double-blind, placebo-controlled, parallel-group study, 99 patients were randomized at a ratio of 2 to 1 to receive terguride or placebo. Over 21 days, the dosage was titrated to a maximum daily dose of 3 mg of terguride or placebo, and this fixed dosage was continued over 9 weeks. The primary efficacy variable was the intensity of pain (100-mm visual analog scale). Secondary efficacy variables included the Fibromyalgia Impact Questionnaire (FIQ) score, the tender point score (TPS), and the Hamilton Depression Scale (HDS) score. During the study, patients were evaluated for the presence of cervical spine stenosis by magnetic resonance imaging (MRI). No significant differences in the change in pain intensity, FIQ score, TPS, or HDS score between baseline and 12 weeks were observed in the terguride group as compared with the placebo group. Cervical spine stenosis was detected in 22% of the patients. Only patients with cervical spine stenosis responded to terguride treatment. FIQ scores improved significantly (per-protocol analysis), and pain intensity, the TPS score, and the HDS score showed a trend toward improvement in the terguride group as compared with the placebo group. Terguride treatment was safe. Only those adverse events already known to be side effects of terguride were observed. Premature termination of the study in patients receiving terguride (26%) occurred predominantly during up-titration and in the absence of comedication for treatment of nausea. Terguride treatment did not improve pain, the FIQ score, the TPS, or the HDS score in the total study population. However, a subgroup of patients with cervical spine stenosis seemed to benefit from terguride treatment.

Heterogeneity Within the Fibromyalgia Population: Theoretical Implications of Variable Tender Point Severity Ratings

The American College of Rheumatology (ACR) tender point (TP) criterion is used in diagnosing fibromyalgia syndrome (FM). There has been little research investigating patterns of positive TP. We investigated response patterns of TP in a sample of patients with FM. Manual TP survey data were available on 1433 patients with FM. Factor analysis was conducted on ACR TP and control (CON) points. Factor scores were cluster analyzed to identify subgroups based on TP scores. Subgroups were compared on demographic and psychosocial variables. Factor analysis resulted in 4 TP groupings: neck/shoulder girdle, gluteal/trochanteric, and upper extremity regions, and a set of CON TP. Cluster analysis revealed 3 clusters. Group 1 was high on all 3 TP regions and the CON set; Group 2 moderate on the 3 TP regions, low on the CON set; and Group 3 was relatively low on all 3 TP regions and the CON set. The group highest on the CON and TP regions reported the greatest pain (7.58 +/- 1.23; p < 0.001), sleep disturbance (7.05 +/- 1.61; p < 0.001), anxiety (10.14 +/- 4.57; p < 0.001), and depression (8.42 +/- 4.4; p < 0.001). TP severity ratings varied among cluster groups, suggesting patients with FM are not homogeneous. Variations in TP severity provide information regarding the degree to which FM affects patients' quality of life. Patients with elevated scores on the CON TP demonstrated a general pattern reflecting lower thresholds for symptom reporting and, perhaps, disease severity. Research is needed to elucidate mechanisms underlying heterogeneity among the FM population.

Somatosensory profiles in subgroups of patients with myogenic temporomandibular disorders and fibromyalgia syndrome

Some patients with myofascial pain from temporomandibular disorders (TMD) report pain in extra-trigeminal body regions. Our aim was to distinguish TMD as regional musculoskeletal pain syndrome (n=23) from a widespread pain syndrome (FMS; n=18) based on patients’ tender point scores, pain drawings and quantitative sensory testing (QST) profiles. Referenced to 18 age- and gender-matched healthy subjects significant group differences for cold, pressure and pinprick pain thresholds, suprathreshold pinprick sensitivity and mechanical detection thresholds were found. Pain sensitivity in TMD patients ranged between those of FMS patients and healthy controls. The group of TMD patients was inhomogeneous with respect to their tender point count with an insensitive group (n=12) resembling healthy controls and a sensitive TMD group (n=9) resembling FMS patients. Nevertheless sensitive TMD patients did not fulfil diagnostic criteria for FMS in regard to widespread pain as shown by their pain drawings. TMD subgroups did not differ with respect to psychological parameters. The sensitive subgroup was more sensitive compared to healthy controls and to insensitive TMD patients in regard to their QST profile over all test areas as well as to their tenderness over orofacial muscles and trigeminal foramina. However, sensitive TMD patients had a short pain duration arguing against a transition from TMD to FMS over time. Data rather suggest an overlap in pathophysiology with FMS, e.g. a disturbance of central pain processing, in this subgroup of TMD patients. Those patients could be identified on the basis of their tender point count as an easy practicable screening tool.

Development and validation of the self-administered Fibromyalgia Assessment Status: a disease-specific composite measure for evaluating treatment effect.

IntroductionThe Fibromyalgia Impact Questionnaire (FIQ) is a composite disease-specific measure validated for fibromyalgia (FM), but it is rarely used in clinical practice. The objective was to develop and analyse the psychometric properties of a new composite disease-specific index (Fibromyalgia Assessment Status, FAS), a simple self-administered index that combines a patient's assessment of fatigue, sleep disturbances and pain evaluated on the basis of the 16 non-articular sites listed on the Self-Assessment Pain Scale (SAPS) in a single measure (range 0 to 10).MethodsThe FAS index was constructed using a traditional development strategy, and its psychometric properties were tested in 226 FM patients (209 women, 17 men); whose disease-related characteristics were assessed by means of an 11-numbered circular numerical rating scale (NRS) for pain, fatigue, sleep disturbances and general health (GH), the tender point score (TPS), the SAPS, the FIQ, and the SF-36. A group of 226 rheumatoid arthritis (RA) patients was used for comparative purposes. Of the 179 FM patients who entered the follow-up study, 152 completed the three-month period and were included in the responsiveness analyses. One hundred and fifty-four patients repeated the FAS questionnaire after an interval of one week, and its test/re-test reliability was calculated. Responsiveness was evaluated on the basis of effect size and the standardised response mean.ResultsThe FAS index fulfilled the established criteria for validity, reliability and responsiveness. Factor analysis showed that SAPS and fatigue contributed most, and respectively explained 47.4% and 31.2% of the variance; sleep explained 21.3%. Testing for internal consistency showed that Cronbach's alpha was 0.781, thus indicating a high level of reliability. As expected, closer significant correlations were found when FAS was compared with total FIQ (rho = 0.347; P < 0.0001) and the FIQ subscales, particularly job ability, tiredness, fatigue and pain (all P < 0.0001), but the correlation between FAS and the mental component summary scale score (MCS) of the SF-36 (rho = -0.531; P < 0.0001) was particularly interesting. Test/re-test reliability was satisfactory. The FAS showed the greatest effect size. The magnitude of the responsiveness measures was statistically different between FAS (0.889) and the FIQ (0.781) (P = 0.038), and between the SF-36 MCS (0.434) and the SF-36 physical component summary scale score (PCS) (0.321) (P < 0.01).ConclusionsThe self-administered FAS is a reliable, valid and responsive disease-specific composite measure for assessing treatment effect in patients with FM.