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).

RESULTS:In 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.

译文

目的 : 研究疼痛阈值的测量与痛苦症状之间的关系,以确定纤维肌痛是否是临床中的离散结构/疾病。
方法 : 在门诊风湿病中心1993年的627名患者1996年接受了压痛点和度日检查。全部完成乏力,睡眠障碍,焦虑,抑郁,整体严重程度,疼痛,功能障碍的评估量表,以及由睡眠障碍,乏力,焦虑,抑郁,和全球严重程度-风湿病困扰指数 (RDI)。
结果 : 在回归分析中,RDI与压痛点的计数呈线性关系 (r2 = 0.30)。在RDI和测年测量之间发现较小的关联 (r2 = 0.08)。与任何单个纤维肌痛症状变量相比,RDI与两种疼痛阈值的相关性更强。在偏相关分析中,与症状变量有关的所有信息都包含在压痛点计数中,并且度量法与症状没有独立关系。
结论 : 压痛点与纤维肌痛变量和困扰呈线性关系,并且没有与非常高的压痛点相关的纤维肌痛或窘迫变量的离散增强或扰动。尽管纤维肌痛是可识别的临床实体,但似乎没有理由将纤维肌痛作为一种离散性疾病进行治疗,并且在临床患者以及研究中考虑整个范围的压痛和困扰似乎是合适的。招标点计数用作遇险的 “沉降率”,并且比dolorimetry评分更好。

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