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Tender Points, Distress, and Fibromyalgia

Fibromyalgia involves multiple and dispersed tender points that induce pain. In conjunction with the pain are the psychological symptoms of depression, anxiety, and fatigue. This study examined associations between tender point counts, and components of somatization, including childhood events, illness and self-care behavior, and fatigue.

The authors began with 289 subjects that displayed psychological distress assessed by the General Health Questionnaire, Somatic Symptom checklist, and Illness Attitude Scales. Of these, 99 (34%) had a high tender point count. When evaluating these 99 subjects (and comparing them to low-count participants) the authors found the following psychological and somatic trends among high tender point patients:

  • Higher levels of fatigue.
  • Lower levels of self-care.
  • Scored in the top third of the Illness Behavior scales.
  • Had physical symptoms of an unknown origin.
  • Sought more medical consultations.
  • Were more likely to be female and older.
  • Had more somatic and psychological symptoms.
  • Reported child abuse nearly five times as much as those with the lowest number of tender points.
  • Did not report a lack of maternal care or overprotection, but did perceive their father as uncaring.

These findings indicate, "It is possible that these characteristics of somatization and illness behavior, and their childhood antecedents, contribute to the development of the syndrome of fibromyalgia."

McBeth J, Macfarlane G, Benjamin S, et al. The association between tender points, psychological distress, and adverse childhood experiences. Arthritis & Rheumatism 1999;42(7):1397-1404.