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.
The Parker Institute, Department of Rheumatology, Copenhagen University Hospital Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark.
Kirstine
0000-0003-0792-505X
K
Amris
The Parker Institute, Department of Rheumatology, Copenhagen University Hospital Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark ; Institute of Public Health, University of Southern Denmark, 5000 Odense, Denmark.
Eva Ejlersen
EE
Wæhrens
The Parker Institute, Department of Rheumatology, Copenhagen University Hospital Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark.
Anders
0000-0003-4029-5627
A
Jespersen
The Parker Institute, Department of Rheumatology, Copenhagen University Hospital Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark ; Section for Statistics and Data Analysis, Department of Applied Mathematics and Computer Science, Technical University of Denmark, 2800 Lyngby, Denmark.
Anders
A
Stockmarr
Oregon Health & Science University, Portland, OR 97239, USA.
Robert
R
Bennett
The Parker Institute, Department of Rheumatology, Copenhagen University Hospital Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark.
Henning
H
Bliddal
The Parker Institute, Department of Rheumatology, Copenhagen University Hospital Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark.
Bente
0000-0003-3710-5212
B
Danneskiold-Samsøe