THE RELIABILITY OF ALGOMETRY IN THE ASSESSMENT OF PATIENTS WITH FIBROMYALGIA SYNDROME

Objectives: The purpose of this review is to document the utility and reliability of quantitative body tenderness examination in fibromyalgi a syndrome [FMS] by two methods: digital pressure tender point index [ TPI], and average pain threshold [APT] by algometry. Findings: Body te nderness in people with musculoskeletal pain has been recognized for o ver 500 years. Current criteria for the diagnosis of FMS are based on chronic widespread pain and pain induced by digital palpation at II or more of 18 anatomically defined tender point [TP] sites. The relative reliabilities of TPI and APT as measures of severity have been confir med. Inter-rater and intra-rater, test-retest reliability assessments for paired examinations have shown that both APT and TPI were highly r eliable but that APT has been marginally superior. Some self-report me asures of FMS subjects, such as visual analog scales [for pain, insomn ia, headache, stiffness] and several questionnaires [for disability, a nxiety, depression] correlate with tenderness while others do not. Bot h TPI and APT have correlated with pain, stiffness and disability but TPI also correlated with anxiety, and depression. Conclusions: Both TP I and APT are highly reliable as semi-objective measures to document t enderness severity in FMS patients. They exhibit slightly different co nceptual constructs in that APT appears to be less influenced by psych ological factors than the TPI. These findings highlight the usefulness of combining subjective and semi-objective measures in the routine cl inical [and research outcome] assessment of people with FMS.