Primary fibromyalgia is greater than tender points: toward a multiaxial taxonomy.

Primary fibromyalgia remains a controversial and puzzling condition. The diagnosis is based on subjective symptoms, exclusionary criteria and the presence of tender points. Much of the discussion of primary fibromyalgia centers on physical or psychological bases for the etiology, exacerbation and maintenance of the symptoms. An alternative to the current dichotomous way of conceptualizing primary fibromyalgia is presented based on a multiaxial perspective that integrates physical, psychosocial and behavioral factors creating an empirically derived taxonomy. The utility of this approach is illustrated from research with groups of patients with chronic pain. The implications of the multiaxial taxometric approach for understanding primary fibromyalgia and its treatment are described.