Wolfe F
Arthritis Research Center and University of Kansas School of Medicine, Wichita 67214, USA.
J Rheumatol. 1998 Mar;25(3):546-50.
To investigate the relationship between control points and symptom and distress severity in fibromyalgia (FM).
Eighty-four new patients with FM seen at an outpatient rheumatology center from December 1994 through August 1996 underwent tender point and dolorimetry examinations at 18 active and 4 control sites. All completed the assessment scales for fatigue, sleep disturbance, anxiety, depression, global severity, pain, and 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).
Control point positivity was common in FM (63.1%) and was associated with somewhat more severe FM symptoms and general distress, yielding an increase in the RDI of 9.2 units or 0.55 standard deviation units. There was no evidence of particularly worse disease in patients with high counts of control tender points, and increasing numbers of tender points beyond the first positive control point were generally not associated with, or were only weakly associated with, increasing symptom severity. Many patients with positive control points had only mild levels of symptom severity. Finally, we found no clusters of patients with very severe symptoms associated with control points, or with dolorimetry scores, or with ratios of dolorimetry scores from different body regions of varying pain thresholds.
Positive control points are a common feature (63%) in FM, and appear to be a marker for a generally low pain threshold rather than a disproportionate increase in severe symptoms or distress. Control point positivity should not be used to disqualify a diagnosis of FM. Control point measurements do not add much to FM diagnosis or assessment and, perhaps, should be abandoned. At the least, they should be designated "high threshold" points rather than control points. Dolorimetry is considerably less useful in FM assessment than the manual tender point examination.
研究纤维肌痛（FM）中控制点与症状及痛苦严重程度之间的关系。
1994年12月至1996年8月在门诊风湿病中心就诊的84例新诊断的FM患者，在18个活动点和4个对照点接受了压痛点和痛觉测量检查。所有患者均完成了疲劳、睡眠障碍、焦虑、抑郁、整体严重程度、疼痛和功能残疾的评估量表，以及由睡眠障碍、疲劳、焦虑、抑郁和整体严重程度得分构成的痛苦综合测量指标——风湿病痛苦指数（RDI）。
控制点阳性在FM中很常见（63.1%），且与稍严重的FM症状和一般痛苦相关，使RDI增加9.2个单位或0.55个标准差单位。没有证据表明对照压痛点计数高的患者病情特别严重，且超过第一个阳性对照点的压痛点数量增加通常与症状严重程度增加无关或仅弱相关。许多有阳性控制点的患者症状严重程度仅为轻度。最后，我们未发现与控制点、痛觉测量得分或不同疼痛阈值的不同身体区域的痛觉测量得分比值相关的症状非常严重的患者集群。
阳性控制点是FM的常见特征（63%），似乎是一般疼痛阈值较低的标志，而非严重症状或痛苦的不成比例增加。不应将控制点阳性用于排除FM诊断。控制点测量对FM诊断或评估的帮助不大，或许应予以摒弃。至少，应将其指定为“高阈值”点而非控制点。在FM评估中，痛觉测量比手动压痛点检查的作用要小得多。
