Search

Objective The aim of this study was to evaluate the efficacy and safety of a single trigger point injection (TPI) of a local anesthetic for the treatment of myofascial pain syndrome (MPS) in patients with incurable cancer. Methods This multicenter, exploratory, open-label, randomized comparative trial was conducted in five specialized palliative care departments. Hospitalized patients with incurable cancer who had been experiencing pain related to MPS were randomized to receive either a TPI of 1% lidocaine plus conventional care (TPI group) or conventional care alone (control group). The short-term efficacy and occurrence of adverse events (AEs) were compared between groups. The primary endpoint was the percentage of patients who experienced a reduction in pain scores of ≥50%, assessed using an 11-point Numerical Rating Scale, at 3 days post-intervention. Adverse events were assessed using the Common Terminology Criteria for AEs v5.0. Results Fifty patients were enrolled, and the trial completion rate was 100%. The proportion of patients who experienced an improvement in Numerical Rating Scale pain scores of ≥50% was 70.8% (95% confidence interval, 52.4%-89.2%) in the TPI group and 0.0% in the control group; the difference was statistically significant (P  < .001). In the TPI group, one case (4.2%) of Grade 1 nausea and 1 case (4.2%) of Grade 1 somnolence were reported. Conclusion A single TPI of a local anesthetic is safe and efficacious in inducing an immediate reduction in MPS-related pain in patients with incurable cancer. Clinical trials registration number: This study was registered with the Japan Registry of Clinical Trials (approval number: jRCTs051210132) on December 16, 2021. https://jrct.niph.go.jp/en-latest-detail/jRCTs051210132. Approval of the research protocol by a Certified Review Board: The present study was approved by the Wakayama Medical University (reference number: CRB5180004. Registered 26 May 2021). [ABSTRACT FROM AUTHOR]

Objective Exercise induces a hypoalgesic response and improves affect. However, some individuals are unable to exercise for various reasons. Motor imagery, involving kinesthetic and visual imagery without physical movement, activates brain regions associated with these benefits and could be an alternative for those unable to exercise. Virtual reality also enhances motor imagery performance because of its illusion and embodiment. Therefore, we examined the effects of motor imagery combined with virtual reality on pain sensitivity and affect in healthy individuals. Design Randomized crossover study. Setting Laboratory. Subjects Thirty-six participants (women: 18) were included. Methods Each participant completed three 10-min experimental sessions, comprising actual exercise, motor imagery only, and motor imagery combined with virtual reality. Hypoalgesic responses and affective improvement were assessed using the pressure-pain threshold and the Positive and Negative Affect Schedule, respectively. Results All interventions significantly increased the pressure-pain threshold at the thigh (P  < .001). Motor imagery combined with virtual reality increased the pressure-pain threshold more than motor imagery alone, but the threshold was similar to that of actual exercise (both P  ≥ .05). All interventions significantly decreased the negative affect of the Positive and Negative Affect Schedule (all P  < .05). Conclusions Motor imagery combined with virtual reality exerted hypoalgesic and affective-improvement effects similar to those of actual exercise. Clinical trials registration The study was enrolled in the UMIN Clinical Trials Registry (registration number: UMIN000046095). The website for registration information is https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000052614 [ABSTRACT FROM AUTHOR]

Objective Pain hypersensitivity has been described as one of the most disabling symptoms of fibromyalgia syndrome (FMS). Here we analyzed the relationship between an anti-inflammatory diet profile and the pressure pain thresholds (PPTs) of tender point sites and other fibromyalgia-related symptoms in patients with FMS. Methods This cross-sectional study included 95 women diagnosed with FMS and 98 menopause-status matched controls. The Dietary Inflammatory Index (DII) was calculated by conducting a 24-hour diet recall interview. The PPTs of tender point sites and self-reported global pain levels were evaluated by algometry and the visual analog scale, respectively. Disease severity, fatigue, sleep anxiety, and central sensitization were also evaluated. Results Linear regression analysis revealed that the PPTs of tender point sites including the occiput (β  = 0.234, 95% confidence interval [CI] = 0.016–0.452, P  =   0.036), trapezius (β  = 0.299, 95% CI = 0.083–0.515, P  =   0.007), zygapophyseal joint (β  = 0.291, 95% CI = 0.022–0.559, P  =   0.035), second rib (β  = 0.204, 95% CI = 0.060–0.348, P  =   0.006), gluteus (β  = 0.591, 95% CI = 0.110–1.072, P  =   0.017), greater trochanter (β  = 0.379, 95% CI = 0.016–0.742, P  =   0.041), and knee (β  = 0.482, 95% CI = 0.117–0.850, P  =   0.011) were associated with DII score after adjustments for the age, menopausal status, and global energy levels reported by the patients with FMS. No significant differences were found for the cases or controls between the DII score and the remaining clinical symptoms. Analyses of covariance showed that the PPTs of the aforementioned tender point sites were also significantly associated (P  <   0.05) with the DII score quartiles in patients with FMS, but no significant differences were found between these quartiles and the other clinical symptoms. Conclusions A pro-inflammatory diet was associated with pain hypersensitivity in patients with FMS. [ABSTRACT FROM AUTHOR]

Objective Athletes are at risk for developing chronic pain conditions, but the role of exercise in the modulation of pain in athletes has not been well established. The aim of this study was to investigate conditioned pain modulation (CPM) and exercise-induced hypoalgesia (EIH) responses between 13 endurance-trained athletes and 13 normally active controls. Methods In a cross-sectional, nonrandomized study with two independent groups of college-aged males and females, pressure pain thresholds (PPTs) were assessed in the vastus lateralis (VL) and brachioradialis (BR) using a pressure algometer before and after a conditioning stimulus, an isometric hand grip exercise to failure, and a 30-minute run. Results PPTs increased following the conditioning stimulus, indicating a CPM response, to a similar degree in the BR (19.3% ± 26.5% vs 18.6% ± 16.2%, P  = 0.93) and VL (18.9% ± 25.9% vs 28.7% ± 27.4%, P  = 0.73) in the athletes and controls. PPTs increased following isometric exercise to a similar extent in athletes and controls in the BR (23.9% ± 22.8% vs 28.2% ± 24.0%, P  = 0.75) and VL (15.8% ± 14.8% vs 15.5% ± 11.6%, P  = 0.94). Following 30 minutes of running, EIH was similar between athletes and controls in the VL (21.2% ± 17.2% vs 13.8% ± 13.3%, P  = 0.23) but was attenuated in the BR of the athletes (6.1% ± 16.9% vs 20.9% ± 20%, P  = 0.047). Conclusions Athletes and controls exhibited similar endogenous pain inhibitory function both locally and systemically following CPM and isometric, upper body exercise. After the 30-minute run, BR EIH was reduced in the athletes compared with controls, suggesting a reduced systemic response following familiar exercise—perhaps due to the exercise being perceived as less painful and/or effortful. [ABSTRACT FROM AUTHOR]

Objective Pain pressure thresholds (PPT) are used to study peripheral and central pain processing. In the tendon, pathological changes may exist without pain. This pilot study aimed to compare PPT between individuals with normal tendons and asymptomatic tendon pathology, and between individuals with and without a history of tendon pain. Methods The patellar, Achilles, and supraspinatus tendons of 128 asymptomatic participants were examined with ultrasound. Global PPT average was determined using a digital algometer at the patellar tendon, quadriceps muscle, L3 spinous process, and deltoid muscle insertion. Participants were separated into three groups: (1) healthy control group (no pathology, no history of pain), (2) tendon pathology at any site without a history of pain, (3) history of tendon pain anywhere. Results There were 92 controls, seven with asymptomatic pathology and 29 with a history of tendon pain. Asymptomatic tendon pathology at any site (without a history of pain) was associated with globally increased PPTs compared with controls (P  < 0.001, pathology N = 7, N = 92 controls). Matched pair analysis remained significant (P  < 0.004). A history of tendon pain was associated with globally increased PPTs compared with the control group (P  = 0.026). Matched pair analysis was not significant (P  = 0.122). Conclusions Asymptomatic tendon pathology is associated with higher PPTs. These findings point toward central nervous system adaptations but in a novel way—central desensitization. This challenges the validity of conclusions drawn from PPT studies that do not verify normal structure in the control group; artificial inflation of control group data may incorrectly indicate decreased PPTs in the comparison group. [ABSTRACT FROM AUTHOR]

Objective. Fibromyalgia is a chronic pain condition with few effective treatments. Many fibromyalgia patients seek acupuncture for analgesia; however, its efficacy is limited and not fully understood. This may be due to heterogeneous pathologies among participants in acupuncture clinical trials. We hypothesized that pressure pain tenderness would differentially classify treatment response to verum and sham acupuncture in fibromyalgia patients. Design. Baseline pressure pain sensitivity at the thumbnail at baseline was used in linear mixed models as a modifier of differential treatment response to sham versus verum acupuncture. Similarly, needleinduced sensation was also analyzed to determine its differential effect of treatment on clinical pain. Methods and Patients. A cohort of 114 fibromyalgia patients received baseline pressure pain testing and were randomized to either verum (N559) or sham (N555) acupuncture. Participants received treatments from once a week to three times a week, increasing in three-week blocks for a total of 18 treatments. Clinical pain was measured on a 101- point visual analog scale, and needle sensation was measured by questionnaire throughout the trial. Results. Participants who had higher pain pressure thresholds had greater reduction in clinical pain following verum acupuncture while participants who had lower pain pressure thresholds showed better analgesic response to sham acupuncture. Moreover, patients with lower pressure pain thresholds had exacerbated clinical pain following verum acupuncture. Similar relationships were observed for sensitivity to acupuncture needling. Conclusions. These findings suggest that acupuncture efficacy in fibromyalgia may be underestimated and a more personalized treatment for fibromyalgia may also be possible. [ABSTRACT FROM AUTHOR]

Objective. To study the relationship between tension-type headaches and the oculomotor system in terms of binocular coordination, mechanosensitivity of the supraorbital nerve, and myofascial trigger points in the lateral rectus muscle, assessing the influence of visual effort caused by using a computer at work. Design. Observational study with blind evaluation of the response variable. Methods. Two groups were compared: 19 subjects with tension-type headaches and 16 healthy subjects, both exposed to computer use at work. A blinded assessor conducted three tests: measurement of the supraorbital nerve pressure pain threshold using a pressure algometer, evaluation of myofascial trigger points of the lateral rectus using the verbal numerical scale, and assessment of binocular coordination in smooth pursuit eye movements using an innovative video-oculography system. Tests were performed before work began and four hours later, and subjects in the headache group were examined when they presented a headache score of less than or equal to 3 on the verbal numerical scale. Results. The headache group presented a greater sensitivity of the supraorbital nerve and greater local and referred pain of the lateral rectus (P<0.05). Visual effort caused a significant worsening of these variables in both groups. However, binocular coordination after visual effort was only significantly affected in the headache group (P<0.05), primarily in horizontal movements. Conclusions. The finding of a higher alteration of the sensitivity of the supraorbital nerve, the myofascial trigger points of the lateral rectus, binocular coordination, and the significant influence of visual effort in patients with tension-type headaches suggest a new clinical perspective for problems related to tension-type headaches. [ABSTRACT FROM AUTHOR]

Objective. Isometric exercises produce an acute decrease in the pain sensitivity, known as exercise-induced hypoalgesia (EIH). Existing EIH paradigms use exercises at the extremities with more pronounced EIH at local compared to remote body sites, indicating local inhibition in addition to central inhibitory mechanisms. So far the results on EIH in patients with low back pain (LBP) are equivocal and no studies have investigated an EIH paradigm targeting the lower back in order to assess EIH in patients with LBP. Thus, the aim of this pilot study was to assess pressure pain sensitivity at local and remote assessment sites, before and after an isometric back exercise in healthy women and men. Methods. In a pre-posttest design, pressure pain thresholds (PPT) were assessed at the lower back, biceps femoris muscle, and hand in 29 healthy subjects (17 women) before and after 120 seconds of the isometric Biering-Soerensen back extension test. Results. After exercise, PPT increased significantly at the hand in women, but not in men (P = 0.027). Moreover, PPT at the leg increased independently of sex (P< 0.004). The increase in PPT at the lower back after exercise approached significance (P = 0.07). Conclusions. The results of this pilot study indicate that isometric back exercise produces local and remote hypoalgesia. Remote EIH was only demonstrated in women, supporting the influence of sex in the hypoalgesic response after exercise. The effect of isometric back exercise on pain sensitivity in patients with low back pain should be investigated in future studies. [ABSTRACT FROM AUTHOR]

Isometric exercise has been shown to activate endogenous pain inhibitory pathways in healthy adults, but not in some clinical pain populations. Objective Exercise-induced muscle damage (EIMD) and the associated delayed-onset muscle soreness (DOMS) are a model for studying clinical pain; thus, our purpose was to examine the effects of isometric exercise on pressure pain threshold (PPT) in the presence and absence of DOMS. Methods Data were collected on 23 males (22.8 ± 2.5 yrs). PPT was assessed in the right (exercising) and left (resting) quadriceps prior to, every 30seconds during, and 2 and 15minutes following an isometric contraction of the right quadriceps at 25% of maximal voluntary contraction (MVC) held until fatigue. Unilateral eccentric exercise was performed to induce DOMS in the exercising leg and testing was repeated 48hours later. Results DOMS increased (P < 0.001) and resting PPT decreased (P = 0.03) following EIMD. PPTs were elevated during exercise in the exercising (P ≤ 0.002) and resting (P ≤ 0.002) quadriceps but did not differ between the control and EIMD conditions in either leg (P ≤ 0.61). PPT remained elevated 2 and 15minutes postexercise (P < 0.05) in the exercised quadriceps in both conditions, but values returned to baseline at 2 (P = 0.91) and 15minutes (P = 0.28) postisometric exercise in the resting quadriceps. Conclusions Unlike clinical pain, DOMS had no effect on the PPT response during exercise in either the exercising or resting quadriceps. The fact that exercise altered PPT in both quadriceps during exercise suggests a generalized pain inhibitory mechanism was activated. However, the restriction of postexercise effects to the exercised limb suggests localized inhibitory mechanism(s) were activated after exercise. [ABSTRACT FROM AUTHOR]

Objective. To investigate widespread pressure hyperalgesia in the trigemino-cervical and extra-trigeminal (distant pain-free) regions in women with episodic and chronic migraine. Methods. Fifty-one women with episodic migraine, 52 women with chronic migraine, and 52 healthy women without headache history were recruited. Pressure pain thresholds (PPT) were bilaterally assessed over the trigeminal area (i.e., temporalis muscle), cervical area (i.e., C5/C6 zygapophyseal joint), and two extra-trigeminal areas (i.e., second metacarpal, tibialis anterior muscle) in a blinded design. Clinical features of migraine and anxiety/depression (Hospital Anxiety and Depression Scale, HADS) were also assessed. Results. The multivariate analysis of covariance (ANCOVA) revealed that PPTs were significantly decreased bilaterally over trigeminal and extra-trigeminal points in migraine patients compared to healthy women (all sites, P< 0.001). No differences between episodic and chronic migraine were observed (all, P> 0.919). The presence of neck pain (all, P> 0.282), anxiety (P> 0.425) or depression (all, P> 0.316) did not influence the results. The intensity of migraine pain was negatively associated with widespread pressure pain sensitivity: The greater the intensity of migraine attacks, the lower the widespread PPT levels, i.e., the greater the widespread sensitization. Conclusions. This study found similar widespread pressure hypersensitivity in women with episodic or chronic migraine suggesting that central manifestations are involved both in episodic and chronic migraine. [ABSTRACT FROM AUTHOR]

Objective. Women with provoked vestibulodynia (PVD) suffer pain at the entry of the vagina elicited by pressure as during vaginal penetration. To quantify vestibular pain, we developed a new instrument, an algometer. The aim of this study was to investigate the test-retest reliability of the algometer and evaluate its convergent validity for vestibular pain assessment in women with PVD. Methods. Twenty-six women with PVD participated in the study. Vestibular pain was assessed with the new algometer and the already known vulvalgesiometer during two different sessions 2 to 4 weeks apart. At each session, the pressure pain threshold (PPT) and pressure pain tolerance (PPTol) were measured twice at the 3, 6, and 9 o'clock sites of the vestibule in random order. The test-retest reliability (intra- and inter-session) of the algometer was calculated using the intraclass correlation coefficient (ICC) and standard error of measurement (SEM). Its convergent validity was evaluated by the correlation coefficients between PPTs and PPTols measured by the algometer and those measured with the vulvalgesiometer. Results. Intra-session reliability at all three sites for PPTs and PPTols in both sessions was excellent (ICC = 0.859 to 0.988, P ≤ 0.002). Inter-session reliability was good to excellent (ICC = 0.683 to 0.922, SEM = 15.06 to 47.04g, P ≤ 0.001). Significant correlations were found between the two tools for all sites for PPTs (r = 0.500 to 0.614, P ≤ 0.009) and PPTols (r = 0.809 to 0.842, P< 0.001). Discussion. Findings showed that the algometer is a reliable and valid instrument for measuring PPTs and PPTols in the vestibular area in women with PVD. This technology is promising for pinpointing treatment mechanisms and efficacy. [ABSTRACT FROM AUTHOR]

Objective To investigate the differences in pressure sensitivity in the cervical musculature including the upper trapezius, sternocleidomastoid, suboccipital, levator scapulae, and anterior scalene muscles between women with migraine and healthy controls. Design Cross-sectional study. Subjects Thirty women with migraine and 30 healthy women participated. Methods Pressure pain thresholds (PPT) were bilaterally assessed over upper trapezius, sternocleidomastoid, suboccipital, levator scapulae, and anterior scalene muscles in a blinded design. Mean values of both sides were pooled for statistical analysis. Comparison between groups was performed by unpaired Student t-test and correlation with headache features with Spearman's correlation test. Results Migraine patients exhibited lower PPT in all muscles compared with controls: upper trapezius ( P = 0.046); suboccipital ( P < 0.001); sternocleidomastoid ( P < 0.001); anterior scalene ( P < 0.001), and levator scapulae ( P < 0001). No associations were observed between the frequency and the intensity of migraine or years with the disease and PPT. Conclusion This study showed generalized pressure pain hypersensitivity in the cervical musculature in women with migraine. Our findings provide support for the physical therapy treatment and evaluation of musculoskeletal cervical spine disorders in individuals with migraine and reinforce that all cervical muscles should be evaluated. [ABSTRACT FROM AUTHOR]

Objective. This study aims to investigate the presence of bilateral pressure pain hypersensitivity in arm trunk nerves and upper limb mechanosensitivity in breast cancer patients with neck-shoulder pain after medical treatments. Methods. Twenty-two breast cancer survivors (mean age 49.05 ± 7.8 years) and matched healthy controls (mean age 50.76 ± 7.6 years) participated in the study. Neck and shoulder pain was evaluated using an 11-point numerical point rating scale. Pressure pain thresholds (PPTs) were bilaterally assessed over the median, radial, and ulnar nerve trunks and tibialis muscle, and the neurodynamics of the upper limb by neural tolerance to movement was evaluated in the median, radial, and ulnar nerves. Results. Thirteen (59.1%) patients reported spontaneous neck pain, and 16 (72.7%) patients showed spontaneous shoulder/axillary pain. Analysis of variance revealed that breast cancer survivors showed significant between-group but not betweenside differences over the median nerve trunk (group: P = < 0.001; side: P = 0.146), radial nerve trunk (group: P = < 0.001; side: P = 0.300), ulnar nerve trunk (group: P = < 0.001; side: P = 0.744), and tibialis anterior muscle (group: P = < 0.001; side: P = 0.118). The patients also showed statistically significant differences in range of motion (ROM) between groups and between sides in ULNT1MEDIAN (group: P = < 0.001; side: P = < 0.001) and ULNTULNAR (group: P = 0.009; side: P = 0.002). The analysis did not show statistically significant differences in ROM between groups, but there was a statistical significance between sides for ULNTRADIAL (group: P = 0.081; side: P = 0.046). Conclusions. Breast cancer survivors present bilateral and widespread neural hypersensitivity, as they did in muscular tissue in previous studies. Breast cancer survivors demonstrate a reduction in ROM during ULNTs in the affected side. [ABSTRACT FROM AUTHOR]

Background There is evidence that the pressure pain threshold ( PPT) is reduced in children with migraine and that it varies according to age, sex, and region of the body. However, in view of the lack of consensus in the literature, the objective of the present study was to evaluate the PPT in children with migraine of both genders aged 6-12 years. Methods Fifty children with migraine without aura and 50 children without headache were studied. The PPT was evaluated using an algometer at nine bilateral anatomical sites. Results Comparison of children with migraine to children without headache did not show differences in PPT, except for the points of insertion of occipital muscles and the anterior aspect of C5- C7, where the values were lower in the children with migraine. Analysis according to gender revealed that both girls and boys had a lower PPT in at least one region evaluated. Conclusion Comparison of the PPTs between sites revealed that the pericranial and cervical regions showed a lower PPT than the extracephalic sites in children with migraine. [ABSTRACT FROM AUTHOR]

Objective To investigate whether bilateral deep tissue pressure hyperalgesia exists in individuals with unilateral thumb carpometacarpal osteoarthritis ( CMC OA). Methods A total of 32 patients with CMC OA (29 females and 3 males, aged 69-90 years old) and 32 healthy matched controls (29 females and 3 males, aged 70-90 years) were recruited. Pressure pain thresholds ( PPTs) were bilaterally assessed over the first CMC joint, the hamate bone and the lateral epicondyle in a blinded design. Mixed models analyses of variance were conducted to determine the differences in pressure pain sensitivity between groups and sides. Results The results showed that PPTs were significantly decreased over the first CMC joint ( F = 6.551, P = 0.012) and the hamate bone ( F = 9.783, P = 0.002) but not over the lateral epicondyle ( F = 2.712, P = 0.102) in patients with thumb CMC OA as compared with healthy controls; patients with unilateral thumb CMC OA exhibited bilateral pressure pain hyperalgesia in both hands compared with healthy people. PPTs were not significantly associated to the intensity of pain (all, P > 0.05). Discussion This study revealed bilateral localized pressure pain hypersensitivity over the hand in individuals with unilateral thumb CMC OA, suggesting spinal cord sensitization mechanisms in this population. Future studies should analyze the presence of widespread pressure pain sensitivity in patients with thumb CMC OA to further determine the presence of central sensitization mechanisms. [ABSTRACT FROM AUTHOR]

Objective The goal of present study was to examine the influence of demographic characteristics, lifestyle, and metabolic factors on pressure-induced pain threshold. Design and Setting The study population comprised 2,517 healthy men at second-phase recruitment of a population-based cohort in China. The pressure pain threshold ( PPT) at two locations, triceps and inguinal lines, was obtained using a digital pressure algometer. Education and occupation, as well as lifestyle factors, were self-reported in a face-to-face interview. Blood lipid and fasting glucose were measured as a routine healthy check-up program. Results A lower PPT was found among men with younger age, higher level of education, and non-manual occupation. In addition, men with central obesity and moderate leisure time physical exercise were more sensitive to muscle mechanical stimuli. PPT was significantly correlated with high-density lipoprotein cholesterol (β for triceps = 0.064, and β for inguinal lines = 0.052) in a multivariate linear regression model, after controlling for multiple variables. Elevated PPT was also found among subjects with hyperglycemia (both P for triceps and inguinal lines <0.001) and excess drinking ( P for triceps = 0.005). Conclusions It is important for physicians and researchers to consider these variables when evaluating pain sensitivity in clinic and in research. The underling mechanisms between these factors and pressure pain perception are worthy of further exploration. [ABSTRACT FROM AUTHOR]

Objective. To pilot methodologies designed to critically assess the American College of Rheumatology’s (ACR) diagnostic criteria for fibromyalgia. Design. Prospective, psychophysical testing. Setting. An urban teaching hospital. Subjects. Twenty-five patients with fibromyalgia and 31 healthy controls (convenience sample). Interventions. Pressure pain threshold was determined at the 18 ACR tender points and five sham points using an algometer (dolorimeter). Outcome Measures. The patients “algometric total scores” (sums of the patients’ average pain thresholds at the 18 tender points) were derived, as well as pain thresholds across sham points. Results. The “algometric total score” could differentiate patients with fibromyalgia from normals with an accuracy of 85.7% ( P < 0.001). Even a single tender point had a diagnostic accuracy between 75% and 89%. Although fibromyalgics had less pain across sham points than across ACR tender points, sham points also could be used for diagnosis (85.7%; Ps < 0.001). Hierarchical cluster analysis showed that three points could be used for a classification accuracy equivalent to the use of all 18 points. Conclusions. There was a significant difference in the “algometric total score” between patients with fibromyalgia and controls, and we suggest this quantified (although subjective) approach may represent a significant improvement over the current diagnostic scheme, but this must be tested vs other painful conditions. The points specified by the ACR were only modestly superior to sham points in making the diagnosis. Most importantly, this pilot suggests single points, smaller groups of points, or sham points may be as effective in diagnosing fibromyalgia as the use of all 18 points, and suggests methodologies to definitively test that hypothesis. [ABSTRACT FROM AUTHOR]