Biomedical subjects

J Schollum

Publications and source records attributed to J Schollum.

6 recordsLinked to original sources

PubMed1996

More pain, more tender points: is fibromyalgia just one end of a continuous spectrum?

OBJECTIVES: To investigate the hypothesis that fibromyalgia represents one end of a spectrum in which there is a more general association between musculoskeletal pain and tender points. METHODS: The subjects studied were 177 individuals selected from a population based screening survey for musculoskeletal pain. All subjects completed a pain mannikin and were examined for the presence of tender points at the nine American College of Rheumatology bilateral sites. RESULTS: There were moderately strong associations (odds ratios range 1.3-3.1) between the reported presence of pain in a body segment and the presence of a tender point within that segment. Further, there was evidence of a trend of increasing number of tender points with increasing number of painful segments. The reporting of non-specific pain, aching, or stiffness, was also associated with high tender point counts. CONCLUSION: This study illustrates that the association between tender points and pain is not restricted to the clinically defined subgroup with chronic widespread pain. Given that widespread pain and tender points have previously been linked with distress, this might reflect lesser degrees, or earlier phases of the somatisation of distress.

Chronic Disease↗

PubMed1996

The natural history of chronic pain in the community: a better prognosis than in the clinic?

OBJECTIVE: To evaluate the predictors of improvement at 2 years in subjects with chronic widespread pain ascertained from a community survey. METHODS: As part of a community based epidemiological survey on the occurrence of pain, 141 subjects (age range 24-74 years; 44 men, 97 women) were selected for more detailed assessment. Followup information on pain experience was collected at a median of 27 months (range 15-35). Subjects were categorized according to whether they had no pain, chronic widespread pain (according to the American College of Rheumatology criteria), or regional pain, both at initial assessment and followup. In addition, subjects were examined at both time periods for tender points. RESULTS: Of those with chronic widespread pain at initial assessment, 35% still had chronic widespread pain at followup, 50% regional pain, and 15% no pain. Of those originally with regional pain, 65% still had regional pain, 19% chronic widespread pain, and 16% no pain at followup. Logistic regression analysis was conducted to examine factors among those with chronic widespread pain associated with still having these symptoms at followup. Female sex, older age, leaving school at a young age, high tender point count, high levels of fatigue, or additional physical or psychological symptoms were all associated with symptoms being less likely to resolve. CONCLUSION: Chronic widespread pain in the community has a generally good prognosis. However, those with additional symptoms associated with the fibromyalgia syndrome were more likely still to have chronic widespread pain 2 years later.

Adult↗

PubMed1996

Widespread pain: is an improved classification possible?

OBJECTIVE: The classification of widespread pain, proposed by the American College of Rheumatology (ACR) for use in the clinic as a screen for fibromyalgia, as described, does not require truly widespread pain. Studies considering the epidemiology of widespread pain per se may therefore require a definition with greater face validity, which might also show enhanced associations with other physical and psychological measures. We aimed to develop a more coherent definition of widespread pain for use in epidemiological studies and to compare performance in identifying individuals with significant morbidity. METHODS: A group of 172 subjects who had participated in a community based study on the occurrence of pain were identified and categorized by their pain experience as indicated on line drawings of the body according to ACR definition and to a new, more stringent definition that required the presence of more diffuse limb pain. A number of other clinical and psychological measures were recorded for these individuals and the association between their pain status measures and these other variables was assessed and compared. RESULTS: Persons satisfying the newly proposed definition for chronic widespread pain, in comparison with those who satisfied only the present ACR definition, had a significantly higher score on the General Health Questionnaire [median difference (MD) 7.95% CI 1.13], a higher score on the Health and Fatigue Questionnaire (MD 10.95% CI 0.15), and greater problems with sleep (sleep problem score MD 4.95% CI 0.9). Those satisfying the new definition also had a greater number of tender points on examination (MD 3.95% CI -1.7). The morbidity of those satisfying only the present ACR definition was closer to persons who had regional pain. CONCLUSION: A redefinition of widespread pain has produced a group of subjects whose pain is (a) likely to be more "widespread" and (b) is associated more strongly with factors such as psychological disturbance, fatigue, sleep problems, and tender points, and may be more appropriate in epidemiological studies.

Adolescent↗

PubMed1995

Development and preliminary assessment of a simple measure of overall status in rheumatoid arthritis (OSRA) for routine clinical use.

We describe the development and initial assessment of a simple measure of overall status in rheumatoid arthritis (OSRA) for use in the routine clinical setting. The measure is constructed in four parts: demographic details, activity score, damage score and treatment category. It requires no laboratory tests and uses details collected routinely during a clinic visit. It was validated in a series of 488 patients. The measure proved acceptable and demonstrated face, content, construct and discriminant validity. OSRA will be useful as an audit tool in the serial follow-up of RA patients and in describing the characteristics of a population of such patients.

Activities of Daily Living↗

PubMed1994

Population study of tender point counts and pain as evidence of fibromyalgia.

OBJECTIVE: To determine the relation between tender points, complaints of pain, and symptoms of depression, fatigue, and sleep quality in the general population. DESIGN: Two stage cross sectional study with an initial questionnaire about pain to classify those eligible for an examination of tender points. SETTING: Two general practices in north west England. SUBJECTS: Stratified random sample of adults from age-sex registers. Of the responders, 250 were selected for examination of tender points on the basis of their reported pain complaints; 177 subsequently participated. MAIN OUTCOME MEASURES: Tender point count (0 to 18) grouped into four categories with the highest (> or = 11) corresponding to the criteria of the American College of Rheumatology for fibromyalgia. Assessment of pain (chronic widespread, regional, none). Measures of depression, fatigue, and difficulty with sleeping. RESULTS: Women had a higher median tender point count (six) than did men (three). Counts were higher in those with pain than in those who had no pain and in those with widespread compared with regional pain. Most subjects with chronic widespread pain, however, had fewer than 11 tender points (27/45; 60%). Two people with counts of 11 or more were in the group reporting no pain. Mean symptom scores for depression, fatigue, and sleep problems increased as the tender point count rose (P value for trend < 0.001). These trends were independent of pain complaints. CONCLUSIONS: Tender points are a measure of general distress. They are related to pain complaints but are separately associated with fatigue and depression. Sleep problems are associated with tender points, although prospective studies are needed to determine whether they cause tenderness to develop. Fibromyalgia does not seem to be a distinct disease entity.

Adolescent↗

PubMed1993

The prevalence of chronic widespread pain in the general population.

OBJECTIVE: To establish the prevalence of chronic widespread pain and associated symptoms in a general population sample. METHODS: Cross sectional postal survey of 2,034 adults in the north of England. RESULTS: The point prevalence of chronic widespread pain was 11.2%. The symptom was strongly associated with other somatic complaints and with measures of depression and anxiety. CONCLUSION: In the general population, this cardinal symptom of fibromyalgia is common and identifies a group who are more likely also to report symptoms of fatigue and depression.

Adolescent↗