On the basis of the limited number of studies available , and significant problems with their design , reporting , statistical integrity , and clinical applicability , physical examination can not currently be recommended as a reliable test for the diagnosis of trigger points .
BACKGROUND Trigger points are promoted as an important cause of musculoskeletal pain .
There is no accepted reference st and ard for the diagnosis of trigger points , and data on the reliability of physical examination for trigger points are conflicting .
OBJECTIVES To systematic ally review the literature on the reliability of physical examination for the diagnosis of trigger points .
A cross-national study of the course of persistent pain in primary care
& NA ; Data from the World Health Organization 's study of psychological problems in general health care were used to examine the course of persistent pain syndromes among primary care patients . Across 15 sites in 14 countries , 3197 r and omly selected primary care patients completed baseline and 12‐month follow‐up assessment s  of pain , other somatic symptoms , and anxiety and depressive disorders  ( the Composite International Diagnostic Interview ) , and an assessment of occupational role disability  ( the Social Disability Schedule ) . Of patients with a persistent pain condition at baseline , 49 % had not recovered 12 months later . The probability of non‐recovery varied significantly across study centers and was significantly associated with the number of pain sites at baseline . After adjustment for age , sex , and study center , baseline anxiety or depressive disorder did not predict non‐recovery of persistent pain . Among those without a persistent pain disorder at baseline , the rate of onset was 8.8 % with a significant variability in risk across centers . The baseline characteristics predicting the onset of persistent pain disorder were psychological disorder , poor self‐rated health , and occupational role disability . A persistent pain disorder at baseline predicted the onset of a psychological disorder to the same degree that a baseline psychological disorder predicted the subsequent onset of persistent pain . Persistent pain conditions are common among primary care patients , and the probability of resolution over 12 months is approximately 50 % . We found a strong and symmetrical relationship between persistent pain and psychological disorder . Impairment of daily activities appears to be a central component of that relationship
On the basis of the limited number of studies available , and significant problems with their design , reporting , statistical integrity , and clinical applicability , physical examination can not currently be recommended as a reliable test for the diagnosis of trigger points .
BACKGROUND Trigger points are promoted as an important cause of musculoskeletal pain .
There is no accepted reference st and ard for the diagnosis of trigger points , and data on the reliability of physical examination for trigger points are conflicting .
OBJECTIVES To systematic ally review the literature on the reliability of physical examination for the diagnosis of trigger points .