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 .
Chronic pain, work performance and litigation
& NA ; The overall population impact of chronic pain on work performance has been underestimated as it has often been described in terms of work‐related absence , excluding more subtle effects that chronic pain may have on the ability to work effectively . Additionally , most studies have focussed on occupational and /or patient cohorts and treatment seeking , rather than sampling from the general population . We undertook a population ‐based r and om digit dialling computer‐assisted telephone survey with participants r and omly selected within households in order to measure the impact of chronic  pain on work performance . In addition , we measured the association between pain‐related disability and litigation . The study took place in Northern Sydney Health Area , a geographically defined urban area of New South Wales , Australia , and included 484 adults aged 18 or over with chronic pain . The response rate was 73.4 % .  Working with pain was more common ( on an average 83.8 days in 6 months ) than lost work days due to pain ( 4.5 days ) among chronic pain participants in full‐time or part‐time employment . When both lost work days and reduced‐effectiveness work days were summed , an average of 16.4 lost work day equivalents occurred in a 6‐month period , approximately three times the average number of lost work days . In multiple logistic regression modelling with pain‐related disability as the dependent variable , past or present pain‐related litigation had the strongest association ( odds ratio (OR)=3.59 , P=0.001 ) . In conclusion , chronic pain had a larger impact on work performance than has previously been recognised , related to reduced performance while working with pain . A significant proportion were able to work effectively with pain , suggesting that complete relief of pain may not be an essential therapeutic target . Litigation ( principally work‐related ) for chronic pain was strongly associated with higher levels of pain‐related disability , even after taking into account other factors associated with poor functional outcomes
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 .