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We examined to what extent patients with fibromyalgia differ from painfree control subjects in the perception and processing not only of somatosensory but also of external stimuli. For this purpose the acoustic perception of 30 patients with fibromyalgia was compared with that of 36 generally pain-free age and gender matched subjects. The groups were also controlled for organic disease of pathological dysfunction of the ear and auditory nerves. Thresholds of unpleasantness and hearing thresholds were determined autiometrically for various frequencies. In addition the participants rated their experience of daily noise, vulnerability to acoustic stress, and functional and affective complaints associated with fibromyalgia. As expected the results show reduced unpleasantness thresholds for all frequencies and a nonsymptomatic hearing loss for higher frequencies. The elevated hearing threshold correlated significantly with experience of noise at the place of work, which was also elevated in the fibromyalgia group. Generalized pain had a high impact on the interaction between threshold of unpleasantness and daily noise experience. We interpret the differences in thresholds of hearing and of unpleasantness in patients with fibromyalgia as a form of either preconscious or conscious acts to protect against disturbing stimulation. Our results support the notion of a generalized disturbancy of perceptual thresholds in patients with fibromyalgia not restricted to the perception of pain.

Strategies for validating complaints about pain and pain-related disability are considered important in the assessment of persons with chronic pain. Validation strategies should be based on principles of psychological assessment. In order to limit the amount of validating activities in clinical practice core outcome domains for subjects with chronic pain are identified (pain and bodily complaints, coping and treatment, level of physical, psychosocial, and cognitive functioning, working ability). Based on results from research on malingering the recommended validation strategies are multiple intra-individual comparisons of different levels and sources of data, use of reliable and valid tests and questionnaires, consideration of incidental inconsistencies, use of validating scales for response sets of acquiescence, social desirability, or defensiveness and symptom validity testing based on the principle of low item difficulties. The principles of validation are demonstrated exemplarily with respect to the selected outcome domains.

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