Pressure pain thresholds and musculoskeletal morbidity in automobile manufacturing workers

Abstract

Reduced pressure pain thresholds (PPTs) have been reported in occupational groups with symptoms of upper extremity musculoskeletal disorders (UEMSDs). The purpose of this study was to determine whether automobile manufacturing workers (n=460) with signs and symptoms of UEMSDs had reduced PPTs (greater sensitivity to pain through pressure applied to the skin) when compared with unaffected members of the cohort, which served as the reference group. The association of PPTs with symptom severity and localization of PE findings was investigated, as was the hypothesis that reduced thresholds would be found on the affected side in those with unilateral physical examination (PE) findings. PPTs were measured during the workday at 12 upper extremity sites. A PE for signs of UEMSDs and symptom questionnaire was administered. After comparison of potential covariates using t tests, linear regression multivariable models were constructed with the average of 12 sites (avgPPT) as the outcome. Subjects with PE findings and/or symptoms had a statistically significant lower avgPPT than non-cases. AvgPPT was reduced in those with more widespread PE findings and in those with greater symptom severity (test for trend, P</=0.05). No difference between side-specific avgPPT was found in those with unilateral PE findings. Reduced PPTs were associated with female gender, increasing age, and grip strength below the gender-adjusted mean. After adjusting for the above confounders, avgPPT was associated with muscle/tendon PE findings and symptom severity in multivariable models. PPTs were associated with signs and symptoms of UEMSDs, after adjusting for gender, age and grip strength. The utility of this noninvasive testing modality should be assessed on the basis of prospective large cohort studies to determine if low PPTs are predictive of UEMSDs in asymptomatic individuals or of progression and spread of UEMSDs from localized to more diffuse disorders.