Assessment Of Pressure Pain Thresholds Research Articles

Avaliação da força de preensão palmar e limiar de tolerância a dor à pressão entre indivíduos jovens e idosos

Objective: Was to compare and verify the associations between muscle strength and pressure pain threshold (PPT) between elderly and young individuals. Methods: Observational cross-sectional study in which 53 volunteers participated and were evaluated in relation to muscle strength through handgrip strength tests, maximum isometric knee extension strength tests and trunk extension tests. The PPT assessment was carried out using algometry in the following regions: hand, vastus medialis, vastus lateralis, and lumbar region. Data were analyzed using the SPSS v.26 package and Spearman visualization coefficients were established. Results: The young group presented higher values in relation to dynamometry (p<0.05) in all assessments compared to the elderly, but no significant differences were found in relation to PPT. The group of young people showed significant and moderate associations (r= 0.410 to r= 0.599) between strength x PPT. In the elderly group, correlations ranged from moderate (r= 0.536 to r= 0.597) to strong (r= 0.607 to r= 0.725). Conclusion: Young people obtained higher values in strength assessments and in their relationship with the elderly, but there was no difference between the PPT between the groups. In the young group, moderate associations were found between the strength variables and PPT. In the elderly group, the associations between FPP x algometry were moderate and strong.

Characterization of sleep disturbance in established rheumatoid arthritis patients: exploring the relationship with central nervous system pain regulation

BackgroundTo characterize sleep disturbance in patients with established rheumatoid arthritis (RA) and explore the relationship between sleep and mechanisms of central nervous system pain regulation.MethodsForty-eight RA participants completed wrist-worn actigraphy monitoring and daily sleep diaries for 14 days to assess sleep-wake parameters. Participants underwent quantitative sensory testing to assess pressure pain thresholds, temporal summation, and conditioned pain modulation. Data were analyzed using descriptive statistics, Spearman’s correlation, and multivariable median regression analyses.ResultsMedian actigraphy and sleep diary derived sleep duration was 7.6 h (interquartile range (IQR) 7.0, 8.2) and 7.1 h (IQR 6.7, 7.6), respectively. Actigraphy based sleep fragmentation (rho = 0.34), wake after sleep onset (rho = 0.36), and sleep efficiency (rho = -0.32) were each related to higher temporal summation values in unadjusted analyses, but these relationships did not persist after controlling for age, body mass index, disease duration, and swollen joint count. No significant relationships were observed between sleep with pressure pain thresholds and conditioned pain modulation.ConclusionActigraphy and sleep diary monitoring are well tolerated in established RA patients. Future investigations should include both subjective and objective assessments, as they may provide information relating to different components and mechanisms.

Effects of Anti-CGRP Monoclonal Antibodies on Neurophysiological and Clinical Outcomes: A Combined Transcranial Magnetic Stimulation and Algometer Study.

the aim of this study was to investigate the neurophysiological effect of anti-CGRP monoclonal antibodies on central and peripheral levels in migraine patients. An observational cohort study in patients with migraine was performed. All subjects underwent Single-Pulse and Paired-Pulse Transcranial Magnetic Stimulation, as well as a Pressure Pain Threshold assessment. The same protocol was repeated three and four months after the first injection of anti-CGRP monoclonal antibodies. A total of 11 patients with a diagnosis of migraine and 11 healthy controls were enrolled. The main findings of this study are the significant effects of anti-CGRP mAb treatment on the TMS parameters of intracortical inhibition and the rise in the resting motor threshold in our group of patients affected by resistant migraine. The clinical effect of therapy on migraine is associated with the increase in short-interval intracortical inhibition (SICI), resting motor threshold (RMT), and Pressure Pain Threshold (PPT). In all patients, all clinical headache parameters improved significantly 3 months after the first injection of mAbs and the improvement was maintained at the 1-month follow-up. At baseline, migraineurs and HCs had significant differences in all TMS parameters and in PPT, while at follow-up assessment, no differences were observed on RMT, SICI, and PPT between the two groups. After anti-CGRP monoclonal antibody injection, a significant increase in the intracortical inhibition, in the motor threshold, and in the Pressure Pain Threshold in critical head areas was observed in patients with migraine, which was related to significant clinical benefits. Anti-CGRP monoclonal antibodies improved clinical and neurophysiological outcomes, reflecting a normalization of cortical excitability and peripheral and central sensitization. By directly acting on the thalamus or hypothalamus and indirectly on the trigeminocervical complex, treatment with anti-CGRP monoclonal antibodies may modulate central sensorimotor excitability and peripheral sensitization pain.

The effect of resistance exercise on multimodal pain thresholds in local and systemic muscle sites.

Dynamic resistance exercise may produce reductions in pain locally at the exercising muscle and systemically at non-exercising sites. However, limited research has examined these changes with multiple noxious stimuli. This study examined changes in heat pain threshold (HPT) and pressure pain threshold (PPT) on different musculature after an upper and lower body exercise to compare local and systemic effects. A crossover design with 28 participants (mean age: 21 ± 4 years, 21 female) completed three sessions. Visit one included baseline quantitative sensory testing and 5-repetition maximum (RM) testing for upper (shoulder press) and lower (leg extension) body. In subsequent sessions, participants performed upper or lower body exercises using an estimated 75% 1-RM with pre/post assessment of HPT and PPT at three sites: deltoid, quadriceps, and low back. A significant three-way interaction was observed for HPT (F (1.71, 3.80) = 2.19, p = 0.036, η2p = 0.12) with significant increases in HPT over the quadriceps (p = 0.043) after leg extension and over the deltoid (p = 0.02) after shoulder press. Significant systemic changes were not observed for HPT or PPT. Local but not systemic effects were demonstrated after an acute bout of exercise. Peripheral pain sensitivity may be more responsive to heat stimuli after resistance exercise.

Elevated pain sensitivity is associated with reduced rapid eye movement (REM) sleep in females with comorbid temporomandibular disorder and insomnia.

Patients with chronic pain disorders, including Temporomandibular Disorders (TMDs) endorse high levels of sleep disturbances, frequently reporting reduced sleep quality. Despite this, little is known about the effect that daytime pain has on the microstructure and macro-architecture of sleep. Therefore, we aimed to examine the extent to which daytime pain sensitivity, measured using quantitative sensory testing (QST), is associated with objective sleep parameters the following night, including sleep architecture and power spectral density, in women with TMD. 144 females with myalgia and arthralgia by examination using the Diagnostic criteria for TMD completed a comprehensive QST battery consisting of General Pain Sensitivity, Central Sensitization Index, and Masseter Pressure Pain Threshold assessments. Polysomnography was collected the same night to measure sleep architecture and calculate relative power in delta, theta, alpha, sigma, and beta power bands. Central Sensitization (B = -3.069, P = .009), General Pain Sensitivity Indices (B = -3.069, P = .007), and Masseter Pain Pressure Threshold (B = 0.030, P = .008) were significantly associated with lower REM% both before and after controlling for covariates. Pain sensitivity measures were not significantly associated with relative power in any of the spectral bands nor with any other sleep architectural stages. Our findings demonstrate that higher generalized pain sensitivity, masseter pain pressure threshold, as well as central sensitization were associated with a lower percentage of REM in participants with myofascial pain and arthralgia of the masticatory system. These findings provide an important step toward understanding the mechanistic underpinnings of how chronic pain interacts with sleep physiology.

Instrumental assessment of pressure pain threshold over trigeminal and extra-trigeminal area in people with episodic and chronic migraine: a cross-sectional observational study

BackgroundCentral and peripheral sensitization are characterized by widespread hyperalgesia that is manifested by larger pain extent area and reduction in pressure pain threshold (PPT). PPT decreases in patients with migraine not only over the trigeminal cervical complex but also throughout the body.MethodsA cross-sectional study was adopted to assess the local and widespread hyperalgesia in chronic and episodic migraine patients respect to healthy controls. The guidelines of Andersen’s were used to evaluate the PPT bilaterally over 3 muscles in the trigemino-cervical complex (temporalis, sub-occipitalis, trapezius) and over 1 muscle far from this area (tensor fasciae latae).ResultsThirty subjects with episodic migraine (35.8 ± 2.82 years), 30 with chronic migraine (53.03 ± 19.79 years), and 30 healthy controls (29.06 ± 14.03 years) were enrolled. The interaction effect was present for the trapezius muscle with a significant difference between the right and the left side in episodic group (p = 0.003). A group effect was highlighted in all four muscles analyzed such as suboccipital (p < 0.001), temporalis (p > 0.001), trapezius (p < 0.001), and TFL (p < 0.001). PPT was usually higher in the control group than in the episodic group which in turn was characterized by higher PPT values than the chronic group.ConclusionsPeople with chronic and episodic migraine presented lower PPT than healthy controls both in the trigeminal and in the extra-trigeminal area. People with chronic migraine presented lower PPT than episodic migraine only in the trigeminal area. Temporalis and sub-occipitalis are the most sensitive muscles in people with chronic and episodic migraine.

Effect of High-intensity LASER Therapy, Kinesio-taping and Plantar-fascia Stretching on Patients with Plantar Fasciitis: A Study Protocol

Introduction: Plantar Fasciitis (PF) is the most frequent musculoskeletal condition that primarily affects the foot, causing tenderness and disturbed foot function. Need of the study: The planned clinical trial will proceed with the aim of ensuring that the intervention is accessible to the general public, irrespective of the outcomes. This study will help in exploring the effect of HILT, KT and plantar-fascia stretching and to add this method as adjunct to conventional physiotherapy approach in plantar fasciitis sufferers. Aim: To evaluate the effect of combination of {High-Intensity Light Amplification by Stimulated Emission of Radiation (LASER) Therapy HILT)} with Kinesio-taping (KT), and plantar-fascia stretching in improving pain pressure threshold and foot function in individuals suffering from PF. Materials and Methods: A single-blinded randomised clinical trial design will be employed to enroll both male and female participants aged &gt;18 years, with plantar heel pain lasting more than 4 weeks and will be randomly divided into two groups. The experimental group will receive HILT along with KT using the low-dye taping technique, while the comparator group will receive HILT along with plantar-fascia stretching. A power analysis will be conducted to determine the appropriate sample size based on the findings of a pilot study. Outcome measures will include pressure algometry to assess pressure pain threshold and the foot function index to evaluate disability. The study outcomes could either indicate a meaningful difference between the groups or not. This will confirm the practical relevance of the intervention for individuals suffering from plantar fasciitis.

Inertial Sensors and Pressure Pain Threshold to Evaluate People with Primary Adhesive Capsulitis: Comparison with Healthy Controls and Effects of a Physiotherapy Protocol.

Inertial sensors (IMUs) have been recently widely used in exercise and rehabilitation science as they can provide reliable quantitative measures of range of motion (RoM). Moreover, the pressure pain threshold (PPT) evaluation provides an objective measure of pain sensation in different body areas. The aim of this study was to evaluate the efficacy of physiotherapy treatment in people with adhesive capsulitis in terms of RoM and pain improvement measured by IMUs and the PPT. A combined prospective cohort/cross-sectional study was conducted. Nineteen individuals with adhesive capsulitis (10/19 females, 54 ± 8 years) and nineteen healthy controls (10/19 females, 51 ± 6 years) were evaluated for active glenohumeral joint RoM and PPT on shoulder body areas. Then, individuals with adhesive capsulitis were invited to 20 sessions of a physiotherapy protocol, and the assessments were repeated within 1 week from the last session. The range of motion in the flexion (p = 0.001) and abduction (p < 0.001) of the shoulder increased significantly after the physiotherapy protocol. Similarly, the PPT was found to increase significantly in all the assessed shoulder body areas, leading to no significant differences compared to the healthy controls. IMU and PPT assessments could be used to evaluate the efficacy of physical therapy in people with adhesive capsulitis.

Risk factors for persistent pain after breast cancer surgery: a multicentre prospective cohort study.

Identifying factors associated with persistent pain after breast cancer surgery may facilitate risk stratification and individualised management. Single-population studies have limited generalisability as socio-economic and genetic factors contribute to persistent pain development. Therefore, this prospective multicentre cohort study aimed to develop a predictive model from a sample of Asian and American women. We enrolled women undergoing elective breast cancer surgery at KK Women's and Children's Hospital and Duke University Medical Center. Pre-operative patient and clinical characteristics and EQ-5D-3L health status were recorded. Pain catastrophising scale; central sensitisation inventory; coping strategies questionnaire-revised; brief symptom inventory-18; perceived stress scale; mechanical temporal summation; and pressure-pain threshold assessments were performed. Persistent pain was defined as pain score ≥ 3 or pain affecting activities of daily living 4months after surgery. Univariate associations were generated using generalised estimating equations. Enrolment site was forced into the multivariable model, and risk factors with p < 0.2 in univariate analyses were considered for backwards selection. Of 210 patients, 135 (64.3%) developed persistent pain. The multivariable model attained AUC=0.807, with five independent associations: age (OR 0.85 95%CI 0.74-0.98 per 5 years); diabetes (OR 4.68, 95%CI 1.03-21.22); pre-operative pain score at sites other than the breast (OR 1.48, 95%CI 1.11-1.96); previous mastitis (OR 4.90, 95%CI 1.31-18.34); and perceived stress scale (OR 1.35, 95%CI 1.01-1.80 per 5 points), after adjusting for: enrolment site; pre-operative pain score at the breast; pre-operative overall pain score at rest; postoperative non-steroidal anti-inflammatory drug use; and pain catastrophising scale. Future research should validate this model and evaluate pre-emptive interventions to reduce persistent pain risk.

Relationship between self-reported pain, pain threshold, pain catastrophization and quality of life in patients with TMD.

The aim of this study was to verify if there is a relationship between self-reported pain, PPT (pressure pain threshold) of the masseter, temporal and sternocleidomastoid muscles, pain catastrophizing and quality of life in patients with TMD (temporomandibular disorder) of muscular origin. Ninety-seven patients with muscular TMD (TMD group) and 97 asymptomatic (control group) were included in the study. The evaluation methods used were: 1) Self-reported pain was assessed using the Visual Analogue Scale (VAS) for questions 7, 8 and 9 of the RDC/TMD Axis I questionnaire; 2) The PPT assessment was performed using a digital algometer on the masseter, temporal, and sternocleidomastoid muscles (both sides); 3) Pain catastrophizing was assessed using the PCS (Pain Catastrophizing Scale); and 4) Oral health-related quality of life was assessed using the OHIP-14 (Oral Healthy Impact Profile-14). Data were submitted to Spearman correlation and logistic regression (p<0.05). There were significant positive correlations between self-reported pain (VAS-Q7, VAS-Q8 and VAS-Q9), pain catastrophizing (PCS-Helplessness, PCS-Magnification, PCS-Rumination and PCS-Total) and quality of life (OHIP-14) (p<0.05). There was a significant negative correlation of self-reported pain (VAS-Q8) with PPT of the temporal (left) and sternocleidomastoid (both sides) (p<0.05). The rumination and magnification domains increased the chance of high self-reported pain in all situations (VAS-Q7, VAS-Q8 and VAS-Q9) (p<0.05). The helplessness domain only increased the chance of high self-reported pain for VAS-Q8 (p<0.05). The presence of TMD of muscular origin, high self-reported pain (VAS-Q7) or pain catastrophizing increased the chance of a low quality of life in relation to the control group (p<0.05). In addition, the reduction in sternocleidomastoid PPT increased the chance of poor quality of life (p<0.05). Key words:Myofascial pain syndromes, pain catastrophizing, myalgia, quality of life, surveys and questionnaires, temporomandibular joint disorders.

Chronic postoperative pain after total knee arthroplasty: The potential contributions of synovitis, pain sensitization and pain catastrophizing-An explorative study.

BackgroundA subset of osteoarthritis patients will experience chronic postoperative pain after total knee arthroplasty (TKA), but the source of pain is unclear. The aim of this exploratory study was to assess patients with and without postoperative pain after TKA using magnetic resonance imaging (MRI), quantitative sensory testing (QST), clinical assessment of pain and assessments of catastrophizing thoughts.MethodsForty‐six patients completed the 6‐month postoperative assessment. MRI findings were scored according to the MRI Osteoarthritis Knee Score recommendation for Hoffa synovitis, effusion size and bone marrow lesions. QST included assessment of pressure pain thresholds (PPTs), temporal summation of pain (TSP) and conditioned pain modulation (CPM). Pain catastrophizing was assessed using the Pain Catastrophizing Scale (PCS). Clinical pain assessment was conducted using a visual analogue scale (VAS, 0–10 cm), and groups of moderate‐to‐severe (VAS > 3) and none‐to‐mild postoperative pain (VAS ≤ 3) were identified.ResultsPatients with moderate‐to‐severe postoperative pain (N = 15) demonstrated higher grades of Hoffa synovitis (p < 0.001) and effusion size (p < 0.001), lower PPTs (p = 0.039), higher TSP (p = 0.001) and lower CPM (p = 0.014) when compared with patients with none‐to‐mild postoperative pain (N = 31). No significant difference was found in PCS scores between the two groups. Multiple linear regression models found synovitis (p = 0.036), effusion size (p = 0.003), TSP (p = 0.013) and PCS (p < 0.001) as independent parameters contributing to the postoperative pain intensity.ConclusionThese exploratory findings could indicate that chronic postoperative pain after TKA is a combination of joint‐related synovitis and effusion, sensitization of central pain mechanisms and potentially pain catastrophizing thoughts, but larger studies are needed to confirm this.SignificanceThe end‐stage treatment of knee osteoarthritis is total knee arthroplasty. Some patients experience chronic postoperative pain after total knee arthroplasty, but the mechanism for chronic postoperative pain is widely unknown. The current study indicates that higher levels postoperative of synovitis and effusion, higher temporal summation of pain and higher pain catastrophizing scores could be associated with higher chronic postoperative pain.

Current Concept of Quantitative Sensory Testing and Pressure Pain Threshold in Neck/Shoulder and Low Back Pain.

In recent years, several published articles have shown that quantitative sensory testing (QST) and pressure pain threshold (PPT) are useful in the analysis of neck/shoulder and low back pain. A valid reference for normal PPT values might be helpful for the clinical diagnosis of abnormal tenderness or muscle pain. However, there have been no reliable references for PPT values of neck/shoulder and back pain because the data vary depending on the devices used, the measurement units, and the area examined. In this article, we review previously published PPT articles on neck/shoulder and low back pain, discuss the measurement properties of PPT, and summarize the current data on PPT values in patients with chronic pain and healthy volunteers. We also reveal previous issues related to PPT evaluation and discuss the future of PPT assessment for widespread use in general clinics. We outline QST and PPT measurements and what kinds of perceptions can be quantified with the PPT. Ninety-seven articles were selected in the present review, in which we focused on the normative values and abnormal values in volunteers/patients with neck/shoulder and low back pain. We conducted our search of articles using PubMed and Medline, a medical database. We used a combination of “Pressure pain threshold” and “Neck shoulder pain” or “Back pain” as search terms and searched articles from 1 January 2000 to 1 June 2022. From the data extracted, we revealed the PPT values in healthy control subjects and patients with neck/shoulder and low back pain. This database could serve as a benchmark for future research with pressure algometers for the wide use of PPT assessment in clinics.

Comparative Effectiveness of Jade Stone Mobilisation, Non-Abrasive Cupping, and Manual Drainage Technique in Subjects with Chronic Sinusitis: A Randomized Clinical Trial

Purpose: Sinusitis in recent times has been known as one of the major causes for reduced quality of life and work absenteeism. Chronic sinusitis being one of the health hazards affecting QOL of subjects of any age and gender requires a specific therapeutic intervention. Clinical trials that can demonstrate the effectiveness of manual therapy intervention in sinusitis cases are lacking. Hence, this study aims to evaluate and compare the effectiveness of three manual therapy techniques in subjects with chronic sinusitis. Method: The current study is a prospective, parallel arm, randomised clinical trial performed at physiotherapy OPD, tertiary health centre, Belagavi. Forty-five subjects who had chronic sinusitis were randomised and allocated into three different manual therapy groups with 15 subjects each study group. Sample size was calculated using the formula n= Sd2[Zα + Zβ]2/d2 where α value was set at 1.96 and β was set at 0.842. Both male and female subjects between 18-45 years of age with chronic sinusitis for more than 3 months were included in the study (with 1 dropout due to loss to follow-up). Subjects in group A received jade stone mobilization, group B received non-abrasive cupping, and group C received manual drainage technique for 3 times a week for 2 weeks with a follow-up at the 6th week from the baseline. As an outcome measure pressure algometer and SNOT-22 questionnaire were taken to assess pressure pain threshold and quality of life of sinusitis subjects respectively. Results: The results showed significant improvement between and within all the three study groups post 2 weeks of intervention in terms of pain pressure threshold and quality of life. However, at 6th week follow-up, the jade stone group showed greater improvement than the other two groups. Conclusion: The study concluded that all the three manual interventions are safe and effective manual therapy techniques to treat the cases of chronic sinusitis.

Preoperative dynamic quantitative sensory testing in remote pain-free areas is associated with axial pain after posterior cervical spinal surgeries

BackgroundPostoperative axial pain (PAP), characterized by pain and/or stiffness around the posterior neck, periscapular areas and/or shoulder region, is a vexing complication affecting 5–60% of patients undergoing posterior cervical decompression. Given its relatively high frequency and negative impact on patients’ physical and mental status, efforts preoperatively to confirm patients at risk of developing PAP to offer more efficient pain management to minimize this complication have a high priority. The aim of this study is to investigate the role of preoperative dynamic quantitative sensory testing (QST) in predicting the PAP after posterior cervical decompression.MethodsThis longitudinal observational study included 122 patients with degenerative cervical myelopathy undergoing laminoplasty or laminectomy. Preoperatively, all patients underwent the assessment of pressure pain thresholds (PPTs) at local and remote pain-free areas and both temporal summation (TS) and conditioned pain modulation (CPM) at remote pain free-areas. These patients underwent further pain-related, psychosocial and clinical function assessments before and/or after operation.ResultsIn the present study, 21 patients (21/122, 17.2%) developed PAP, and the 6-month postoperative follow-up demonstrated that 8 of these 21 patients developed chronic PAP (CPAP). All preoperative covariates with significant differences between the PAP and non-PAP groups were subjected to multivariate logistic regression, and the presence of preoperative axial pain, surgical plan including C2 decompression, total international physical activity questionnaire score (cutoff value [CV]: 2205.5, sensitivity: 82.4%; specificity: 61.1%) and TS value (CV: 2.5, sensitivity: 42.9%; specificity: 83.2%) were independently associated with PAP (P < 0.05). Logistic regression further revealed that the presence of preoperative axial pain, TS value (CV: 2.5, sensitivity: 62.5%; specificity: 83.2%) and CPM value (CV: 0.65, sensitivity: 87.5%; specificity: 61.4%) were significant predictors of CPAP (P < 0.05).ConclusionsThe findings of this study support the hypothesis that preoperative endogenous pain modulation efficiency may be associated with axial pain after posterior cervical decompression. Clinically, preoperative estimation of both TS and CPM in remote pain-free areas may provide additional useful information for identifying patients who may be at risk of developing both PAP and CPAP, which may be beneficial in enabling stratification in the perioperative period of patients based on individual vulnerabilities to avoid/reduce this complication.

Sleep and Experimental Pain Sensitivity in People with HIV

People with HIV (PWH) appear to be at high risk for the experience of recurring pain symptoms throughout their lifetimes. There is also evidence to suggest a high prevalence of insomnia and sleep difficulties in PWH. Insomnia may lead to exaggerated pain states in PWH such as hyperalgesia, which refers to the phenomenon of heightened sensitivity to painful stimuli. The goals of this research are to examine differences in insomnia severity, sleep behaviors, and experimental pain sensitivity between PWH and controls without HIV. Participants included 25 PWH and 25 without HIV, who were all recruited from a local HIV treatment center (PWH) and the surrounding community (without HIV). Participants completed the Insomnia Severity Index and the RU_SATED scale, a measure of subjective sleep health. A quantitative sensory testing (QST) battery was then completed that included an assessment of pressure pain threshold (PPT) followed by temporal summation (TS) of mechanical pain; both administered at the trapezius. Compared to those without HIV, PWH reported greater severity of insomnia symptoms (p<.001) as well as poorer sleep health (p<.001). PWH also demonstrated significantly greater TS of mechanical pain compared to participants without HIV (p=.027). There was no significant difference for PPT (p=.901). In a stratified correlation analysis, the association between poorer sleep health and greater TS of mechanical pain was larger for PWH (r=-.344, p=.092) than it was for participants without HIV (r=-.004, p=.985). This ongoing study provides tentative evidence that PWH may experience worse sleep and enhanced pain facilitation (i.e., TS of mechanical pain) compared to those without HIV. It may also be that poor sleep is promoting enhanced pain facilitation in PWH; however, this possibility should be considered with caution given the small sample size and cross-sectional study design. Grant support from NHLBI - R01HL147603.

Intra-rater and inter-rater reliability of pressure pain threshold assessment in stroke patients.

As pain is a common symptom following a stroke, pressure pain threshold (PPT) assessment can be used to evaluate pain status or pain sensitivity of patients. However, the reliability of PPT test in stroke patients is still unknown. To examine the intra- and inter-rater reliability of PPT measurements in poststroke survivors and explore their factors. An observational study. The setting of the study is a rehabilitation hospital. The population of the study was represented by a total of 54 patients after stroke. The study included 16 measured points on the affected and unaffected sides. PPT was assessed by two raters in turn. Intra- and inter-rater reliability was evaluated by intraclass correlation coefficients (ICC). All intra-rater (ICC=0.84-0.97) and inter-rater (ICC=0.83-0.95) reliability for PPT assessment were good or excellent in stroke patients. Of the 16 points, 12 showed higher intra-rater ICC values than inter-rater, whereas no evident difference was observed between the affected and unaffected sides. Furthermore, patients who were male, ischemic, or with higher motor function generally performed higher ICC values than those who were female (24 out of 32 results), hemorrhagic (28 out of 32 results), or mobility dysfunction (26 out of 32 results), respectively. PPT assessment with good or excellent reliability can be used in stroke patients. Neither of the two sides (affected or unaffected) affects PPT reliability, and intra-rater reliability is better than inter-rater reliability. In addition, gender, stroke type, and motor function can affect the reliability of measuring mechanical pain threshold in poststroke survivors. The pressure algometer can be used as a reliable and portable tool to assess the mechanical pain tolerance and sensory function in stroke patients in clinics.

Algometer Assessment of Pressure Pain Threshold After Onabotulinumtoxin-A and Physical Therapy Treatments in Patients With Chronic Migraine: An Observational Study.

The purpose of this study was to evaluate pain hypersensitivity in chronic migraine patients 3 months after undergoing onabotulinumtoxin-A therapy, physical therapy (PT), or the combination of the two. Pressure pain threshold (PPT) was assessed in accordance with Andersen's guidelines, focusing on five muscles in the trigeminocervical area (namely, trapezius, levator scapulae, temporalis, sub-occipitalis, and scalenus medius) and one muscle outside of the area, (i.e., tensor fasciae latae). Moreover, three headache parameters, namely, attack frequency, duration, and pain intensity, were recorded in an ad hoc diary kept by the patients. A total of 30 patients were included in three treatment groups: 1. onabotulinumtoxin-A therapy, 2. PT, and 3. a combination of onabotulinumtoxin-A and PT. The results show that, at the final assessment, the PPT was significantly reduced in the combined treatment group compared to the two single-therapy groups. As regards headache parameters, frequency and duration of the attacks were decreased significantly in all three treatment groups, whereas in pain intensity, the reduction was statistically significant in the combined treatment group and the onabotulinumtoxin-A therapy. Results suggest that a better pain modulation in patients with chronic migraine can be achieved with a combined treatment of onabotulinumtoxin-A and physical therapy. Indeed, the combination of both pharmacological and non-pharmacological treatments results in the reduction of both headache-related parameters and widespread pressure hyperalgesia.

Pressure pain threshold mappings of the infraspinatus muscle in chronic unilateral shoulder pain patients do not reflect generalized hypersensitivity

ObjectivesIncreased mechanical sensitivity has been observed on the unaffected side in chronic pain conditions, suggesting generalized or widespread hypersensitivity. However, this cannot be considered as a universal response since this hypersensitivity is inconsistent across muscle pain pathologies. The aim of this study was to assess generalized hypersensitivity in chronic unilateral shoulder pain, using pressure pain threshold (PPT) mappings of the infraspinatus muscle. The proposed evaluation is based on the assessment of PPT on a limited subset of sites, reducing potential habituation or sensitization effects. MethodsTwenty-nine patients with unilateral shoulder pain (USP) and twenty-seven healthy volunteers were recruited. PPT was assessed using a manual pressure algometer. Six sites distributed over the infraspinatus muscle were assessed, and three repetitions were performed at each site. Mappings were derived using two-dimensional interpolation. ResultsLower PPT values were found in the symptomatic side in comparison with the asymptomatic side at all assessment sites (estimated difference: 1.42 ± 0.10 kgf/cm2, p < 0.001), but there were no differences among the asymptomatic side of USP patients and any of the sides in healthy volunteers (largest estimated difference: 0.17 ± 0.28 kgf/cm2, p = 0.927). Furthermore, the medial region of the infraspinatus muscle showed higher mechanical sensitivity in both healthy volunteers and USP patients. ConclusionsThese results suggest that USP does not induce generalized hypersensitivity, in contrast with previously reported findings. Physiotherapists could take these results into account for the assessment and treatment of patients with USP.

AN OBSERVATIONAL STUDY ON ASSESSMENT OF PAIN THRESHOLD IN TRIVIDHA SATWABALA

Introduction: ‘Purusha’ the sentient being in Ayurveda is formed by the combination of Satwa (Mind), Atma (Soul) and Shareera (Body). Among these, paramount importance has been given to the role of the mind in both health and diseased states. In the present study, the term Satwa has been used to denote Satwabala or the psychic strength of an individual. The assessment of Satwabala is an important part in examination of the patient and while planning the treatment. The interrelationship of mind and body is well explained in Ayurveda. The pain inflicted on one's body has influence on his mind. Some people feel pain more intensely than others and some tolerate it so much more than others. Thus, quantification of pain with reference to psychic strength is essential for diagnostic and pain monitoring purposes in clinical practice. Aim and Objectives: The study was carried out with an aim to assess the Pain threshold in the form of Pressure Pain Threshold [PPT] and the Pain intensity in the form of the Visual Analog Scale [VAS] in three types of Satwabala. It was hypothesised that there could be a positive relation between Satwabala and Pain threshold. Methods: For the objective assessment of Pressure Pain Threshold a simple handheld pressure Algometer has been used. For the subjective measurement of experimental pain, Visual Analog Scale was used. Further, the Satwa of participants was assessed using a standard questionnaire. Results: The resultssuggested that in people between the age group of 18-40 years, there exist a statistically highly significant positive correlation between Satwabala and Pain threshold with P&lt; 0.01. Keywords: Satwa, Satwabala, Pain threshold, Pressure Pain Threshold, Visual Analog Scale.

Quantitative Sensory Testing in Children with Sickle Cell Disease

▪Background: Quantitative Sensory Testing (QST) is used in a variety of pain disorders such as arthritis and neuropathic pain syndromes, to characterize pain and predict prognosis and response to specific therapies. QST evaluates sensory function using a set of psychophysical procedures to measure subjective somatosensory responses to various physical stimuli. In Sickle Cell Disease (SCD) the painful vasoocclusive crisis is the most difficult management challenge and factors underlying the transition from acute to chronic pain and the wide interpatient variability in the pain experience are poorly understood. Optimal management for this complex pain syndrome remains unclear despite over three decades of basic and clinical research in the field.In this study, we aimed to duplicate results in the literature documenting altered QST thresholds in SCD and test the reproducibility of results over time to validate QST as a therapeutic endpoint for use in clinical trials evaluating novel preventative pain therapies.Objectives: Primary objectives were to test thermal thresholds in children with SCD versus African American controls and determine consistency over 6 months. Exploratory objectives were to correlate QST with clinical factors and select biomarkers and assess pressure pain thresholds (PPTs).Methods: Fifty-seven SCD and 60 control subjects aged 8-20 years underwent heat (wdt) and cold (cdt) detection and pain (hpt and cpt) threshold testing using a Medoc TSAII. A thermal composite score (TCS) was constructed by averaging the wdt, cdt, hpt, and cpt threshold responses from the testing instrument's starting temperature of 32°C. All participants were tested at baseline and 3 months; SCD subjects were additionally tested at 6 months and blood collected for future biomarker assessment. PPTs were performed using an SBMedic algometer. A single individual performed all QST. Descriptive statistics were computed and covariate-adjusted differences in thresholds within and between groups evaluated over time by mixed effects regression models with random intercepts and linear contrast tests. The intraclass correlation coefficient (ICC) from these models was used to assess within-subject consistency and Spearman's correlation was used to evaluate associations between thresholds and biomarkers. In addition, as a nested pseudo-intervention study, we analyzed a subset of “new” hydroxyurea (HU) users consisting of SCD subjects in whom HU was initiated within a few weeks prior to, or shortly after baseline testing. Significance was set at 0.05.Results: There were no significant differences in mean thermal or PPTs between SCD and control participants at baseline (Table 1) or month 3. QST measurements were consistent in SCD and control subjects for cpt, wdt, hpt and TCS (each ICC>0.55), but not necessarily for cdt (ICC = 0.37). Although generally internally consistent, there was some variability in mean thermal thresholds among SCD subjects over time, but the only significant difference between the 3 and 6 month means was for hpt (+0.67°C; 95% CI 1.15, 0.19). There was no association between mean thermal thresholds and chronic transfusion therapy. The group in whom HU was initiated shortly after baseline testing (n=6) demonstrated significant reductions in all thermal sensitivity and pain threshold measurements following HU initiation (Table 2).Conclusions: In contrast to Brandow's study (Brandow, American Journal Hematology, 2012), which documented thermal hypersensitivity in SCD, we have not demonstrated significant differences in thermal thresholds between SCD and control subjects. This could be due, in part, to differences in body sites used for testing. Results between second and third test sessions were highly consistent, indicating that reliability may improve once subjects have experience with QST. Subjects on whom HU was initiated shortly after baseline testing (new HU users) exhibited progressive and significant decreases in both cold and heat sensitivity from baseline to 6 months, suggesting that thermal testing is sensitive to effective therapy to prevent vasoocclusive pain. These findings are of critical importance to inform the planning of future SCD related clinical trials using QST as an endpoint in the evaluation of preventative pain therapies.Supported by National Institute of General Medical Sciences National Institutes of Health Award P20GM109021 and U54GM104941 [Display omitted] DisclosuresNo relevant conflicts of interest to declare.