Pressure Algometry Research Articles

Association Between the 2011 Fibromyalgia Survey Criteria and Multisite Pain Sensitivity in Knee Osteoarthritis.

The present study evaluated the relationship between the 2011 American College of Rheumatology fibromyalgia (FM) survey criteria and quantitative sensory testing (QST). Patients with knee osteoarthritis scheduled to undergo knee arthroplasty completed the FM survey criteria and self-report measures assessing clinical symptoms. Patients also underwent a battery of QST procedures at the surgical knee and remote body sites, including pressure algometry, conditioned pain modulation, and temporal summation. All assessments were completed before surgery. FM survey criteria were used to calculate a continuous FM score indicating FM severity. A total of 129 patients were analyzed. Of these, 52.7% were female, 93.8% were Caucasian, and 3.8% met the FM survey criteria for FM classification. Mean age for females (63.6 y) and males (64.7 y) was similar. Females and males differed significantly in nearly every outcome, including FM severity, clinical pain, anxiety, depression, and pressure pain sensitivity. In females, FM scores significantly correlated with pressure pain sensitivity, but not conditioned pain modulation or temporal summation, such that increased sensitivity was associated with greater FM severity at all body sites examined. In addition, as FM scores increased, the association between pain sensitivity at the surgical knee and pain sensitivity at remote body sites also increased. No relationship between FM score and QST was observed in males. We demonstrated an association between diffuse hyperalgesia as measured by QST and FM severity in females with knee osteoarthritis. These results suggest that the FM survey criteria may represent a marker of pain centralization in females with potential utility in clinical decision making.

Characterization of neuroinflammation and periphery-to-CNS inflammatory cross-talk in patients with disc herniation and degenerative disc disease

The aim of the study was to identify inflammatory cytokines/chemokines associated with neuroinflammation and periphery-to-CNS inflammatory cross-talk in degenerative disc disease (DDD) and lumbar disc herniation (LDH), common causes of low back pain (LBP). A secondary aim was to investigate the associations between cytokines and symptom severity. MethodsIn total, 40 DDD and 40 LDH patients were recruited from a surgical waiting list, as well as 39 healthy controls (HC) and 40 cerebrospinal fluid (CSF) controls. The subjects completed questionnaires and pressure algometry was performed at the lumbar spine and forearm. The CSF, serum and disc tissues were collected during surgery. Inflammatory mediators TNF, INFg, IL-1b, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-13 and MCP1 were analysed by immunoassay (Meso Scale Discovery) and quantitative real-time polymerase chain reaction (qPCR) was used for analysis of IL-6, IL-8, MCP1 and TSPO expression in intervertebral discs (IVDs). ResultsIn the LDH group, we found elevated IL-8 concentrations in CSF indicating neuroinflammation, while IL-8 and MCP1 concentrations in serum were lower compared to HC. The IVD expression of IL-6, IL-8 and TSPO was lower in LDH patients compared to DDD. LDH patients had a positive correlation between IL-8 concentrations in CSF and serum and IL-8 in CSF was associated with higher pain intensity and increased spinal pressure pain sensitivity. The MCP1 concentration in serum was associated with higher global pain ratings and increased spinal pressure pain sensitivity, while IL-6 serum concentration correlated with the intensity of the neuropathic pain component (leg pain) in LDH patients. IVD expression of TSPO in LDH patients was associated with increased intensity of back pain. No differences were found in cytokine CSF concentrations between DDD patients and CSF controls, but DDD patients had lower IL-8 and MCP1 serum concentrations than HC. In female DDD patients, IL-8 and MCP1 concentrations in serum were associated with increased intensity of back pain. ConclusionOur results suggest that neuroinflammation mediated by elevated IL-8 concentrations in CSF and IL-8 mediated periphery-to-CNS inflammatory cross-talk contributes to pain in LDH patients and suggest a link between TSPO expression in discs and low back pain.

Autoalgometry: An Important Tool for Pressure Pain Threshold Evaluation.

The term “pain threshold” refers to the measurement of the intensity of a physical stimulus that evokes pain. To estimate the pain threshold, a mechanical or electrical stimulus with increasing intensity is usually applied until the subject under evaluation refers to a pain sensation. This study aims to evaluate the autoalgometric pain threshold as a perfect technique to determine the effects of stimulation rate in relation to both gender and the site of stimulation. In this experimental model, pressure algometry was applied: the subject under evaluation pushed a finger against a small round metal tip, producing and at the same time controlling the intensity of the noxious stimulus. Through autoalgometry, the stimulus intensity was recorded over time, measuring the force change rate applied and studying the subject’s behavior on approaching pain. This test was performed with 50 healthy volunteers on two days, applying a fast or slow rate of stimulation. The results described demonstrate that there is a positive correlation between the pressure increase rate and the pressure threshold evaluation. In light of these findings, autoalgometry can be proposed as an objective measure of pressure pain threshold for clinical and research use.

Validation of Two Pain Assessment Tools Using a Standardized Nociceptive Stimulation in Critically Ill Adults

ContextThe Behavioral Pain Scale (BPS) or the Critical-Care Pain Observation Tool (CPOT) are recommended in practice guidelines for pain assessment in critically ill adults unable to self-report. However, their use in another language requires cultural adaptation and validation testing. ObjectivesCross-cultural adaptation of the CPOT and BPS English versions into Brazilian Portuguese, and their validation by comparing behavioral scores during rest, standardized nociceptive stimulation by pressure algometry (SNSPA), and turning were completed. In addition, we explored clinical variables that could predict the CPOT and BPS scores. MethodsA prospective cohort study was conducted with 168 medical-surgical critically ill adults unable to self-report in the intensive care unit. Two nurses were trained to use the CPOT and BPS Brazilian Portuguese versions at the following assessments: 1) baseline at rest, 2) after SNSPA with a pressure of 14 kgf/cm2, 3) during turning, and 4) 15 minutes after turning. ResultsInter-rater reliability of nurses' CPOT and BPS scores was supported by high weighted kappa >0.7. Discriminative validation was supported with higher CPOT and BPS scores during SNSPA or turning in comparison to baseline (P < 0.001). The Glasgow Coma Scale score was the only variable that predicted CPOT and BPS scores with explained variance of 44.5% and 55.2%, respectively. ConclusionThe use of the Brazilian CPOT and BPS versions showed good reliability and validity in critically ill adults unable to self-report. A standardized procedure, the SNSPA, was used for the first time in the validation process of these tools and helped us improve the validation process.

Assessment of CPM reliability: quantification of the within-subject reliability of 10 different protocols.

Background and aims Conditioned Pain Modulation (CPM) is a well-established phenomenon and several protocols have shown acceptable between-subject reliability [based on intraclass correlation coefficient (ICC) values] in pain-free controls. Recently, it was recommended that future CPM test-retest reliability studies should explicitly report CPM reliability based on CPM responders and non-responders (within-subject reliability) based on measurement error of the test stimulus. Identification of reliable CPM paradigms based on responders and non-responders may be a step towards using CPM as a mechanistic marker in diagnosis and individualized pain management regimes. The primary aim of this paper is to investigate the frequency of CPM responders/non-responders, and to quantify the agreements in the classification of responders/non-responders between 2 different days for 10 different CPM protocols. Methods Data from a previous study investigating reliability of CPM protocols in healthy subjects was used. In 26 healthy men, the test-stimuli used on both days were: Pain thresholds to electrical stimulation, heat stimulation, manual algometry, and computer-controlled cuff algometry as well as pain tolerance to cuff algometry. Two different conditioning stimuli (CS; cold water immersion and a computer-controlled tourniquet) were used in a randomized and counterbalanced order in both sessions. CPM responders were defined as a larger increase in the test stimulus response during the CS than the standard error of measurement (SEM) for the test-stimuli between repeated baseline tests without CS. Results Frequency of responders and non-responders showed large variations across protocols. Across the studied CPM protocols, a large proportion (from 11.5 to 73.1%) of subjects was classified as CPM non-responders when the test stimuli standard error of measurements (SEM) was considered as classifier. The combination of manual pressure algometry and cold water immersion induced a CPM effect in most participants on both days (n=16). However, agreement in the classification of CPM responders versus non-responders between days was only significant when assessed with computer-controlled pressure pain threshold as test-stimulus and tourniquet cuff as CS (κ=0.36 [95% CI, 0.04-0.68], p=0.037). Conclusions and implications Agreements in classification of CPM responders/non-responders using SEM as classifier between days were generally poor suggesting considerable intra-individual variation in CPM. The most reliable paradigm was computer-controlled pressure pain threshold as test-stimulus and tourniquet cuff as conditioning stimulus. However while this CPM protocol had the greatest degree of agreement of classification of CPM responders and non-responders across days, this protocol also failed to induce a CPM response in more than half of the sample. In contrast, the commonly used combination of manual pressure algometry and cold water immersion induced a CPM effect in most participants however it was inconsistent in doing so. Further exploration of the two paradigms and classification of responders and non-responders in a larger heterogeneous sample also including women would further inform the clinical usefulness of these CPM protocols. Future research in this area may be an important step towards using CPM as a mechanistic marker in diagnosis and in developing individualized pain management regimes.

Strain counter-strain technique versus kinesio tape in treating patients with myofascial neck pain syndrome

Myofascial pain syndrome is one of the most common complaints in clinical practice. Strain counter-strain technique is non-invasive therapeutic modality for treatment of soft tissue disorders. Kinesio tape is now widely used in management of musculoskeletal injuries. Forty-five patients with myofascial neck pain syndrome assigned randomly into: strain counter-strain technique group ( n = 15), kinesio tape group ( n = 15) and control group ( n = 15). The strain counter-strain technique was applied for two weeks (3 sessions/week-20 minutes per session). Kinesio tape was applied for upper Trapezius muscle for two weeks (3 days on and one day off). Pressure algometry, Visual Analogue Scale (VAS) and Neck Disability Index (NDI) were used to evaluate participants before and after the corresponding interventions. Analysis of variance test (Anova) was used to determine differences between groups for all measured parameters. Paired t -test was used to compare between the pre- and post-treatment values within groups. For the 45 study participants (33 women and 12 men; mean age = 44.1 ± 7 years) statistical analysis revealed that subjects in strain counter-strain technique and kinesio tape groups experienced significant increase in pressure pain threshold, decrease in neck disability scale and pain level than those in the control group in favour of strain counter-strain technique group ( P > 0.05). The results suggest that treatment with strain counter-strain technique and kinesio tape were effective however strain counter-strain technique was more effective for management of myofascial neck pain syndrome.

The added value of bedside examination and screening QST to improve neuropathic pain identification in patients with chronic pain

BackgroundThe assessment of a neuropathic pain component (NePC) to establish the neurological criteria required to comply with the clinical description is based on history taking, clinical examination, and quantitative sensory testing (QST) and includes bedside examination (BSE). The objective of this study was to assess the potential association between the clinically diagnosed presence or absence of an NePC, BSE, and the Nijmegen–Aalborg screening QST (NASQ) paradigm in patients with chronic (≥3 months) low back and leg pain or with neck shoulder arm pain or in patients with chronic pain due to suspected peripheral nerve damage.MethodsA total of 291 patients participated in the study. Pain (absence or presence of neuro-pathic pain) was assessed independently by two physicians and compared with BSE (measurements of touch [finger, brush], heat, cold, pricking [safety pin, von Frey hair], and vibration). The NASQ paradigm (pressure algometry, electrical pain thresholds, and conditioned pain modulation) was assessed in 58 patients to generate new insights.ResultsBSE revealed a low association of differences between patients with either absent or present NePC: heat, cold, and pricking sensations with a von Frey hair were statistically significantly less common in patients with present NePC. NASQ did not reveal any differences between patients with and without an NePC.ConclusionCurrently, a standardized BSE appears to be more useful than the NASQ paradigm when distinguishing between patients with and without an NePC.

Cuff Pressure Algometry in Patients with Chronic Pain as Guidance for Circumferential Tissue Compression for Wearable Soft Exoskeletons: A Systematic Review.

In this article, we report on a systematic review of the literature on pressure-pain thresholds induced and assessed by computerized cuff pressure algometry (CPA). The motivation for this review is to provide design guidance on pressure levels for wearable soft exoskeletons and similar wearable robotics devices. In our review, we focus on CPA studies of patients who are candidates for wearable soft exoskeletons, as pain-related physiological mechanisms reportedly differ significantly between healthy subjects and patients with chronic pain. The results indicate that circumferential limb compression in patients most likely becomes painful at ∼10-18 kPa and can become unbearable even below 25 kPa. The corresponding ranges for healthy control subjects are 20-42 kPa (painful limits) and 34-84 kPa (unbearable levels). In addition, the increase of pain with time tends to be significantly higher, and the adaptation to pain significantly lower, than in healthy subjects. The results of this review provide guidance to designers of wearable robotics for populations with chronic pain regarding rates and magnitudes of tissue compression that may be unacceptable to users.

The peer effect on pain tolerance.

Background and aims Twin studies have found that approximately half of the variance in pain tolerance can be explained by genetic factors, while shared family environment has a negligible effect. Hence, a large proportion of the variance in pain tolerance is explained by the (non-shared) unique environment. The social environment beyond the family is a potential candidate for explaining some of the variance in pain tolerance. Numerous individual traits have previously shown to be associated with friendship ties. In this study, we investigate whether pain tolerance is associated with friendship ties. Methods We study the friendship effect on pain tolerance by considering data from the Tromsø Study: Fit Futures I, which contains pain tolerance measurements and social network information for adolescents attending first year of upper secondary school in the Tromsø area in Northern Norway. Pain tolerance was measured with the cold-pressor test (primary outcome), contact heat and pressure algometry. We analyse the data by using statistical methods from social network analysis. Specifically, we compute pairwise correlations in pain tolerance among friends. We also fit network autocorrelation models to the data, where the pain tolerance of an individual is explained by (among other factors) the average pain tolerance of the individual's friends. Results We find a significant and positive relationship between the pain tolerance of an individual and the pain tolerance of their friends. The estimated effect is that for every 1 s increase in friends' average cold-pressor tolerance time, the expected cold-pressor pain tolerance of the individual increases by 0.21 s (p-value: 0.0049, sample size n=997). This estimated effect is controlled for sex. The friendship effect remains significant when controlling for potential confounders such as lifestyle factors and test sequence among the students. Further investigating the role of sex on this friendship effect, we only find a significant peer effect of male friends on males, while there is no significant effect of friends' average pain tolerance on females in stratified analyses. Similar, but somewhat lower estimates were obtained for the other pain modalities. Conclusions We find a positive and significant peer effect in pain tolerance. Hence, there is a significant tendency for students to be friends with others with similar pain tolerance. Sex-stratified analyses show that the only significant effect is the effect of male friends on males. Implications Two different processes can explain the friendship effect in pain tolerance, selection and social transmission. Individuals might select friends directly due to similarity in pain tolerance, or indirectly through similarity in other confounding variables that affect pain tolerance. Alternatively, there is an influence effect among friends either directly in pain tolerance, or indirectly through other variables that affect pain tolerance. If there is indeed a social influence effect in pain tolerance, then the social environment can account for some of the unique environmental variance in pain tolerance. If so, it is possible to therapeutically affect pain tolerance through alteration of the social environment.

Experimental Referred Pain Extends Toward Previously Injured Location: An Explorative Study

Facilitated pain mechanisms have been demonstrated in musculoskeletal pain, but it is unclear whether a recent painful injury leaves the pain system sensitized. Pain characteristics were assessed in individuals who recently recovered from ankle pain (recovered pain group; n = 25) and sex-matched control subjects (n = 25) in response to tonic pressure pain and saline-induced pain applied at the shin muscle. Pain intensity and pain referral patterns were recorded bilaterally after the painful muscle stimulus. Pressure pain thresholds were measured at the lower legs and shoulder. Cuff pressure algometry on the lower leg was used to assess pain detection threshold, pressure evoking 6-cm pain score on a 10-cm visual analog scale, pain tolerance, temporal summation of pain, and conditioned pain modulation. Compared with in control subjects, saline-induced and pressure-induced pain in the shin muscle were more frequently felt as referred pain in the previously painful ankle (P < .05), and the pain area within the previously affected ankle was larger after saline-induced pain (P < .05). In the recovered pain group, conditioned pain modulation responses and the cuff pressure needed to reach a 6-cm pain score on a 10-cm visual analog scale was higher in the previously painful leg compared with in the contralateral leg (P < .05). No group differences were found in pressure pain threshold, pain detection threshold, pain tolerance, and temporal summation of pain. PerspectiveThese explorative findings demonstrate that pain mechanisms responsible for pain location may be reorganized and continue to be facilitated despite recovery. A large prospective study is needed to clarify the time profile and functional relevance of such prolonged facilitation in the pain system for understanding recurring pain conditions.

L’algométrie par pression est un excellent outil de mesure de la douleur après ostéotomie titbiale de fermeture

PurposeThe aim of this study was to assess the utility of pressure algometry (PA), to measure pain relief in the medial part of the knee after a closing-wedge high tibial osteotomy (CWHTO). MethodsProspective study including 44 CWHTO. Pain relief was evaluated with the visual analogue scale (VAS) and PA, a radiological study was done and a functional assessment was carried out with the KSS pre-operatively, at 6-months and at 1-year after the surgery. PA was applied to the medial and lateral part of the knee and to the infra-clavicular fossa as a control point. ResultsThe mechanical femorotibial angle was changed from 172.2 (SD2.2) to 180.6 (SD2.6)(P=0.00). KSS Knee improved from 53.4 (SD11.2) to 92.8 (SD7.3)(P=0.00), KSS Function from 69.4(SD9.3) to 93.1 (SD8)(P=0.00). The VAS went from 6.84 (SD1.5) to 2.5 (SD2.1)(P=0.00) at the 1-year follow-up. The pressure pain threshold (PPT), measured with PA in the medial part of the knee also improved from 348.8kPa (SD159.3) to 447.1kPa (SD218.8)(P=0.01). However, the PPT in the lateral part of the knee and in the sub-clavicular fossa remained the same from the pre-operative period to 6-months and 1-year, postoperatively. Neither were there any differences between the 6-months and 1-year postoperative values in terms of the different functional, radiological and pain relief obtained. ConclusionThe pain relief obtained after a CWHTO in the medial part of the knee can be measured by using PA. Furthermore, the functional and pain improvement obtained at 1-year follow-up is no better than those obtained at 6-months postoperatively.

Behavioural and physiological responses to clove oil injected under the horn bud of calves

The aim of this study was to evaluate the acute and longer-term behavioural and physiological responses caused by administering clove oil under the horn bud of calves and compare these with the responses caused by cautery disbudding. Forty female Friesian-cross calves (mean ± SD: 3.5 ± 2.72 d of age) were allocated to one of four treatments (n = 10 calves/treatment): 1) control handling (CON), 2) administration of 0.5 mL of clove oil under each horn bud (CLOV), 3) cautery disbudding (CAUT) or 4) local anaesthetic plus cautery disbudding (LA + CAUT). Lying behaviour was recorded continuously using accelerometers, while other behaviours were recorded from video for the same 2 h periods on 3 days relative to treatment: baseline (day before), D0 (0–24 h after) and D1 (24–48 h after). Pain sensitivity adjacent to the horn bud was measured using pressure algometry, and blood samples were collected to measure complete blood cell counts and serum amyloid A concentrations, before and 48 h after administration of treatments. CAUT calves tended to perform more head shakes than CON and CLOV calves during the first 2 h after treatment (change from baseline, no./2 h: CON: −0.3, CAUT: 4.7, LA + CAUT: 3.0, CLOV: −0.4, SED = 2.33, P = 0.096). Compared to baseline, CLOV calves spent less (P < 0.05) time head rubbing than LA + CAUT calves on D0, however, on D1 all treatments rubbed their heads less (P < 0.05) compared to CON calves. Compared to baseline, CAUT and LA + CAUT calves spent less (P < 0.05) time running than CON calves on D0, but the time spent running did not differ between CON and CLOV calves. Mean daily lying times after administration of treatments were greater in CLOV compared to CON and CAUT calves, and CLOV and LA + CAUT calves did not differ (change from baseline (min/24 h): CON: −14.8, CAUT: 25.1, LA + CAUT: 64.2, CLOV: 94.8, SED = 31.77; P = 0.016). Overall, all treatments displayed more sensitivity in response to pressure algometry than CON calves (change from baseline (kg of force): CON: −0.3, CAUT: −2.2, LA + CAUT: −1.8, CLOV: −1.5, SED = 0.46; P = 0.003). There was no treatment effect on blood constitutes. Our results suggest that injecting clove oil under the horn bud was initially less painful, and in the 48 h after treatment, did not cause more pain than cautery disbudding. Unlike cautery disbudding, injecting clove oil does not involve tissue removal nor is there a risk of thermal damage to the brain. Therefore, clove oil could be an alternative to cautery disbudding, if this method is found to efficaciously prevent horn growth.

Test Procedures to Assess Somatosensory Abnormalities in Individuals with Peripheral Joint Pain: A Systematic Review of Psychometric Properties.

Test procedures that were developed to assess somatosensory abnormalities should possess optimal psychometric properties (PMPs) to be used in clinical practice. The aim of this systematic review was to evaluate the literature to assess the level of evidence for PMPs of test procedures investigated in individuals with peripheral joint pain (PJP). A comprehensive electronic literature search was conducted in 7 databases from inception to March 2016. The Quality Appraisal for Reliability Studies (QAREL) checklist and the Consensus-based Standards for the Selection of Health Status Measurement Instruments (COSMIN) tool were used to assess risk for bias of the included studies. Level of evidence was evaluated based on the methodological quality and the quality of the measurement properties. Forty-one studies related to PJP were included. The majority of included studies were considered to be of insufficient methodological quality, and the level of evidence for PMPs varied across different test procedures. The level of evidence for PMPs varied across different test procedures in different types of PJP. Hand-held pressure algometry is the only test procedure that showed moderate positive evidence of intrarater reliability, agreement, and responsiveness, simultaneously, when it was investigated in patients with chronic knee osteoarthritis. This systematic review identified that the level of evidence for PMPs varied across different testing procedures to assess somatosensory abnormalities for different PJP populations. Further research with standardized protocols is recommended to further investigate the predictive ability and responsiveness of reported test procedures in order to warrant their extended utility in clinical practice.

Pressure algometry is an excellent tool to measure knee pain relief after a closing-wedge high tibial osteotomy.

The aim of this study was to assess the utility of pressure algometry (PA) to measure pain relief in the medial part of the knee after a closing-wedge high tibial osteotomy (CWHTO). Prospective study including 44 CWHTO. Pain relief was evaluated with the visual analogue scale (VAS) and PA, a radiological study was done and a functional assessment was carried out with the KSS preoperatively, at 6-months and at 1-year after the surgery. PA was applied to the medial and lateral part of the knee and to the infra-clavicular fossa as a control point. The mechanical femorotibial angle was changed from 172.2° (SD2.2) to 180.6° (SD2.6) (p=0.00). KSS Knee improved from 53.4 (SD11.2) to 92.8 (SD7.3) (p=0.00), KSS Function from 69.4 (SD9.3) to 93.1 (SD8) (p=0.00). The VAS went from 6.84 (SD1.5) to 2.5 (SD2.1) (p=0.00) at the 1-year follow-up. The pressure pain threshold (PPT), measured with PA in the medial part of the knee also improved from 348.8kPa (SD159.3) to 447.1kPa (SD218.8) (p=0.01). However, the PPT in the lateral part of the knee and in the sub-clavicular fossa remained the same from the preoperative period to 6-months and 1-year, postoperatively. Neither were there any differences between the 6-month and 1-year postoperative values in terms of the different functional, radiological and pain relief obtained. The pain relief obtained after a CWHTO in the medial part of the knee can be measured by using PA. Furthermore, the functional and pain improvement obtained at 1-year follow-up is no better than those obtained at 6-months postoperatively.

The effects of McKenzie exercises in chronic nonspecific low back pain patients with central sensitization: A pilot study

BACKGROUND: The possibility of the presence of central sensitization (CS) among chronic nonspecific low back pain (CNSLBP) patients to predict treatment response by related outcome measures has not been adequately explored. The purpose of this pilot study was to determine the feasibility of a study to compare “McKenzie exercise program” (MEP) and “conventional physiotherapy program” (CPP) outcomes for participants with CNSLBP, investigate whether any difference in outcome was related to CS, disability, fear-avoidance beliefs and trunk flexors and extensors muscles endurance, and to inform the design of a main study.OBJECTIVE: The present study tests whether MEP reduces CS better in CNSLBP patients having CS compared to CPP.METHODS: Forty-two patients with CNSLBP were randomly allocated into two groups. The experimental group (n = 22) received only MEP and control group (n = 20) received only CPP. Each group received specific weekly treatment five times during the study for 2 months. Outcome measures were CS Inventory-Gujarati (CSI-G) for the presence of CS, numerical pain rating scale (NPRS) for pain intensity, pressure pain threshold (PPT) by pressure algometry, Roland–Morris Disability Questionnaire-Gujarati (RMDQ-G) for disability, Fear-avoidance-beliefs Questionnaire-Gujarati (FABQ-G) for fear-avoidance beliefs, and trunk flexors and extensors endurance tests.RESULTS: Both the groups showed a decrease in NPRS, CSI-G, RMDQ-G, and FABQ-G scores and increase in PPT and trunk flexors and extensors endurance scores. However, decrease in NPRS, CSI-G, RMDQ-G, and FABQ-G scores and increase in PPT scores were significantly better in the experimental group. In contrast, control group performed significantly better on trunk flexors and extensors endurance scores.CONCLUSION: McKenzie exercises are effective in reducing pain, pain sensitization, disability and fear avoidance beliefs; however, it does not improve trunk flexors and extensors endurance in CNSLBP patients with or without CS.

Osgood-schlatter Disease Diagnosis by Algometry and Infrared Thermography

Background: The diagnosis of Osgood-Schlatter Disease (OSD) is based on clinical signs and symptoms. However, more objective parameters, like thermal images, have been researched to determine, along algometry, valid parameters. Objective: The aim of this study was to analyze the thermal differences and the painful sensibility between the knees (with SOS and contralateral) of young soccer players. Methods: 6 young men, aged between 12 and 15, members of football schools, composed the sample. Images were taken from an anterior view of both knees, with the volunteer in a seated position, the knees flexed at 90º degrees and both feet flat on the floor. After the thermal image capture, the patients were submitted to an evaluation with the pressure algometer. Results: According to the results, it was found that the knee affected by the OSD showed temperatures significantly higher than the contralateral (p = 0.027) and also greater sensitivity to the pressure algometry (p = 0.027). Conclusion: it can be concluded that the inflammatory process, during OS Syndrome, promotes a local thermal hyper-radiation, identified with the high sensitive thermographic infrared image, producing a significant difference in local temperature between the knees of a single individual. Moreover, this process also increases the pain sensibility, accessed by pressure algometry.

Age Interactions on Pain Sensitization in Patients With Severe Knee Osteoarthritis and Controls

Widespread pressure hyperalgesia, facilitated temporal summation of pain (TSP), and impaired conditioned pain modulation (CPM) have been found in knee osteoarthritis (KOA) patients compared with controls and these parameters have further been suggested to be altered in the elderly. This study investigated the influence of age on pressure hyperalgesia, TSP, and CPM in patients with KOA and controls. One hundred thirty-three severe KOA patients and 50 age-matched and sex-matched asymptomatic controls were assessed by cuff algometry and handheld pressure algometry. Pain sensitivity was assessed around the head of the gastrocnemius muscle to identify mild pain detection threshold (MPDT) and pressure tolerance threshold (PTT). TSP was assessed by visual analogue scale scores of the pain evoked by 10 repetitive cuff stimulations. CPM was assessed as the difference in PTT before and during cuff-induced tonic arm pain. Pressure pain thresholds (PPTs) were assessed by handheld algometry at the tibialis anterior muscle. Two subgroups were analyzed in the age range below and above 65 years. Pearson correlations between age and pain parameters were applied. Patients demonstrated reduced MPDT, PTT, and PPT (P<0.01), facilitated TSP (P<0.02), and a trend toward impaired CPM (P=0.06) compared with controls. A negative correlation was found between MPDT, PTT, and PPT and age (P<0.05) but no age-related association was found for TSP and CPM. Pressure hyperalgesia was affected by age whereas dynamic pain mechanisms such as TSP and CPM were unaffected suggesting that these parameters are robust for a larger age range and reliable for long-term follow-up studies.

The Short-Term Effect of Kettlebell Swings on Lumbopelvic Pressure Pain Thresholds: A Randomized Controlled Trial.

Keilman, BM, Hanney, WJ, Kolber, MJ, Pabian, PS, Salamh, PA, Rothschild, CE, and Liu, X. The short-term effect of kettlebell swings on lumbopelvic pressure pain thresholds: a randomized controlled trial. J Strength Cond Res 31(11): 3001-3009, 2017-The purpose of this study was to investigate the short-term effect of kettlebell swings (KBSs) on lumbopelvic pressure pain thresholds (PPTs) in healthy adults. Sixty participants (male = 23, female = 37, mean age = 25.12 ± 2.86 years, height = 170.73 ± 9.2 cm, mass = 70.49 ± 13.32 kg) were randomized into one of 2 groups. The experimental group performed a warm-up followed by 8 consecutive 20-second rounds of KBS with 10-second rest periods. The control group performed the warm-up alone. An evaluator blinded to group assignment, assessed PPTs immediately before and after the intervention using a handheld pressure algometer. The algometer was applied to the regions of the right paravertebral (PVM), quadratus lumborum (QL), and piriformis (PF) muscles perpendicular to the skin based on standardized palpation procedures. The participants were instructed to report when sensation changed from "comfortable pressure" to "slightly unpleasant pain." No significant group differences existed at baseline for PPTs (PVM p = 0.068; QL p = 0.134, & PF p = 0.105). Significant group by time interactions existed for each site after the interventions (PVM, p = 0.018; QL, p = 0.004; PF, p = 0.026) favoring the KBS group. Results suggest that KBSs create a reduction in muscle sensitivity to noxious pressure based on pressure algometry measurements. These findings may be due to the unique cyclic muscle contraction associated with KBSs, which has been proposed to facilitate removal of muscle metabolites. The findings of this study provide a foundation for future studies to examine the use of this type of training in patients with low back pain of a muscular etiology or postexercise muscle soreness. Furthermore, future studies should evaluate specific mechanisms for these effects.

Computerized Cuff Pressure Algometry as Guidance for Circumferential Tissue Compression for Wearable Soft Robotic Applications: A Systematic Review.

In this article, we review the literature on quantitative sensory testing of deep somatic pain by means of computerized cuff pressure algometry (CPA) in search of pressure-related safety guidelines for wearable soft exoskeleton and robotics design. Most pressure-related safety thresholds to date are based on interface pressures and skin perfusion, although clinical research suggests the deep somatic tissues to be the most sensitive to excessive loading. With CPA, pain is induced in deeper layers of soft tissue at the limbs. The results indicate that circumferential compression leads to discomfort at ∼16-34 kPa, becomes painful at ∼20-27 kPa, and can become unbearable even below 40 kPa.

Pain Threshold in Migraine and Tension-Type Headache by Pressure Algometry in Craniocervical Muscles and Peripheral Nerves in Both Genders

Pain Threshold in Migraine and Tension-Type Headache by Pressure Algometry in Craniocervical Muscles and Peripheral Nerves in Both Genders