Pressure Pain Threshold Measurements Research Articles

Effect of transcutaneous electromyostimulation on pressure pain threshold and tolerance in athletes under eccentric exercise

Exercise-induced hypoalgesia typically reported during and / or following exercise. In this study, we investigated the role of transcutaneous electromyostimulation (EMS) on pressure pain threshold and tolerance in athletes under eccentric exercise. Eleven male athletes aged 23,125 ± 0,99 years with 10,25 ± 2,66 years of athletic training were recruited for this study. Following baseline measurements of pressure pain threshold and tolerance from m. biceps brachii and m. triceps brachii muscle and myofascial regions of the dominant upper extremity by using a digital algometer, subjects were underwent an acute bout of eccentric exercise. Participants were completed 4 sets of eccentric exercise each comprising 20 repetitions of lifting 80% of their 1 RM by using a dumbbell. Pressure pain threshold and tolerance tests were repeated 10, 20 and 30 minutes, and 24 and 48 hours following exercise. One week after acute exercise protocol, EMS protocol was applied to the participants immediately following eccentric exercise, and all measurements were repeated at the same timeline as eccentric exercise. Standard EMS protocol at active recovery mode for 10 minutes was applied to the m. biceps brachii muscle by using surface electrodes. Results are presented as mean + standarts deviation. Data of the same timeline were analyzed by using repeated measures of ANOVA followed by Tukey’s post hoc test. A level of p<0.05 was accepted statistical significant. Eccentric exercise resulted to increase the pain tolerence in athletes, and EMS was found to decrease the pain tolerence 10 and 20 minutes at the muscle region, and 10 and 30 minutes, and 24 hours at the myofascial region of m. biceps brachii, 10 min and 24 hr from muscle region, 10 and 30 min and 24 hr from myofascial region of M. triceps brachii following acute bout of eccentric exercise. We concluded that EMS at active recovery phase mitigates the the hypoalgesic response following single bout of eccentric exercise.

The effect of simultaneously performed cognitive task and physical exercise on pressure pain threshold and tolerance in athletes

The aim of the study was to investigate the alterations of the pain threshold and tolerance after single, or dual task in athletes. Twenty male athletes and twenty non-athletic, recreationally active college students were participated in the study. Subjects were asked to perform Harvard step test (single task), and cognitive task was concurrent performance of an arithmetic task while performing Harvard step test. Pressure pain threshold (PPT) and pressure pain tolerance (PPTO) were assessed from muscle, tendon, bone and myofascial region from the dominant thigh by using a digital algometer. All measurements were repeated at rest, or following single and dual task. Results are presented as mean + standart deviation. Data were analyzed by using repeated measures of ANOVA test. A level of p<0.05 was accepted statistical significant. Athletes had higher PPT and PPTO measurements from muscle and myofascial region of thigh at rest. PPT and PPTO values were increased after single, or dual task in sedentary subjects, while athletic subjects had increased muscle and myofascial PPT and PPTO values after dual task. In conclusion, our results supports the notion that cognitive functions may interact the pain processing at rest, or following exercise in athletes.

Reliability Measures of Subcutaneous Pressure Pain Threshold Measurements: A Proposed Method of Assessing Painful Musculoskeletal Disorders

Background: Pressure algometry is a widely used method aiming to investigate deep tissue mechanical pain threshold in painful musculoskeletal disorders. Considering from the literature the input of skin and subcutaneous tissue in the determination of pressure pain threshold, and the distinctive role in clinical setting of the subcutaneous pressure threshold measurement(sPPT), it becomes necessary to investigate the reliability of the sPPT measurements. This study examines the short and longer-term intra-examiner reliability of sPPT measurements. Methods: Thirty subjects were examined at 3 pre-determined time intervals, in various parts of the body, by the same examiner in the same clinical setting. Short (between days) and longer-term (after a week) test-retest reliability was investigated. A number of statistical procedures was computed: ICC, ANOVA, standard error of measurement (SEM), smallest detectable difference (SDD) and confirmatory scatterplots. Results: The ICC statistic reached good to excellent levels for both types of reliability (0.70 – 0.97). ANOVA produced non-significant differences at all measurements. SEM gave a satisfactory overall mean value of 6.07 kPa (short-term) for all measuring sites (range: 3.2-10.1) and similarly for the longer-term reliability (Mean=6.2, range:3.1-11.2). SDD were satisfactory in the majority of the measurements [short: Mean=11.76, range: 5.9-20, longer: Mean=12.0, range: 6.5-22] but relatively high in some measuring sites, nevertheless fully acceptable and safely within the pressure algometry limits as defined in the literature. Conclusions: Subcutaneous pressure threshold measurement is a reliable to reproduce with stable results procedure, either for short or longer periods of time (from 1 to 7 days), across the whole body (upper – lower body),by the same examiner. Its fluctuation in absolute values is within the literature limits of deep pressure algometry.

Effects of cervical deep muscle strengthening in a neck pain: a patient with klippel-feil syndrome.

[Purpose] This study aimed to identify the effects of cervical deep muscle strengthening (CDS) on neck pain in a patient with Klippel-Feil syndrome (KFS). [Subjects and Methods] The subjects was a 39 year-old woman with neck pain and KFS that included incomplete block vertebrae in the C2–3 segments and block vertebrae in the C6–7 segments. The subject performed an exercise program including cervical strengthening exercise (level 1) and CDS exercise (level 2) for 6 weeks. Neck pain intensity was measured using the visual analogue scale (VAS) and the pressure pain threshold (PPT). All measurements were obtained before and after the CDS exercise program. [Results] The VAS and PPT measurements decreased; range of motion in the cervical joint increased. [Conclusion] CDS exercises were effective interventions for reducing neck pain in a patient with Klippel-Feil syndrome.

Comparison of muscle and joint pressure-pain thresholds in patients with complex regional pain syndrome and upper limb pain of other origin

Pain localized in the deep tissues occurs frequently in complex regional pain syndrome (CRPS). In addition, hyperalgesia to blunt pressure over muscles is common in CRPS, but it often appears in limb pain of other origin as well. Considering that 3-phase bone scintigraphy (TPBS) reveals periarticular enhanced bone metabolism in CRPS, joint-associated hyperalgesia to blunt pressure might be a more specific finding than hyperalgesia over muscles. In 34 patients with upper limb pain (18 CRPS, 16 non-CRPS; diagnosed in accordance to the Budapest criteria) and in 18 healthy controls, pressure-pain thresholds (PPT) were assessed bilaterally over the thenar (PPTThenar), the metacarpophalangeal (PPTMCP), and the proximal interphalangeal (PPTPIP) joints using a pressure algometer (Somedic, Sweden). Beforehand, all patients had received TPBS for diagnostic purposes independently of the study. Region-of-interest (ROI) ratios (mineralization phase) for the MCP and PIP, excluding fracture sites, were correlated with the PPT. In CRPS, all ROI ratios were significantly increased and all PPT of the affected hand were decreased compared to non-CRPS (PPTThenar: 243±150kPa vs 358±197kPa, PPTMCP: 80±67kPa vs 159±93kPa, PPTPIP: 80±56kPa vs 184±110kPa; P<.01) and controls (PPTThenar: 478±106kPa, PPTMCP: 254±50kPa, PPTPIP: 275±76kPa; P<.01). A PPTThenar below 293kPa revealed 77% sensitivity but only 63% specificity, whereas a PPTPIP below 102kPa had 82% sensitivity and 94% specificity to identify CRPS. Only in CRPS were PPTMCP and PPTPIP correlated significantly inversely with the ROI ratio (MCP: r=−0.439, PIP: r=−0.447). PPTPIP shows higher specificity for CRPS type I than PPTThenar without loss of sensitivity. Therefore, measurement of joint PPT could be a noninvasive diagnostic tool reflecting increased bone metabolism assessed by TPBS as a sign of bone pathophysiology.

Acute Effects of Massage or Active Exercise in Relieving Muscle Soreness

Massage is commonly believed to be the best modality for relieving muscle soreness. However, actively warming up the muscles with exercise may be an effective alternative. The purpose of this study was to compare the acute effect of massage with active exercise for relieving muscle soreness. Twenty healthy female volunteers (mean age 32 years) participated in this examiner-blind randomized controlled trial (ClinicalTrials.gov NCT01478451). The participants performed eccentric contractions for the upper trapezius muscle on a Biodex dynamometer. Delayed onset muscle soreness (DOMS) presented 48 hours later, at which the participants (a) received 10 minutes of massage of the trapezius muscle or (b) performed 10 minutes of active exercise (shoulder shrugs 10 × 10 reps) with increasing elastic resistance (Thera-Band). First, 1 treatment was randomly applied to 1 shoulder while the contralateral shoulder served as a passive control. Two hours later, the contralateral resting shoulder received the other treatment. The participants rated the intensity of soreness (scale 0-10), and a blinded examiner took measures of pressure pain threshold (PPT) of the upper trapezius immediately before treatment and 0, 10, 20, and 60 minutes after treatment 48 hours posteccentric exercise. Immediately before treatment, the intensity of soreness was 5.0 (SD 2.2) and PPT was 138 (SD 78) kPa. In response to treatment, a significant treatment by time interaction was found for the intensity of soreness (p < 0.001) and PPT (p < 0.05). Compared with control, both active exercise and massage significantly reduced the intensity of soreness and increased PPT (i.e., reduced pain sensitivity). For both types of treatment, the greatest effect on perceived soreness occurred immediately after treatment, whereas the effect on PPT peaked 20 minutes after treatment. In conclusion, active exercise using elastic resistance provides similar acute relief of muscle soreness as compared with that using massage. Coaches, therapists, and athletes can use either active warm-up or massage to reduce DOMS acutely, for example, to prepare for competition or strenuous work, but should be aware that the effect is temporary, that is, the greatest effects occurs during the first 20 minutes after treatment and diminishes within an hour.

Pain Physiology Education Improves Health Status and Endogenous Pain Inhibition in Fibromyalgia

There is evidence that education on pain physiology can have positive effects on pain, disability, and catastrophization in patients with chronic musculoskeletal pain disorders. A double-blind randomized controlled trial (RCT) was performed to examine whether intensive pain physiology education is also effective in fibromyalgia (FM) patients, and whether it is able to influence the impaired endogenous pain inhibition of these patients. Thirty FM patients were randomly allocated to either the experimental (receiving pain physiology education) or the control group (receiving pacing self-management education). The primary outcome was the efficacy of the pain inhibitory mechanisms, which was evaluated by spatially accumulating thermal nociceptive stimuli. Secondary outcome measures included pressure pain threshold measurements and questionnaires assessing pain cognitions, behavior, and health status. Assessments were performed at baseline, 2 weeks, and 3 months follow-up. Repeated measures ANOVAS were used to reveal possible therapy effects and effect sizes were calculated. After the intervention the experimental group had improved knowledge of pain neurophysiology (P<0.001). Patients from this group worried less about their pain in the short term (P=0.004). Long-term improvements in physical functioning (P=0.046), vitality (P=0.047), mental health (P<0.001), and general health perceptions (P<0.001) were observed. In addition, the intervention group reported lower pain scores and showed improved endogenous pain inhibition (P=0.041) compared with the control group. These results suggest that FM patients are able to understand and remember the complex material about pain physiology. Pain physiology education seems to be a useful component in the treatment of FM patients as it improves health status and endogenous pain inhibition in the long term.

Alternating-Frequency TENS Effects on Experimental Pain in Healthy Human Participants

Transcutaneous electrical nerve stimulation (TENS) is a modality commonly used in pain management. This study investigated the hypoalgesic effects of alternating-frequency TENS (4 Hz for 3 s/110 Hz for 3 s) on pressure pain threshold (PPT). Two-hundred and eight healthy, pain-free volunteers (19 to 59 y old; 104 males, 104 females) were randomized to 8 groups: 6 active TENS groups, placebo, and control (n=26 per group). Parameter combinations were such that alternating-frequency TENS was combined with different levels of intensity "low" (strong but comfortable) or "high" (strong and uncomfortable but not painful). TENS was administered either at the forearm (segmental stimulation), at the ipsilateral leg (extrasegmental stimulation), or at both sites (dual-site stimulation) for 30 minutes and monitored for 30 further minutes. PPT measurements were taken bilaterally from the mid-point of first dorsal interosseous muscle, by an independent blinded rater, at baseline and at 6 subsequent 10-minute intervals. Square-root transformed data were analyzed using repeated measures analysis of covariance (baseline values and sex as covariates). Alternating-frequency TENS groups did not achieve significant hypoalgesic effects compared with placebo or control (P>0.05). The largest increase in PPT (from baseline) was 76.6 kPa with low-intensity segmental alternating frequency TENS at the 20-minute stimulation time point. This change from baseline is below a difference of 100 kPa that is considered to be a clinically meaningful change in hypoalgesia. The alternating-frequency setting does not result in large hypoalgesic effects such as those previously reported using fixed-frequency TENS.

SAT0393 The Effects of Coexisting Fibromyalgia on Disability of the Computer Users with Cumulative Trauma Disorders

BackgroundThe effects of coexisting fibromyalgia syndrome (FS) on disability of computer users with cumulative trauma disorders (CTD) hasn’t been studied previously.ObjectivesTo evaluate the existence of FS in computer users with...

Palmitoylethanolamide and stearoylethanolamide levels in the interstitium of the trapezius muscle of women with chronic widespread pain and chronic neck-shoulder pain correlate with pain intensity and sensitivity

Chronic widespread pain (CWP) is a complex condition characterized by central hyperexcitability and altered descending control of nociception. However, nociceptive input from deep tissues is suggested to be an important drive. N-Acylethanolamines (NAEs) are endogenous lipid mediators involved in regulation of inflammation and pain. Previously we have reported elevated levels of the 2 NAEs, the peroxisome proliferator-activated receptor type-α ligand N-palmitoylethanolamine (PEA) and N-stearoylethanolamine (SEA) in chronic neck/shoulder pain (CNSP). In the present study, the levels of PEA and SEA in women with CWP (n=18), CNSP (n=34) and healthy controls (CON, n=24) were investigated. All subjects went through clinical examination, pressure pain threshold measurements and induction of experimental pain in the tibialis anterior muscle. Microdialysis dialysate of the trapezius was collected before and after subjects performed a repetitive low-force exercise and analyzed by mass spectrometry. The levels of PEA and SEA in CNSP were significantly higher post exercise compared with CWP, and both pre and post exercise compared with CON. Levels of both NAEs decreased significantly pre to post exercise in CWP. Intercorrelations existed between aspects of pain intensity and sensitivity and the level of the 2 NAEs in CWP and CNSP. This is the first study demonstrating that CNSP and CWP differ in levels of NAEs in response to a low-force exercise which induces pain. Increases in pain intensity as a consequence of low-force exercise were associated with low levels of PEA and SEA in CNSP and CWP. These results indicate that PEA and SEA have antinociceptive roles in humans.

The repeatability of pressure algometry in asymptomatic individuals over consecutive days

BackgroundTo determine if electronic pressure algometry is a statistically stable measure of spinal pressure pain threshold (PPT) in asymptomatic individuals, in particular, to determine if repeated measurements at the same site changes the PPT, and to determine if repeatability differs in each of the spinal regions tested. DesignRepeated measures design. SettingUniversity teaching clinic. ParticipantsThirty-three asymptomatic participants. InterventionsThe PPT of three spinal segments (C6, T6 and L4) was measured three times in consecutive measures (10 s apart), then repeated one day and two days post-initial measurement. Measurements were taken using an electronic pressure algometer. Main outcome measuresPPT, intra-class correlation coefficient and test of significant equality. ResultsResults demonstrated that the PPT measurement is statistically stable both between days (p < 0.001) and within day (p < 0.001). The intra-class correlation coefficient (ICC) values between the mean scores of daily trials demonstrated excellent concordance for each spinal segment (ICC = 0.860–0.953), with the exception of the correlation between day 1 and day 3 at T6, demonstrating good concordance (ICC = 0.676). All trial-to-trial correlations demonstrated excellent concordance both within trials of the same day (ICC = 0.833–0.988) and subsequent days (ICC = 0.823–0.940). ConclusionElectronic pressure algometry is a repeatable and statistically stable measure of the spinal PPT, both between days and within-day. The results provide evidence that the use of this device may be of value as an outcome measure for primary spinal complaints such as low back or thoracic spine pain.

Immediate Effects of Region-Specific and Non–Region-Specific Spinal Manipulative Therapy in Patients With Chronic Low Back Pain: A Randomized Controlled Trial

Manual therapists typically advocate the need for a detailed clinical examination to decide which vertebral level should be manipulated in patients with low back pain. However, it is unclear whether spinal manipulation needs to be specific to a vertebral level. The purpose of this study was to analyze the immediate effects of a single, region-specific spinal manipulation defined during the clinical examination versus a single non-region-specific spinal manipulation (applied on an upper thoracic vertebra) in patients with chronic nonspecific low back pain for the outcome measures of pain intensity and pressure pain threshold at the time of the assessment. This was a 2-arm, prospectively registered, randomized controlled trial with a blinded assessor. The study was conducted in an outpatient physical therapy clinic in Brazil. The study participants were 148 patients with chronic nonspecific low back pain (with pain duration of at least 12 weeks). The randomization schedule was generated by an independent statistician and was concealed by using consecutively numbered, sealed, opaque envelopes. A single high-velocity manipulation was administered to the upper thoracic region of the participants allocated to the non-region-specific manipulation group and to the painful lumbar levels of the participants allocated to the region-specific manipulation group. Pain intensity was measured by a 0 to 10 numeric pain rating scale. Pressure pain threshold was measured using a pressure algometer. It was not possible to blind the therapist and participants. A total of 148 patients participated in the study (74 in each group). There was no loss to follow-up. Both groups improved in terms of immediate decrease of pain intensity; however, no between-group differences were observed. The between-group difference for pain intensity and pressure pain threshold were 0.50 points (95% confidence interval=-0.10 to 1.10) and -1.78 points (95% confidence interval=-6.40 to 2.82), respectively. No adverse reactions were observed. The immediate changes in pain intensity and pressure pain threshold after a single high-velocity manipulation do not differ by region-specific versus non-region-specific manipulation techniques in patients with chronic low back pain.

Test-Retest Reliability, Repeatability, and Sensitivity of an Automated Deformation-Controlled Indentation on Pressure Pain Threshold Measurement

ObjectiveThe purpose of this study was to construct a computerized deformation-controlled indentation system and compare its test-retest reliability, repeatability, and sensitivity with a manual algometer for pressure pain threshold (PPT) measurements. MethodsPressure pain threshold measurements were made on 16 healthy subjects for 2 sessions on bilateral erector spinae muscles at L1, L3, and L5 spinal levels, consisting of 5 repeated trials each using computerized algometry on one side and manual algometry on the other side. Mean, SD, coefficient of variation, standard error of measurement, minimal detectable change, and intraclass correlation coefficient were calculated for both manual and computerized PPT measurements. Effects of session, level, method, and side on PPT measurements were evaluated using analysis of variance. ResultsManual PPT measurements were significantly larger than computerized PPT measurements (P = .017), and session 2 was significantly larger than session 1 (P = .021). Coefficient of variation, intraclass correlation coefficient, standard error of measurement, and minimal detectable change of the manual and computerized PPT measurements were 10.3%, 0.91, 0.19 kg/cm2, and 0.54 kg/cm2 and 15.6%, 0.87, 0.26 kg/cm2, and 0.73 kg/cm2, respectively. ConclusionsAlthough computerized algometry offers the benefits of eliminating the effects of operator reaction time, operator anticipation, alignment error, and variation in indentation rate on PPT measurements, these results indicate that manual algometry using load-controlled strategy may be better than computerized deformation-controlled algometry in terms of test-retest reliability, repeatability, and sensitivity. Constant load-controlled indentation protocol may be more favorable for PPT measurements. Future computerized instrumentation for PPT measurements should adopt a load-controlled mechanism.

Causes of Hand Tingling in Visual Display Terminal Workers

ObjectiveTo offer the basic data about the causes and distribution of hand tingling, symptoms and physical findings, and pressure pain threshold in desk workers.MethodsFive physiatrists participated in the screening test composed of history and physical examination. A total of 876 desk workers were evaluated and of them 37 subjects with hand tingling were selected. For further analyzing, detailed history taking and meticulous physical examination were taken. Pressure pain threshold (PPT) at the infraspinatus, upper trapezius, flexor carpi radialis, rhomboideus, and flexor pollicis longus were examined. PPT measurements were repeated three times with two minute intervals by a pressure algometer. Electrodiagnostic study was done to detect potential neurologic abnormalities.ResultsThe causes of hand tingling in order of frequency were: myofascial pain syndrome, 68%; cervical radiculopathy, 27%; rotator cuff syndrome, 11%; tenosynovitis, 8%; and carpal tunnel syndrome, 5%. The location of trigger points in the myofascial pain syndrome, which were proven to evoke a tingling sensation to the hand in order of frequency were: infraspinatus, 65.4%; upper trapezius, 57.7%; flexor carpi radialis, 38.5%; rhomboideus 15.4%; and flexor pollicis longus 11.5%. The PPT of the affected side was significantly lower than that of the unaffected side in myofascial pain syndrome (p<0.05).ConclusionThe most common cause of hand tingling in desk workers was myofascial pain syndrome rather than carpal tunnel syndrome. Common trigger points to evoke hand tingling were in the infraspinatus and upper trapezius.

Evaluation of low-level laser therapy effectiveness on the pain and masticatory performance of patients with myofascial pain

This study investigated the effect of low-level laser therapy (LLLT) on the masticatory performance (MP), pressure pain threshold (PPT), and pain intensity in patients with myofascial pain. Twenty-one subjects, with myofascial pain according to Research Diagnostic Criteria/temporomandibular dysfunction, were divided into laser group (n = 12) and placebo group (n = 9) to receive laser therapy (active or placebo) two times per week for 4 weeks. The measured variables were: (1) MP by analysis of the geometric mean diameter (GMD) of the chewed particles using Optocal test material, (2) PPT by a pressure algometer, and (3) pain intensity by the visual analog scale (VAS). Measurements of MP and PPT were obtained at three time points: baseline, at the end of treatment with low-level laser and 30 days after (follow-up). VAS was measured at the same times as above and weekly throughout the laser therapy. The Friedman test was used at a significance level of 5% for data analysis. The study was approved by the Ethics Committee of the Federal University of Sergipe (CAAE: 0025.0.107.000-10). A reduction in the GMD of crushed particles (p < 0.01) and an increase in PPT (p < 0.05) were seen only in the laser group when comparing the baseline and end-of-treatment values. Both groups showed a decrease in pain intensity at the end of treatment. LLLT promoted an improvement in MP and PPT of the masticatory muscles.

Effects of Carrier Frequency of Interferential Current on Pressure Pain Threshold and Sensory Comfort in Humans

ObjectiveTo assess the effect of carrier frequency of interferential current (IFC) on pressure pain threshold (PPT) and sensory comfort in healthy subjects. DesignA double-blind randomized trial. SettingUniversity research laboratory. ParticipantsHealthy subjects (N=150). InterventionsApplication of the IFC for 20 minutes and measures of PPT collected in the regions of the nondominant hand and forearm. Main Outcomes MeasuresWe measured PPT and comfort at frequencies of 1kHz, 2kHz, 4kHz, 8kHz, and 10kHz. ResultsThere was a significant increase in PPT in the 1-kHz group when compared with the 8-kHz and 10-kHz groups. There was a greater discomfort in the 1-kHz and 2-kHz groups. ConclusionsIFC with a carrier frequency of 1kHz promotes a higher hypoalgesic response during and after stimulation than IFC with carrier frequencies of 8kHz and 10kHz. Carrier frequencies of 1kHz and 2kHz are perceived as more uncomfortable than carrier frequencies of 4kHz, 8kHz, and 10kHz.

Why are autonomic responses to pressure pain different from those to heat pain and ischaemic pain?

[ In this issue of the Scandinavian Journal of Pain, Mohn et al. pubish an experimental human pain study in which they measured utonomic responses to acute pain stimuli and the modulation f pressure pain sensitivity in normotensive, healthy, pain-free omen during the follicular phase of their menstrual cycle [1]. hey measured pressure pain threshold and pressure pain tolernce at the right masseter muscle and on the sternum. They used a isual analogue pain scale (VAS) tomeasure pain intensity and pain iscomfort. They registered continuously mean arterial pressure, eart rate and facial and digital skin blood flux. They found that he pain threshold was higher on the sternum than at themasseter uscle. The degree of pain discomfort was higher at the pressure ain tolerance level at the masseter. Pressure pain stimulation of he masseter muscle caused increases in blood pressure and heart ate, but a decrease in finger skin blood flux. However, there was o correlation between cardiovascular responses andpressure pain ensitivity. Thus, pressurepain stimulationwasassociatedwith sigificant changes in cardiovascular responses, but pressure painwas ot modulated by the cardiovascular responses. This well done study is important because it increases our nowledge of autonomic cardiovascular responses to acute presure pain. Cardiovascular responses to thermal pain stimuli [2] and o elctrocutaneous pain stimuli [3] are different from the present bservations on pressure pain. The technique of continuous skin lood flux measurements seem to be especially sensitive to pain timuli: Skin blood flux may increase in the face while it decreases n a finger, as it does during electrocutaneous pain stimuli.

The effect of increasing sets (within one treatment session) and different set durations (between treatment sessions) of lumbar spine posteroanterior mobilisations on pressure pain thresholds

Spinal mobilisations are a common form of treatment intervention applied by physiotherapists in clinical practice to manage musculoskeletal pain and/or dysfunction. Previous research has demonstrated that mobilisations cause a hypoalgesic effect. However, there is very little research investigating the optimal treatment dose inducing this effect. AimTo investigate the effect of the number of sets (up to 5) and different durations (30 vs. 60 s) on pressure pain thresholds (PPTs) at different sites. MethodsThis single-blinded, randomised, same subject repeated measures crossover design included 19 asymptomatic healthy volunteers. The participants received 5 sets of either 30 or 60 s of postero-anterior mobilisations to L4 on different days. PPTs were measured immediately before, between and after the intervention at 4 different standardised sites. ResultsA 4-way ANOVA analysis revealed that there was no statistically significant difference between 30 versus 60 s of mobilisations. However, there was a tendency for PPT values to be higher for the 60 s intervention. All PPT measurements after the interventions were significantly higher than the baseline. Only the measurement after the 4th set of mobilisations was significantly higher than the measurement after the 1st set (p = 0.035). ConclusionsThe results suggest that in order to induce the greatest local hypoalgesia, at least 4 sets of mobilisations are required. The different durations of 30 versus 60 s of mobilisation may not change the extent of the hypoalgesic effect.

A randomized, placebo-controlled double-blinded comparative clinical study of five over-the-counter non-pharmacological topical analgesics for myofascial pain: single session findings

ObjectivesTo investigate the effects of topical agents for the treatment of Myofascial Pain Syndrome (MPS) and Myofascial Trigger Point (MTRP).MethodsSubjects with an identifiable trigger point in the trapezius muscle, age 18-80 were recruited for a single-session randomized, placebo-blinded clinical study. Baseline measurements of trapezius muscle pressure pain threshold (PPT: by pressure algometer) along with right and left cervical lateral flexion (rangiometer) were obtained by a blinded examiner. An assessor blinded to the outcomes assessments applied one of 6 topical formulations which had been placed in identical plastic containers. Five of these topicals were proposed active formulations; the control group was given a non-active formulation (PLA). Five minutes after the application of the formula the outcome measures were re-tested. Data were analyzed with a 5-way ANOVA and Holms-adjusted t-tests with an alpha level of 0.05.Results120 subjects were entered into the study (63 females; ages 16-82); 20 subjects randomly allocated into each group. The pre- and post-treatment results for pressure threshold did show significant intra-group increases for the Ben-Gay Ultra Strength Muscle Pain Ointment (BG), the Professional Therapy MuscleCare Roll-on (PTMC roll-on) and Motion Medicine Cream (MM) with an increased threshold of 0.5 kg/cm2 (+/-0.15), 0.72 kg/cm2 (+/-0.17) and 0.47 Kg/cm2 (+/-0.19) respectively. With respect to the inter-group comparisons, PTMC roll-on showed significant increases in pressure threshold compared with Placebo (PLA) (p = 0.002) and Icy Hot Extra Strength Cream (IH) (p = 0.006). In addition, BG demonstrated significant increases in pressure threshold compared with PLA (p = 0.0003).ConclusionsWith regards to pressure threshold, PTMC roll-on, BG and MM showed significant increases in pain threshold tolerance after a short-term application on a trigger points located in the trapezius muscle. PTMC roll-on and BG were both shown to be superior vs placebo while PTMC was also shown to be superior to IH in patients with trigger points located in the trapezius muscle on a single application.CMCC Research Ethics Board Approval # 1012X01, 2011

Effect of Thumb Joint Mobilization on Pressure Pain Threshold in Elderly Patients with Thumb Carpometacarpal Osteoarthritis

ObjectiveThis study evaluated the effects of Maitland's passive accessory mobilization on local hypoalgesia and strength in thumb carpometacarpal osteoarthritis (TCOA). MethodsTwenty-eight patients between 70 and 90 years old with secondary TCOA were randomized into glide mobilization and sham groups. This study was designed as a double-blind, randomized controlled trial. Therapy consisted of Maitland's passive accessory mobilization of the dominant hand during 4 sessions over 2 weeks. We measured pressure pain threshold (PPT) at the trapeziometacarpal joint (TMJ), the tubercle of the scaphoid bone, and the unciform apophysis of the hamate bone by algometry. The tip and tripod pinch strength was also measured. Grip strength was measured by a grip dynamometer. Measurements were taken before treatment and after 1 week (first follow-up [FU]) and 2 weeks (second FU). ResultsAll values in sham group remained unchanged along the treatment period. In the treated group, the PPT in the TMJ was 3.85 ± 0.35 kg/cm2, which increased after treatment to 3.99 ± 0.37 and was maintained at the same level during the first FU 3.94 ± 0.39 and second FU 4.74 ± 0.40. In contrast, we found no differences in PPT in the other studied structures after treatment. Similarly, tip, tripod pinch, and grip strength remained without change after treatment. ConclusionsPassive accessory mobilization increased PPT in the TMJ; however, it did not increase motor function in patients with TCOA.