Pressure Pain Threshold Measurements Research Articles

Manual trigger point therapy of shoulder pain : Randomized controlled study of effectiveness

Although chronic shoulder pain is highly prevalent and myofascial trigger points (mTrP) are thought to be found in the majority of patients with shoulder complaints, the influence on the pain mechanism remains unclear. There are only very few controlled clinical studies on the effects of manual trigger point compression therapy. This randomized controlled trial (RCT) compared the short-term effects of manual trigger point compression therapy (n= 6) with manual sham therapy (n= 6) in patients with unilateral shoulder pain due to myofascial syndrome (MFS). The measurement data were collected before and after two sessions of therapy. Pressure pain thresholds (PPT) of mTrP and symmetrically located points on the asymptomatic side were measured together with neutral points in order to detect a potential unilateral or generalized hyperalgesia. Additionally, the pain was assessed on a visual analog scale (VAS) at rest and during movement and the neck disability index (NDI) and disabilities of the arm, shoulder and hand (DASH) questionnaires were also completed and evaluated. Both treatment modalities led to a significant improvement; however, the manual trigger point compression therapy was significantly more effective in comparison to sham therapy, as measured by different parameters. The significant improvement of PPT values in the interventional group even at sites that were not directly treated, indicates central mechanisms in pain threshold modulation induced by manual compression therapy. The weaker but still measurable effects of sham therapy might be explained by the sham modality being a hands on technique or by sufficient stimulation of the trigger point region during the diagnostics and PPT measurements.

Provoked Vestibulodynia: Does Pain Intensity Correlate With Sexual Dysfunction and Dissatisfaction?

Provoked vestibulodynia (PVD) is suspected to be the most frequent cause of vulvodynia in premenopausal women. Previous research has been inconclusive as to whether higher vulvovaginal pain ratings are associated with lower sexual function and satisfaction in women with PVD. Whether pain intensity correlates with sexual impairment is an important question given its implications for treatment recommendations. To examine the associations among self-reported and objective pain measurements, sexual function, and sexual satisfaction in a large combined clinical and community sample of premenopausal women diagnosed with PVD. Ninety-eight women with PVD underwent a cotton-swab test, a vestibular friction pain measurement, and a vestibular pressure-pain threshold measurement. In addition to sociodemographics, participants completed measurements of pain, sexual function, and sexual satisfaction. Self-report measurements were the pain numerical rating scale (0-10), the McGill-Melzack Pain Questionnaire, the Female Sexual Function Index, and the Global Measure of Sexual Satisfaction. Objective measurements were pain during a cotton-swab test, pain during a vestibular friction procedure, and the vestibular pressure-pain threshold measurement. Age and relationship duration were significantly correlated with the Female Sexual Function Index total score (r=-0.31, P < .01; and r=-0.22, P < .05, respectively). When controlling for age, intercourse-related pain intensity, pain during the cotton-swab test, pain during vestibular friction, the vestibular pressure-pain threshold, and the McGill-Melzack Pain Questionnaire sensory and affective subscale scores were not significantly associated with sexual function and satisfaction in women with PVD. The findings show that in women with PVD, self-report and objective pain ratings are not associated with sexual function and satisfaction. The results support the biopsychosocial nature of PVD and underscore the importance of a patient-focused multidisciplinary treatment approach for PVD.

Pain Pressure Thresholds Predict TKA Outcome at 6 Weeks and 6 Months

Introduction:8 – 19% of patients report dissatisfaction post Total Knee Arthroplasty (TKA). The reasons for this are complex and multiple factors have been reported to influence these dissatisfaction rates. A recent meta-analysis has confirmed evidence for central sensitisation to pain in patients with knee osteoarthritis (OA). It also called for future research to identify people with knee OA in whom sensitisation is a dominant feature and for longitudinal research to predict sensitisation post TKA. The clinical response to TKA in the presence of sensitisation has not been studied in detail. The purpose of this study was to evaluate the whether pressure pain thresholds would predict the early outcome of TKA and whether these pain thresholds were related to preoperative pain catastrophizing scales. Our hypothesis was that early post op satisfaction outcomes post TKA would relate to pressure pain thresholds (PPT).Methods:78 knees from 76 subjects were included in the study. Pre-operatively pressure pain threshold measurements were taken at the operative site, contralateral knee and at the deltoid. Multiple psychological and social predictors, including the pain catastrophising scale and the American Society Knee Score (2011), were measured preoperatively. The American Knee Society Score (2011) which includes a validated satisfaction component was used to measure TKA outcomes at 6 weeks, 6 months and 12 months post-operatively.Results:19% of the patients had a poor PPT(<175 kPa); 62% (175-430 kPa) moderate and 19% good (>430 kPa) preoperatively. These pre-operative PPT levels corresponded with satisfaction scores at 6 weeks and 6 months. The mean satisfaction score at 6 months in the poor group was 30.7 and 36.4 in the good group (p<0.0005), a significant difference was also demonstrated at 6 weeks. A significant difference in satisfaction scores was also seen between the moderate (32.9) and good groups at 6 weeks (p<0.02) and 6 months (p<0.003). There was no significant difference in satisfaction scores between the poor and moderate groups at 6 weeks or at 6 months. Patients in the poor PPT group had a mean pain catastrophising scale score of 21, this was significantly different to the good PPT group mean score 11.7 (p= 0.02). No patient in the poor PPT group recorded high satisfaction (36 or higher) at 6 weeks, but 5/15 (33%) recorded satisfaction of 36 or higher at 6 months. In the good PPT 11/15 (73.3%) had a satisfaction score of 36 or higher at 6 months.Conclusions:We have demonstrated that PPT’s correlate to significant differences in satisfaction at both 6 weeks and 6 months post TKA thus confirming our hypothesis. Those patients with poor PPT also scored more poorly on the pain catastrophising scale preoperatively. This patient group failed to attain the high levels of satisfaction seen in the good PPT group at 6 months. Care should be exercised in selecting patients with poor PPT’s and high pain catastrophising scale scores for TKA. This patient group may benefit from altered preoperative workup and postop pain treatment.

Effects of scapular taping in young adults with shoulder pain and scapular dyskinesis

To assess the immediate effects of scapular taping on pain, isometric force, and the level of activation of several scapular girdle muscles in individuals with shoulder pain and scapular dyskinesis. Ten individuals with shoulder pain during arm elevation and scapular dyskinesis were included and evaluated by using a visual analogue scale (VAS), pressure algometry, dynamometry, and surface electromyography. All assessments were performed before and immediately after the application of scapular taping. Scapular taping did not change the electromyographic activity of the upper trapezius muscle (p=0.041, IC95%: -0.8256 to 10.8752). The positive effects of taping application were related to pain reduction (p=0.025) and improvement in pressure algometry in the middle deltoid muscle (p=0.020, IC95%:-1.8910 to -0.0490). Maximal isometric force did not change after the application of taping (flexo-abduction p=0.4136, external rotation p=0.4261). Significant correlations were noted between the VAS and pressure pain threshold (PPT) for the upper trapezius muscle (r=-0.6643, p=0.0361) as well as for the PPT measures of the middle deltoid and infraspinatus muscles before (r=0.9491, p=0.0001) and after (r=0.9006, p=0.0004) the application of taping. Scapular taping was not effective for inducing changes in the electromyographic activity of the upper trapezius, lower trapezius, and serratus anterior muscles, nor in altering the isometric force of shoulder flexo-abduction and external rotation. However, taping was effective at improving the pressure algometry values of the middle deltoid. Significant correlations between the pressure algometry of the middle deltoid and infraspinatus muscles, both before and after the application of scapular taping, were noted.

Comparison of Hypoalgesic Effects of Neural Stretching vs Neural Gliding: A Randomized Controlled Trial

ObjectiveThe purpose of this study was to evaluate the immediate mechanical hypoalgesic effect of neural mobilization in asymptomatic subjects. We also compared neural gliding vs neural stretching to see which produced greater hypoalgesic effects in asymptomatic subjects. MethodsForty-five asymptomatic subjects (20 men and 25 women; mean ± SD age, 20.8 ± 2.83 years) were randomly allocated into 3 groups: the neural glide group, the neural stretch group, and the placebo group. Each subject received 1 treatment session. Outcome measures included bilateral pressure pain threshold measured at the trigeminal, cervical, and tibialis anterior points, assessed pre-treatment and immediately post-treatment by a blinded assessor. Three-way repeated-measures analysis of variance was used to evaluate changes in pressure pain threshold, with group (experimental or control) as the between-subjects variable and time (pre-, post-treatment) or side (dominant, nondominant) as the within-subjects variable. ResultsGroup differences were identified between neural mobilization groups and the placebo group. Changes occurred in all of the pressure pain threshold measures for neural gliding, and in all but the trigeminal point for neural stretch. No changes in the pressure pain threshold measures occurred in the placebo group. ConclusionsThis research provides new experimental evidence that neural mobilization produces an immediate widespread hypoalgesic effect vs placebo but neural gliding produces hypoalgesic effects in more body sites than neural stretching.

Strength and Pain Threshold Handheld Dynamometry Test Reliability in Patellofemoral Pain.

Patellofemoral pain syndrome (PFPS), characterized by peri- and retropatellar pain, is a common disorder in young, active people. The etiology is unclear; however, quadriceps strength seems to be a contributing factor, and sensitization might play a role. The study purpose is determining the inter-rater reliability of handheld dynamometry to test both quadriceps strength and pressure pain threshold (PPT), a measure for sensitization, in patients with PFPS. This cross-sectional case-control study comprises 3 quadriceps strength and one PPT measurements performed by 2 independent investigators in 22 PFPS patients and 16 matched controls. Inter-rater reliability was analyzed using intraclass correlation coefficients (ICC) and Bland-Altman plots. Inter-rater reliability of quadriceps strength testing was fair to good in PFPS patients (ICC=0.72) and controls (ICC=0.63). Bland-Altman plots showed an increased difference between assessors when average quadriceps strength values exceeded 250 N. Inter-rater reliability of PPT was excellent in patients (ICC=0.79) and fair to good in controls (ICC=0.52). Handheld dynamometry seems to be a reliable method to test both quadriceps strength and PPT in PFPS patients. Inter-rater reliability was higher in PFPS patients compared to control subjects. With regard to quadriceps testing, a higher variance between assessors occurs when quadriceps strength increases.

Specific exercise training for reducing neck and shoulder pain among military helicopter pilots and crew members: a randomized controlled trial protocol.

BackgroundFlight-related neck/shoulder pain is frequent among military helicopter pilots and crew members. With a lifetime prevalence of 81 % for pilots and 84 % for crew members, the prevalence of neck pain is considered high compared to the general population. The aim of this study was to investigate whether a specifically tailored exercise intervention would reduce the prevalence and incidence rate of neck/shoulder pain among helicopter pilots and crew members.MethodThis study used a prospective, parallel group, single blinded, randomized controlled design. Participants were military helicopter pilots and crew members recruited from the Royal Danish Air Force. Inclusion criteria were: 1) employed within the Royal Danish Air Force as a helicopter pilot or onboard crew member (technician, systems-operator, tactical helicopter observer and/or navigator), 2) maintaining operational flight status at enrollment, and 3) operational flying within the previous 6 months. Primary outcome was change in neck and shoulder pain assessed by 1) a modified version of the “Standardized Nordic questionnaire for the analysis of musculoskeletal symptoms” and by 2) pressure pain threshold measurements. Secondary outcomes included: postural balance, strength, stability, and rate of force development for neck and shoulder muscles. Measurements at baseline and follow-up were conducted at four air force bases in Denmark. Sixty-nine participants were individually randomized to either a training group (TG) or a reference group (RG). Participants in the TG performed 20-weeks of physical exercise training divided into sessions of 3 × 20 min per week. Training was completed within working hours and consisted of specific exercise training for the neck and shoulder muscles based on the principles of “Intelligent Physical Exercise Training”. The RG received no training.DiscussionIn spite of the high prevalence of flight related neck/shoulder pain among military helicopter pilots and crew members there are currently no evidence based guidelines for the prevention or clinical handling of neck pain among these occupational groups. Results from this study may therefore be beneficial for future establishment of such guidelines.Trial registrationEthical committee of Southern Denmark (S-20120121) 29 August, 2012.Clinical Trail Registration (NCT01926262) 16 August, 2013.

Reliability of pressure pain threshold testing in healthy pain free young adults

Background and aimsInvestigation of the multidimensional correlates of pressure pain threshold (PPT) requires the study of large cohorts, and thus the use of multiple raters, for sufficient statistical power. Although PPT testing has previously been shown to be reliable, the reliability of multiple raters and investigation for systematic bias between raters has not been reported.The aim of this study was to evaluate the intrarater and interrater reliability of PPT measurement by handheld algometer at the wrist, leg, cervical spine and lumbar spine. Additionally the study aimed to calculate sample sizes required for parallel and cross-over studies for various effect sizes accounting for measurement error. MethodsFive research assistants (RAs) each tested 20 pain free subjects at the wrist, leg, cervical and lumbar spine. Intraclass correlation coefficient (ICC), standard error of measurement (SEM) and systematic bias were calculated. ResultsBoth intrarater reliability (ICC=0.81–0.99) and interrater reliability (ICC=0.92–0.95) were excellent and intrarater SEM ranged from 79 to 100kPa. There was systematic bias detected at three sites with no single rater tending to consistently rate higher or lower than others across all sites. ConclusionThe excellent ICCs observed in this study support the utility of using multiple RAs in large cohort studies using standardised protocols, with the caveat that an absence of any confounding of study estimates by rater is checked, due to systematic rater bias identified in this study. ImplicationsThorough training of raters using PPT results in excellent interrater reliability. Clinical trials using PPT as an outcome measure should utilise a priori sample size calculations.

Local and Systemic Changes in Pain Sensitivity After 4Weeks of Calf Muscle Stretching in a Nonpainful Population: A Randomized Trial.

Stretching is often used in clinical practice for a variety of purposes, including pain therapy. The possible mechanism behind the effect of stretching remains to be clarified. To investigate whether 4weeks of unilateral stretching of the calf muscles would affect local and central pain sensitivity. This study was a randomized assessor-blinded clinical study. Healthy participants (age 18 to 40) were included and randomized. Participants in the intervention group were instructed to perform 2 stretching exercises targeting the calf muscles; 3 times 30seconds, 7days a week for 4weeks on the dominant leg. Participants in the control group were instructed not to do any stretching for 4weeks. Pressure pain threshold (PPT) and temporal summation (TS) of pressure pain were measured on the stretched calf, the contra-lateral calf, and contra-lateral lower arm using a computerized cuff algometer. Analyses of variance on the per-protocol population (defined as participants that adhered to the protocol) were used to assess group differences in the changes from baseline. Forty healthy volunteers were included, of which 34 participants adhered to the protocol (15 intervention group/19 control group). No statistically significant group differences in the changes from baseline were found regarding PPT and TS measurements for the stretched calf, the contra-lateral calf, and the arm. Four weeks of regular stretching of the calf muscles does not affect pressure pain sensitivity, suggesting that pressure pain sensitivity is unaffected by stretching in a healthy population. The mechanisms underlying any benefits of regular stretching remain to be explained.

Development of the quantitative indicator of abdominal examination for clinical application: a pilot study.

Abdominal examination (AE) is the evaluation of the status of illness by examining the abdominal region in traditional Korean medicine (TKM). Although AE is currently considered an important diagnostic method in TKM, owing to its clinical usage, no studies have been conducted to objectively assess its accuracy and develop standards. Twelve healthy subjects and 21 patients with functional dyspepsia have participated in this study. The patients were classified into epigastric discomfort group (n=11) and epigastric discomfort with tenderness group (n=10) according to the clinical diagnosis by AE. After evaluating the subjective epigastric discomfort in all subjects, two independent clinicians measured the pressure pain threshold (PPT) two times at an acupoint (CV 14) using an algometer. We then assessed the interrater and intrarater reliability of the PPT measurements and evaluated the validity (sensitivity and specificity) via a receiver operating characteristic plot and optimal cutoff value. The results of the interrater reliability test showed a very strong correlation (correlation coefficient range: 0.82-0.91). The results of intrarater reliability test also showed a higher than average correlation (intraclass correlation coefficient: 0.58-0.70). The optimal cutoff value of PPT in the epigastric area was 1.8 kg/cm(2) with 100% sensitivity and 54.54% specificity. PPT measurements in the epigastric area with an algometer demonstrated high reliability and validity for AE, which makes this approach potentially useful in clinical applications as a new quantitative measurement in TKM.

Reliability of 2 Protocols for Assessing Pressure Pain Threshold in Healthy Young Adults

ObjectiveThe purposes of this study were to determine whether there were differences in mean values or reliability for 2 frequently used protocols for pressure pain threshold (PPT) and to calculate how large a difference in PPT is necessary to be 95% confident that a real change has occurred. MethodsThirteen participants (8 females) aged 22.3 (±2.3) years from a university community were included. Two testers evaluated participants using 2 protocols, in which PPT was measured 3 times at 8 different body locations. The “cluster protocol” consisted of 3 successive measurements at each location with a 30-second rest between each measurement. The “circuit protocol” consisted of 1 measurement taken at each anatomical location until “the circuit” was complete and then repeated a total of 3 times. ResultsA 2-way analysis of variance did not reveal significant differences between protocols at any body location (P = .46-.98). Intertester reliability was good to excellent for all locations (intraclass correlation coefficient, 0.84-0.96), and limits of agreement ranged from 108 to 223 kPa. ConclusionsEither the cluster or circuit protocol can be used to measure PPT in clinical or research setting. A difference of 160 kPa is considered sufficient to indicate a real difference between repeated measures of PPT regardless of protocol used for testing.

MTPs are a peripheral source of nociception.

Quintner and Cohen have challenged the existence of myofascial trigger points ⇓. However, there is strong evidence that myofascial trigger points (MTPs) are a peripheral source of nociception, and act as ongoing nociceptive stimuli contributing to pain propagation and widespread pain ⇓. Pressure pain thresholds (PPTs) measurement applied to different locations over the muscles shows that the sites with the lowest PPT corresponding to the locations of MTPs, indicating that muscle nociceptors are sensitized. The sensitized nociceptors lead to an increased neuronal firing. In addition to the nociceptor sensitization, non-nociceptors (mainly the large diameter muscle afferents) may also via central neuronal reorganisation and sensitization contribute to pain perception generated from MTPs. Thus, local pain and tenderness at MTPs are largely due to nociceptor sensitization most likely with a lesser contribution from non-nociceptor activation ⇓. The study by Freeman et al. ⇓, found that anesthetizing of painful trigger points, provokes a remarkably rapid change in central sensitization symptoms (measuring PPTs in a site far away from the areas that had been infiltrated) due to the reduced nociceptive drive needed for maintaining central sensitization. Why such focal pain generators persist and remain active after a reasonable healing period for soft tissue remains unclear. The …

Reliability and responsiveness of algometry for measuring pressure pain threshold in patients with knee osteoarthritis.

[Purpose] This study aimed to establish the intrarater reliability and responsiveness of a clinically available algometer in patients with knee osteoarthritis as well as to determine the minimum-detectable-change and standard error of measurement of testing to facilitate clinical interpretation of temporal changes. [Subjects] Seventy-three patients with knee osteoarthritis were included. [Methods] Pressure pain threshold measured by algometry was evaluated 3 times at 2-min intervals over 2 clinically relevant sites—mediolateral to the medial femoral tubercle (distal) and lateral to the medial malleolus (local)—on the same day. Intrarater reliability was estimated by intraclass correlation coefficients. The minimum-detectable-change and standard error of measurement were calculated. As a measure of responsiveness, the effect size was calculated for the results at baseline and after treatment. [Results] The intrarater reliability was almost perfect (intraclass correlation coefficient = 0.93–0.97). The standard error of measurement and minimum-detectable-change were 0.70–0.66 and 1.62–1.53, respectively. The pressure pain threshold over the distal site was inadequately responsive in knee osteoarthritis, but the local site was responsive. The effect size was 0.70. [Conclusion] Algometry is reliable and responsive to assess measures of pressure pain threshold for evaluating pain patients with knee osteoarthritis.

Effects of single acupuncture point stimulation on mechanical experimental pain

Introduction: In western countries, acupuncture as therapy for pain, is commonly used in treatment of the chronic pain. However, several studies have pointed out its success in treatment of acute pain. It is shown that acupuncture works through simultaneous activation of several pain control mechanisms in CNS. Acupuncture point LI4 (otherwise known as Hegu), is one of the most studied points in acupuncture treatment of pain. Its stimulation is indicated in almost all painful conditions, and its effectiveness is well proven. Algometry, used for pain assessment, has been widely recognized as reliable and objective method for measuring pressure pain threshold and tolerance. Aim: The aim of this study was to explore whether a single acupuncture treatment shows significant short-term analgesic effect on mechanical stimuli, and to determine the distribution of these effects across the body (whether localized, regional or generalized). Material and Methods: Study group included 14 healthy, pain-free students who have passed clinical examination for any possible painful conditions. Pressure pain detection threshold (PPDT) and pressure pain tolerance threshold (PPTT) were measured on 3 points across the body using algometry, before and after interventions. For intervention, all subjects have received deep needling of LI4 acupuncture point, without needle manipulation, administered for duration of 20 minutes. Results: Statistically significant rise in PPDT and PPTT has been observed in each of 3 measured points, following the needling of LI4 acupuncture point, without needle manipulation. There were no significant differences in mean change of PPDT and PPTT upon comparing changes between points. Conclusion: Even a single manual acupuncture point stimulation, can have significant short-term generalized analgesic effect, which is determined using mechanical stimuli to cause experimental pain.

Pressure pain threshold and visual analogue scale changes in the high and low energy extracorporeal shock wave

Objective: This study aims to investigate high energy and low energy extracorporeal shockwave therapy (ESWT) and which one is more effective for shoulder pain. Design: Single blind randomized controlled trial. Methods: Fifty two subjects with upper trapezius (UT) trigger point (TrP) participated in this study. They were allocated to high energy (n=26) and low energy group (n=26). This study applies ESWT and investigates the changes of pressure pain threshold (PPT) and visual analogue scale (VAS). The high and low energy groups received focused piezo electric type ESWT 4 Hz, 1,000 pulses and 0.351 and 0.092 mJ/mm2 respectively. Outcome measures of PPT and pain was measured by algometer and pain VAS. These measurements were performed before and after treatment. Results: The PPT value was significantly increased in both groups after treatment (p<0.05) and VAS scores were significantly decreased after treatment in both groups (p<0.05). However, there were no significant differences between groups. Conclusions: ESWT is an effective treatment for the application of the UT TrP. Although there were significant effects of extracorporeal shock wave therapy on PPT and VAS scores, there were no signficant differences between high and low energy extracorporeal shock wave therapy.

Preoperative widespread pain sensitization and chronic pain after hip and knee replacement: a cohort analysis.

Chronic pain after joint replacement is common, affecting approximately 10% of patients after total hip replacement (THR) and 20% of patients after total knee replacement (TKR). Heightened generalized sensitivity to nociceptive input could be a risk factor for the development of this pain. The primary aim of this study was to investigate whether preoperative widespread pain sensitivity was associated with chronic pain after joint replacement. Data were analyzed from 254 patients receiving THR and 239 patients receiving TKR. Pain was assessed preoperatively and at 12 months after surgery using the Western Ontario and McMaster Universities Osteoarthritis Pain Scale. Preoperative widespread pain sensitivity was assessed through measurement of pressure pain thresholds (PPTs) at the forearm using an algometer. Statistical analysis was conducted using linear regression and linear mixed models, and adjustments were made for confounding variables. In both the THR and TKR cohort, lower PPTs (heightened widespread pain sensitivity) were significantly associated with higher preoperative pain severity. Lower PPTs were also significantly associated with higher pain severity at 12 months after surgery in the THR cohort. However, PPTs were not associated with the change in pain severity from preoperative to 12 months postoperative in either the TKR or THR cohort. These findings suggest that although preoperative widespread pressure pain sensitivity is associated with pain severity before and after joint replacement, it is not a predictor of the amount of pain relief that patients gain from joint replacement surgery, independent of preoperative pain severity.

Associations Between Pressure–Pain Threshold, Symptoms, and Radiographic Knee and Hip Osteoarthritis

To determine the association between generalized evoked pressure pain sensitivity with distal pressure-pain threshold (PPT) and the presence, severity, or number of involved knee/hip joints with radiographic osteoarthritis (rOA) or related symptoms. Data for these cross-sectional analyses come from the second followup (2008-11) of the Johnston County Osteoarthritis Project (n = 1,602). PPT measurements were averaged over 2 trials from both the left and right trapezius. Outcomes of radiographic knee and hip OA were both defined by a Kellgren/Lawrence score of 2-4 and site-specific symptoms were ascertained at clinical interview. Associations were determined with multiple logistic regression models and two-way interactions were tested at P < 0.05. The sample was 67.2% women and 31.0% African American. Participants' mean ± SD age was 67.9 ± 9.0 years, mean ± SD body mass index was 31.5 ± 7.1 kg/m(2) , mean ± SD Center for Epidemiologic Studies Depression Scale score was 6.5 ± 7.4, and mean ± SD total PPT was 3.6 ± 0.7 kg. Significant associations were found between PPT and self-reported knee/hip symptoms. No significant associations were found between PPT and presence, severity, or number of joints with knee and hip rOA without accompanying symptoms. No significant interactions were found with demographic or clinical characteristics. PPT was significantly associated with self-reported single and multijoint symptoms. In contrast, after adjustment, PPT measured at the trapezius was not associated with asymptomatic knee or hip rOA. As such, PPT may prove to be a useful indicator of rOA pain processing and of why individuals respond favorably and others do not to treatments targeting rOA.

중년여성에서 근막이완요법이 신경전도와 통증에 미치는 영향

본 연구는 근막이완요법의 효과를 보기 위하여 중년여성에서 근막요법 전후의 피로와 신경전도에 미치는 영향을 관찰하였다. 28명의 중년여성을 대상으로 오후 6시 이후에 2일 간격으로 총 3회(1, 3, 5 일) 근막이완요법을 실시하였으며, 근막이완요법 전 후의 통증 정도 변화를 설문 조사하였으며, 통각계를 이용하여 승모근에서 압력통각역치와 시각적 통증강도를 측정하였다. 정중신경에서 운동신경전도와 감각신경전도 검사를 실시하여 잠복기, 진폭, 신경전도속도를 측정하였다. 설문조사결과 피로를 많이 느끼는 시간은 18~21시였으며, 피로와 통증을 가장 많이 느끼는 부위는 어깨부위로 조사되었다. 근막이완요법 후에 통증의 정도, 압력통각역치, 시각적 통증강도는 근막이완요법전보다 유의적으로 감소하였다. 근막이완요법전보다 근막이완요법이후 운동신경의 잠복기는 유의적으로 감소되었고 진폭은 유의적으로 증가하였으며 감각신경의 잠복기는 유의적으로 감소되었다. 이와 같은 결과 근막이완요법은 중년여성에서 통증 개선을 위한 대체요법으로 사용될 수 있을 것으로 사료된다. The purpose of this study was to examine the effect of myofascical release (MR) on the degree of pain and nerve conduction velocity (NCV) in middle-aged women. Participants were 28 middle-aged women and MR carried out three times (1, 3, 5 day) at intervals of two times. We did survey about changes of pain before the MR and how they changed after the MR. Also measured pressure pain threshold (PPT) and visual analogue scale (VAS) by using the algometer at trapezius muscle. In median nerve, we did motor nerve conduction velocity (MNCV) test and sensory nerve conduction velocity (SNCV) test for measuring incubation period, amplitude and nerve conduction. The most painful time was 18~21 and the most painful part was shoulder. The pain scale, PPT and VAS after the MR had significantly decreased than before the MR. The latency was significantly decreased and the amplitude was significantly increased in the MNCV and the latency was significantly decreased in the SNCV after the MR. Also it was effective in ameliorating pain scale and latency of NCV. Consequently, the MR can be effective in prevent pain scale caused by fatigue in middle-aged women as replacement therapy.

Measuring mechanical pain: The refinement and standardization of pressure pain threshold measurements

Pain thresholds are widely used in behavioral research, but unlike other pain modalities, a standardized assessment of pressure pain remains a challenge. In this research, we describe the application of an automatic pressure algometer with a linear increase in force. Ergonomically designed fixation devices were developed to increase the accuracy and to shorten the time of each measurement. Ten healthy volunteers were included in a pilot study to test the algometry method. Pressure pain thresholds (PPTs) were investigated over 2 experimental days in three nonconsecutive runs at 29 measurement sites. During the experiment, subjects reported their subjective sleepiness, level of state-anxiety, psychological status and the perceived pain intensity of each measurement. Pain intensity ratings indicate that instructions were followed. State-anxiety and subjective sleepiness levels were low throughout the experiment. The method has proven to be suitable for standardized PPT measurements across the body in an ergonomic, safe, and user-friendly fashion.

Effect of sport massage on pressure pain threshold and tolerance in athletes under eccentric exercise

Extensive line of evidence suggest that pain threshold and tolerance alters following exercise, although the mechanisms have not been elucidated yet. In this study, we investigated the role of sport massage on pressure pain threshold and tolerance in athletes under eccentric exercise. Ten male athletes aged 23 ± 1 years with 9.67 ± 3.04 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 eccentric exercise, sport massage protocol for 10 minutes was manually administered to the dominant arm immediately after exercise, and all measurements were repeated at the same timeline as eccentric exercise. Results are presented as mean + standart deviation. Data of the same timeline were analyzed by using t test. A level of p<0.05 was accepted statistical significant. Eccentric exercise resulted to increase the pain tolerance from muscle and myofascia regions of m. biceps and triceps brachii, and sport massage was found to decrease the pain tolerance at 10 minutes from muscle regions of m. biceps and triceps brachii, 10, 20 and 30 minutes from myofascial region of biceps brachii, and 20 minutes, 24 and 48 hours from myofascial region of m. triceps brachii following acute bout of eccentric exercise in athletes. We concluded that sport massage reduces the hypoalgesic response during acute and delayed period of recovery after eccentric exercise.