Topographical Pressure Pain Sensitivity Maps Research Articles

Topographical Pressure Pain Sensitivity Maps of the Feet Reveal Bilateral Pain Sensitivity in Patients With Unilateral Plantar Heel Pain.

Plantar heel pain is one of the most common foot pain conditions treated by health care providers. To investigate differences in topographical pressure pain sensitivity maps of the feet between patients with unilateral plantar heel pain and healthy individuals, and to determine the relationship between topographical pressure maps, pain intensity, disability, and fascia thickness. Thirty-five patients with unilateral plantar heel pain and 35 matched healthy controls participated in this cross-sectional, case-control study. Pressure pain thresholds (PPTs) were assessed over 7 plantar locations on each foot. Topographical pressure pain sensitivity maps of the plantar region were generated using the averaged PPT of each assessed point. Pain and related disability were assessed with a numeric pain-rating scale (0-10) and the Foot and Ankle Ability Measure, respectively. Plantar fascia thickness was measured via ultrasound. All outcomes were obtained by an assessor blinded to the participants' condition. Topographical pressure sensitivity maps revealed lower bilateral PPTs in patients with plantar heel pain compared to healthy controls, and a higher PPT on the calcaneus bone (P<.01). Women had lower PPTs than men in all areas (P<.001). Individuals with plantar heel pain also had thicker fascia, but only on the affected side, compared to healthy controls. Higher pressure pain sensitivity in the foot was associated with higher pain intensity at first step in the morning and thicker fascia at the calcaneus bone. People with unilateral plantar heel pain had generalized bilateral pressure pain sensitivity in the plantar region of the foot. Greater pain intensity and fascia thickness were associated with higher pressure pain sensitivity in people with plantar heel pain. Case-control study, level 4. J Orthop Sports Phys Ther 2019;49(9):640-646. Epub 26 Mar 2019. doi:10.2519/jospt.2019.8813.

Spotlight on topographical pressure pain sensitivity maps: a review.

Mechanical hyperalgesia defined as decreased pressure pain thresholds (PPTs) is commonly associated with pain. In this narrative review, we report the current state of the art within topographical pressure sensitivity maps. Such maps are based on multiple PPT assessments. The PPTs are assessed by an a priori defined grid with special focus on both spatial and temporal summation issues. The grid covers the muscle or the body region of interest using absolute or relative values determined from anatomical landmarks or anthropometric values. The collected PPTs are interpolated by Shepard or Franke and Nielson interpolation methods to create topographical pressure sensitivity maps. This new imaging technique has proven to be valuable in various disciplines including exercise physiology, neurology, physical therapy, occupational medicine, oncology, orthopedics, and sport sciences. The reviewed papers have targeted different body regions like the scalp, low back, neck–shoulder, and upper and lower extremities. The maps have delineated spatial heterogeneity in the pressure pain sensitivity underlining the different extents of pressure pain hyperalgesia in both experimentally induced and disease-associated pain conditions. Furthermore, various intervention studies have proven the utility of topographical pressure pain sensitivity maps. Topographical pressure pain sensitivity maps have contributed to revealing the efficacy of therapeutic, ergonomic, or training interventions that aim at reducing pain.

Topographical Pressure Pain Sensitivity Maps of the Temporalis Muscle in People with Frequent Episodic and Chronic Tension‐Type Headache

Previous pilot studies suggest the presence of heterogeneous sensitivity to pressure in primary headaches without considering the frequency of headache episodes. To investigate the differences in topographical pressure pain sensitivity maps in the temporalis muscle between individuals with frequent episodic (FETTH) and chronic (CTTH) tension-type headache by controlling the presence of anxiety and depression. oPressure pain thresholds (PPTs) were assessed bilaterally from 9 points distributed over the temporalis muscle (3 points in the anterior portion, 3 in the middle portion, and the remaining 3 in the posterior portion of the muscle belly) in 113 patients with FETTH and 91 with CTTH in a blinded design. Topographical pressure pain sensitivity maps based on interpolation of the PPTs were constructed. Clinical features of headache were collected in a 4-week headache diary. Anxiety and depression (Hospital Anxiety and Depression Scale) were also assessed. The multilevel analysis of covariance found significant difference in PPT levels between points (F = 47.649; P < 0.001), but not between groups (F = 0.801; P = 0.602) or sides (F = 0.331; P = 0.565). No significant effect of gender (F = 0.785; P = 0.667), depression (F = 0.515; P = 0.846), or anxiety (F = 0.639; P = 0.745) was observed. Post hoc comparisons revealed: (1) no differences between FETTH and CTTH; (2) no side-to-side differences; and (3) anterior-to-posterior gradient with the most sensitive points located in the anterior column, followed by those located in the central column and the posterior column of the muscle (all, P < 0.001). This study confirmed an anterior-to-posterior gradient of sensitivity to pressure in both groups, with the highest sensitivity at the anterior part of the muscle. Further, we found similar pressure pain sensitivity in the trigeminal area in people with FETTH or CTTH with no association with depressive or anxiety levels.

Muscle Trigger Points and Pressure Pain Sensitivity Maps of the Feet in Women with Fibromyalgia Syndrome.

OBJECTIVE : To investigate the presence of trigger points (TrPs) in feet musculature and topographical pressure sensitivity maps of the feet as well as the relationship between TrPs, pressure pain maps, and clinical variables in women with fibromyalgia (FMS). METHODS : Fifty-one FMS women and 24 comparable healthy women participated. TrPs within the flexor hallucis brevis, adductor hallucis, dorsal interossei, extensor digitorum brevis, and quadratus plantae, as well as external and internal gastrocnemius, were explored. Pressure pain thresholds (PPTs) were assessed in a blind manner over seven locations on each foot. Topographical pressure sensitivity maps of the plantar region were generated using the averaged PPT of each location. RESULTS : The prevalence rate of foot pain was 63% (n = 32). The number of active TrPs for each FMS woman with foot pain was 5 ± 1.5 without any latent TrPs. Women with FMS without foot pain and healthy controls had only latent TrPs (2.2 ± 0.8 and 1.5 ± 1.3, respectively). Active TrPs in the flexor hallucis brevis and adductor hallucis muscles were the most prevalent. Topographical pressure pain sensitivity maps revealed that FMS women with foot pain had lower PPT than FMS women without pain and healthy controls, and higher PPT on the calcaneus bone (P < 0.001). CONCLUSIONS : The presence of foot pain in women with FMS is high. The referred pain elicited by active TrPs in the foot muscles reproduced the symptoms in these patients. FMS women suffering foot pain showed higher pressure hypersensitivity in the plantar region than those FMS women without pain.

Topographical pressure pain sensitivity maps of the shoulder region in individuals with subacromial pain syndrome

BackgroundTopographical pain maps (TPM) are useful tools to assess deep tissue sensitivity in musculoskeletal pain conditions. There is evidence suggesting bilateral sensitivity in subacromial pain syndrome (SAPS), although it is not widely accepted. No previous study has investigated TPM of the shoulder in SAPS. ObjectiveTo investigate whether differences for TPM of the shoulder are evident among patients with unilateral SAPS and controls. MethodsPressure pain thresholds (PPTs) were assessed 3 times at each point and there was a 20 s rest period between each one. The TPM were calculated using 29 pre-determined points on both shoulders in all groups by inverse distance weighted interpolation of PPT data. Multivariate Analysis of Covariance was applied to detect differences in PPTs between groups, sides, points (gender as covariate). ResultsThe results revealed significant differences between points and genders (both, P < 0.001), but not between groups (P = 0.243) and sides (P = 0.812). Heterogeneous distribution of mechanical pain sensitivity was found in both groups as the PPTs were lower on the root spine of the scapula and the posterior border of the acromion (points 5–8, P < 0.05), glenohumeral joint (points 17–20, P < 0.01) and the anterior deltoid muscle (points 21–25, P < 0.001) compared to the average of the other sites on the shoulder. Women exhibited bilateral lower PPTs in all points than men in both groups (all, P < 0.01). ConclusionsThis study revealed no differences for mechanical pain sensitivity in patients with SAPS experiencing lower levels of pain compared with matched controls, but showed heterogeneous distribution of PPTs in the shoulder.

Differences in pressure pain sensitivity of elite male soccer players on artificial turf and natural grass

The aim of this study was to compare topographical pressure pain sensitivity maps of the lower extremity in elite footballers (soccer) playing on artificial turf or natural grass. A total of 16 football players (mean age ± SD: 22 ± 2 years) for artificial turf and 13 football players (age: 22 ± 3 years) for natural grass participated. Pressure pain thresholds (PPTs) were measured bilaterally over 23 locations of the lower extremity to assess deep structure sensitivity to mechanical pain. The analysis of variance detected significant differences in PPT between groups and measurement points (P < 0.001). Football players playing on natural grass exhibited lower PPT as compared to those playing on artificial turf (P < 0.05). In addition, PPT over vastus medialis muscle had the lowest value (most sensitive) (P < 0.01); whereas PPT over the rectus femoris was the highest one (least sensitive). This study showed the ability of PPT maps to reveal heterogeneous distribution of mechanical sensitivity in relation to...

Topographical Pressure and Thermal Pain Sensitivity Mapping in Patients With Unilateral Lateral Epicondylalgia

Our aim was to quantify spatial differences in pressure and thermal pain sensitivity maps between patients with unilateral lateral epicondylalgia (LE) and age- and sex-matched controls. Pressure (PPT), cold (CPT), and heat (HPT) pain thresholds were assessed over 12 points forming a 3 × 4 matrix (4 points in the superior part, 4 points in the middle, and 4 points in the lower part around the lateral epicondyle) bilaterally in 16 subjects with strictly unilateral LE and 16 age- and sex-matched controls in a blinded design. Topographical pain sensitivity maps to pressure and thermal stimulation over the elbow in patients with LE and healthy controls were calculated. A multilevel 3-way ANCOVA test was applied to detect differences in topographical maps between groups. Subjects with LE showed bilateral lower PPT, higher CPT (pain at higher temperature) and lower HPT (pain at lower temperature) at all the measurement points as compared to controls (all, P < .01). PPT were lower at points over the extensor carpi radialis brevis (ECRB) muscle as compared to points over the extensor digitorum communis muscle ( P < .01) and over the extensor carpi ulnaris muscle ( P < .001). CPT and HPT were not significantly different between points ( P > .05). Topographical pressure and thermal pain sensitivity maps revealed bilateral hyperalgesia in patients with strictly unilateral LE. LE patients exhibited heterogeneously distributed pressure pain hyperalgesia while cold or heat maps were homogenous. The most sensitive localizations for PPT assessment corresponded to the muscle belly of the ECRB. Our results confirm the role of ECRB muscle in LE and argue for evidence of peripheral and central sensitization mechanisms in patients with strictly unilateral symptoms. Perspective Topographical pressure and thermal sensitivity maps revealed bilateral hyperalgesia in patients with strictly unilateral lateral epicondylalgia (LE). LE patients exhibited heterogeneously distributed pressure pain hyperalgesia while cold or heat pain maps were homogenous. The most sensitive localizations for PPT assessment corresponded to the muscle belly of the ECRB.

Pressure pain sensitivity topographical maps reveal bilateral hyperalgesia of the hands in patients with unilateral carpal tunnel syndrome

To assess topographical pressure pain sensitivity maps of the hand in patients with unilateral carpal tunnel syndrome (CTS) as compared with healthy subjects. A total of 20 women with CTS (ages 32-52 years) and 20 healthy matched women (ages 32-51 years) were recruited. Pressure pain thresholds (PPTs) were measured bilaterally over 30 locations of the palm of each hand by an assessor blinded to the subjects' conditions. Patients showed lower PPTs in both hands in all of the measurement points as compared with controls (P < 0.001 for all). PPTs were lower in those points over the proximal phalanx of the fingers and the thenar eminency as compared with those points located over the distal phalanx of the fingers (P < 0.001). CTS patients showed lower PPT levels in dermatomes C6, C7, and C8 when compared with healthy controls (P < 0.001 for all), but without differences between dermatomes (P = 0.4). PPT was negatively correlated with both hand pain intensity and duration of symptoms (P < 0.001 for all). Our findings revealed bilateral generalized pressure pain hyperalgesia in unilateral CTS because lower PPT levels were found in all of the points. The pressure pain hyperalgesia was not uniformly distributed since PPTs were lower in points over the proximal phalanx of the fingers and the thenar eminency as compared with those points located over the distal phalanx of the fingers. The decrease in PPT levels was associated with the intensity and the duration of the pain symptoms, supporting a role of both peripheral and central sensitization mechanisms in this pain condition.

Pressure Pain Sensitivity Mapping of the Temporalis Muscle Revealed Bilateral Pressure Hyperalgesia in Patients with Strictly Unilateral Migraine

Previous studies on pressure pain sensitivity in patients with migraine have shown conflicting results. There is emerging evidence suggesting that pain sensitivity is not uniformly distributed over the muscles, indicating the existence of topographical changes in pressure pain sensitivity. The aim of this study was to calculate topographical pressure pain sensitivity maps of the temporalis muscle in a blind design in patients with strictly unilateral migraine compared with controls. For this purpose, an electronic pressure algometer was used to measure pressure pain thresholds (PPT) over nine points of the temporalis muscle: three points in the anterior, medial and posterior parts, respectively. Pressure pain sensitivity maps of both sides (dominant or non-dominant; symptomatic or non-symptomatic) were calculated. The analysis of variance showed significant differences in PPT values between both groups (F = 279.2; P < 0.001) and points (F = 4.033; P < 0.001). Patients showed lower PPT at all nine points than healthy controls (P < 0.001). We also found lower PPT in the centre of the muscle compared with the posterior part of the muscle within both groups (P < 0.01). Interaction between group and points (F = 1.9; P < 0.05) was also found. Within the migraine group, PPT levels were decreased bilaterally from the posterior to the anterior column of the temporalis muscle (Student-Newman- Keuls analysis; P < 0.05), with the most sensitive in the anterior part of the muscle. For controls, PPT did not follow such anatomical distribution, the most sensitive point being the centre of the mid-muscle belly. This study showed bilateral sensitization to pressure in unilateral migraine, suggesting the involvement of central components.