Increased deep pain sensitivity in persistent musculoskeletal pain but not in other musculoskeletal pain states

AbstractBackgroundPressure pain thresholds (PPTs) in a non-painful body area are known to be affected in some chronic pain states. The aim of this study is to investigate PPTs in a pain-free body part in relation to pain persistence and intensity in patients with musculoskeletal pain.MethodsPatients with musculoskeletal pain were divided into three different pain groups: acute pain (pain duration < 3 months, n = 38), regularly recurrent pain (regularly recurrent pain duration > 3 months, n = 56), persistent pain (persistent pain duration >3 months, n = 52) and a healthy control group (n = 51). PPT measures were conducted over the tibialis anterior muscle on the right leg in all groups.ResultsThe persistent pain group showed significantly lower PPTs over the tibialis anterior muscle compared to controls. No significant differences were found between the acute and regularly recurrent pain groups compared to healthy controls. Significant correlations, albeit small, were found between pain intensity and PPTs.ConclusionsIncreased deep pain sensitivity was found in patients with persistent musculoskeletal pain, but not in regularly recurrent pain or in acute pain. Yet, a limitation of the study is that it did not have sufficient power to detect small levels of increased deep pain sensitivity among the latter groups when compared to healthy controls.ImplicationsKnowledge about increased general hypersensitivity in persistent musculoskeletal pain could be important in clinical treatment.

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Generalized Neck-Shoulder Hyperalgesia in Chronic Tension-Type Headache and Unilateral Migraine Assessed by Pressure Pain Sensitivity Topographical Maps of the Trapezius Muscle

Cephalalgia ◽

10.1111/j.1468-2982.2009.01901.x ◽

2009 ◽

Vol 30 (1) ◽

pp. 77-86 ◽

Cited By ~ 64

Author(s):

C Fernández-de-las-Peñas ◽

P Madeleine ◽

AB Caminero ◽

ML Cuadrado ◽

L Arendt-Nielsen ◽

...

Keyword(s):

Pain Sensitivity ◽

Trapezius Muscle ◽

Tension Type Headache ◽

Healthy Controls ◽

Pressure Pain ◽

Chronic Tension Type Headache ◽

Pressure Pain Thresholds ◽

Pressure Algometer ◽

Type Headache ◽

Topographical Maps

Spatial changes in pressure pain hypersensitivity are present throughout the cephalic region (temporalis muscle) in both chronic tension-type headache (CTTH) and unilateral migraine. The aim of this study was to assess pressure pain sensitivity topographical maps on the trapezius muscle in 20 patients with CTTH and 20 with unilateral migraine in comparison with 20 healthy controls in a blind design. For this purpose, a pressure algometer was used to assess pressure pain thresholds (PPT) over 11 points of the trapezius muscle: four points in the upper part of the muscle, two over the levator scapulae muscle, two in the middle part, and the remaining three points in the lower part of the muscle. Pressure pain sensitivity maps of both sides (dominant/non-dominant; symptomatic/non-symptomatic) were depicted for patients and controls. CTTH patients showed generalized lower PPT levels compared with both migraine patients ( P = 0.03) and controls ( P < 0.001). The migraine group had also lower PPT than healthy controls ( P < 0.001). The most sensitive location for the assessment of PPT was the neck portion of the upper trapezius muscle in both patient groups and healthy controls ( P < 0.001). PPT was negatively related to some clinical pain features in both CTTH and unilateral migraine patients (all P < 0.05). Side-to-side differences were found in strictly unilateral migraine, but not in those subjects with bilateral pain, i.e. CTTH. These data support the influence of muscle hyperalgesia in both CTTH and unilateral migraine patients and point towards a general pressure pain hyperalgesia of neck-shoulder muscles in headache patients, particularly in CTTH.

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Pain thresholds and suprathreshold pain after sleep restriction in migraine – A blinded crossover study

Cephalalgia ◽

10.1177/03331024211056565 ◽

2021 ◽

pp. 033310242110565

Author(s):

Jan Petter Neverdahl ◽

Martin Uglem ◽

Dagfinn Matre ◽

Johannes Orvin Hansen ◽

Morten Engstrøm ◽

...

Keyword(s):

Crossover Study ◽

Pain Sensitivity ◽

Sleep Restriction ◽

Heat Pain ◽

Healthy Controls ◽

Pain Thresholds ◽

Pressure Pain ◽

Disturbed Sleep ◽

Pressure Pain Thresholds ◽

Lower Pain

Objective There is an unexplained association between disturbed sleep and migraine. In this blinded crossover study, we investigate if experimental sleep restriction has a different effect on pain thresholds and suprathreshold pain in interictal migraineurs and controls. Methods Forearm heat pain thresholds and tolerance thresholds, and trapezius pressure pain thresholds and suprathreshold pain were measured in 39 interictal migraineurs and 31 healthy controls after two consecutive nights of partial sleep restriction and after habitual sleep. Results The effect of sleep restriction was not significantly different between interictal migraineurs and controls in the primary analyses. Pressure pain thresholds tended to be lower (i.e., increased pain sensitivity) after sleep restriction in interictal migraineurs compared to controls with a 48-hour preictal-interictal cut-off (p = 0.061). We found decreased pain thresholds after sleep restriction in two of seven migraine subgroup comparisons: heat pain thresholds decreased in migraineurs with lower pain intensity during attacks (p = 0.005) and pressure pain thresholds decreased in migraineurs with higher severity of photophobia during attacks (p = 0.031). Heat pain thresholds tended to decrease after sleep restriction in sleep-related migraine (p = 0.060). Sleep restriction did not affect suprathreshold pain measurements in either group. Conclusion This study could not provide strong evidence for an increased effect of sleep restriction on pain sensitivity in migraineurs compared to healthy controls. There might be a slightly increased effect of sleep restriction in migraineurs, detectable using large samples or more pronounced in certain migraine subgroups.

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Local and Widespread Pressure Pain Hyperalgesia Is Not Side Specific in Females with Unilateral Neck Pain that Can Be Reproduced during Passive Neck Rotation

Journal of Clinical Medicine ◽

10.3390/jcm8081246 ◽

2019 ◽

Vol 8 (8) ◽

pp. 1246 ◽

Cited By ~ 3

Author(s):

Fernando Piña-Pozo ◽

Alberto Marcos Heredia-Rizo ◽

Pascal Madeleine ◽

Isabel Escobio-Prieto ◽

Antonio Luque-Carrasco ◽

...

Keyword(s):

Neck Pain ◽

Pain Intensity ◽

Tibialis Anterior ◽

Pain Sensitivity ◽

Specific Effect ◽

Current Evidence ◽

Pressure Pain ◽

Pain Location ◽

Pressure Pain Thresholds ◽

Neck Rotation

Current evidence for widespread hyperalgesia in non-specific neck pain (NSNP) is unclear. It is currently recommended to group NSNP patients according to pain-provoking movements. The aim of this study was to investigate local and widespread pain sensitivity in females with unilateral NSNP that is reproducible during passive neck rotation compared with matched controls, and to compare the side specific effect of pain location on pressure pain sensitivity among females with unilateral NSNP. Thirty-six females with unilateral NSNP evoked during passive ipsilateral (n = 20) or contralateral (n = 16) rotation toward the painful side were compared with 20 controls. Participants reported their pain intensity at rest and during passive neck rotation and completed the Neck Disability Index. Pressure pain thresholds (PPTs) were assessed bilaterally over the anterior scalene; the sternocleidomastoid; the levator scapulae; lateral to the spinous process of C6; the median, ulnar, and radial nerves; and the tibialis anterior. The ANOVA revealed lower PPTs in females with unilateral NSNP compared with the controls (all at p < 0.001), but no differences were found between the sides, nor was there any Group × side interaction. Among females with NSNP, those with higher pain intensity during ipsilateral rotation toward the painful side showed lower PPTs over the anterior scalene, median nerve, ulnar nerve, and tibialis anterior (all, p < 0.05) than females with higher pain intensity during contralateral rotation toward the painful side. These findings demonstrated bilateral local and widespread pressure pain hyperalgesia in females with unilateral NSNP that was reproducible during passive neck rotation compared with controls. There was no side specific effect of pain location on PPTs among females with unilateral NSNP.

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Trigger points are associated with widespread pressure pain sensitivity in people with tension-type headache

Cephalalgia ◽

10.1177/0333102416679965 ◽

2016 ◽

Vol 38 (2) ◽

pp. 237-245 ◽

Cited By ~ 6

Author(s):

María Palacios-Ceña ◽

Kelun Wang ◽

Matteo Castaldo ◽

Amparo Guillem-Mesado ◽

Carlos Ordás-Bandera ◽

...

Keyword(s):

Pain Sensitivity ◽

Tibialis Anterior Muscle ◽

Trigger Points ◽

Cross Sectional Study ◽

Tension Type Headache ◽

Cross Sectional ◽

Pressure Pain ◽

Upper Trapezius ◽

Pressure Pain Thresholds ◽

Type Headache

Objective To investigate the association between trigger points (TrPs) and widespread pressure pain sensitivity in people with tension-type headache (TTH) and to determine if this association is different between frequent episodic (FETTH) or chronic (CTTH) headache. Design A cross-sectional study. Methods One hundred and fifty-seven individuals (29% male) with TTH participated. Clinical features of headache, i.e., intensity, duration, and frequency, were recorded in a headache diary. Active and latent TrPs were bilaterally explored in the temporalis, masseter, suboccipital, upper trapezius, sternocleidomastoid, and splenius capitis muscles. Pressure pain thresholds (PPT) were assessed over the trigeminal area (i.e., temporalis muscle), extra-trigeminal (i.e., C5/C6 zygapophyseal joint), and two distant pain-free points (i.e., second metacarpal and tibialis anterior muscle). Results Eighty (51%) patients were classified as FETTH, whereas 77 (49%) were classified as CTTH. No differences in the number of either active or latent TrPs (all p > 0.171) or widespread pressure pain sensitivity (all p > 0.351) were observed between FETTH and CTTH groups. The number of active and latent TrPs was significantly and negatively associated with PPTs: The higher the number of active or latent TrPs, the lower the widespread PPT, and the more generalized sensitization. This association was stronger within the FETTH group than the CTTH group. Conclusions This study found that the number of TrPs in head and neck/shoulder muscles was associated with widespread pressure hypersensitivity independently of the frequency of headache.

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Automated Nociceptive Withdrawal Reflex Measurements Reveal Normal Reflex Thresholds and Augmented Pain Ratings in Patients with Fibromyalgia

Journal of Clinical Medicine ◽

10.3390/jcm9061992 ◽

2020 ◽

Vol 9 (6) ◽

pp. 1992

Author(s):

Johannes Ydrefors ◽

Tomas Karlsson ◽

Ulrika Wentzel Olausson ◽

Bijar Ghafouri ◽

Ann-Charlotte Johansson ◽

...

Keyword(s):

Tibialis Anterior ◽

Pain Sensitivity ◽

Tibialis Anterior Muscle ◽

Electromyographic Activity ◽

Nociceptive Withdrawal Reflex ◽

Withdrawal Reflex ◽

Pain Ratings ◽

Subjective Pain ◽

Electrical Stimuli ◽

Spinal Sensitization

The nociceptive withdrawal reflex (NWR) is used to probe spinal cord excitability in chronic pain states. Here, we used an automated and unbiased procedure for determining the NWR threshold and compared the reflex thresholds and corresponding pain ratings in a well-characterized cohort of fibromyalgia (n = 29) and matched healthy controls (n = 21). Surface electrical stimuli were delivered to the foot in a stepwise incremental and decremental manner. The surface electromyographic activity was recorded from the ipsilateral tibialis anterior muscle. Fibromyalgia patients reported significantly higher scores for psychological distress and pain-related disability and a significantly lower score for perceived state of health compared to the matched controls. The subjective pain ratings were significantly higher in patients. The NWR thresholds were similar to the controls. In the patients, but not in controls, the NWR thresholds and subjective pain ratings were significantly correlated. Our results showed an increased subjective pain sensitivity in fibromyalgia, but we found no evidence for spinal sensitization based on the reflex measures.

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Patients with symptomatic permanent atrial fibrillation show quantitative signs of pain sensitisation

European Heart Journal ◽

10.1093/eurheartj/ehab724.0416 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

A Jackson ◽

O Frobert ◽

D Boye Larsen ◽

L Arendt-Nielsen ◽

A Bjorkenheim

Keyword(s):

Atrial Fibrillation ◽

Tibialis Anterior ◽

Tibialis Anterior Muscle ◽

Primary Objective ◽

Pain Modulation ◽

Pain Tolerance ◽

Asymptomatic Group ◽

Pressure Pain Thresholds ◽

Pain Area ◽

Pain Sensitisation

Abstract Background/Introduction Most patients with atrial fibrillation (AF) report symptoms, while around one-third are asymptomatic. We hypothesized that sensory processing, in particular pain, differs in patients with symptomatic and asymptomatic AF. Purpose To assess differences in pain sensitisation in patients with symptomatic and asymptomatic AF. Methods Thirty individuals with permanent AF (15 symptomatic, 15 asymptomatic) completed the AF6 and SF-36 questionnaires and underwent quantitative pain sensitisation testing using pressure algometry at the sternum (referred pain area) and the tibialis anterior muscle (generalized pain area). The primary objective was to assess differences in pressure pain thresholds (PPT), temporal summation of pain (TSP), and conditioned pain modulation (CPM) in the two groups. The secondary objective was to determine association of demographic and clinical parameters to quantitative measures of pain sensitisation. Results The symptomatic group had lower PPTs at both tibialis (p=0.004) and sternum (p=0.01), as well as impaired CPM (p=0.025) and facilitated TSP (p=0.008) at the tibialis but not sternum, compared to the asymptomatic group. The AF6 sum score was negatively correlated to PPT on both tibialis (r=−0.50, p=0.005) and sternum (r=−0.42, p=0.02) and positively correlated to TSP of both tibialis (r=0.57, p=0.001) and sternum (r=0.45, p=0.01), but not to CPM. The physical component summary score was positively correlated to the PPT on both tibialis (r=0.52, p=0.003) and sternum (r=0.40, p=0.03) and negatively to TSP on the tibialis (r=−0.53, p=0.003) but not sternum. Conclusions Patients with symptomatic AF exhibit lower pain tolerance than patients with asymptomatic AF, as well as impaired pain inhibitory control and facilitated summation of pain, indicating that pain sensitisation may be of importance in symptomatic AF. FUNDunding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Department of Cardiology, Örebro University, Sweden PPTs tibialis anterior muscle PPTs sternum

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High concurrent validity between digital and analogue algometers to measure pressure pain thresholds in healthy participants and people with migraine: a cross-sectional study

The Journal of Headache and Pain ◽

10.1186/s10194-021-01278-8 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

René F. Castien ◽

Michel W. Coppieters ◽

Tom S. C. Durge ◽

Gwendolyne G. M. Scholten-Peeters

Keyword(s):

Concurrent Validity ◽

Tibialis Anterior Muscle ◽

Intraclass Correlation ◽

Cephalic Region ◽

Limits Of Agreement ◽

Temporal Muscle ◽

Pain Thresholds ◽

Pressure Pain ◽

Pressure Pain Thresholds ◽

Healthy Participants

Abstract Background Pressure pain thresholds (PPTs) are commonly assessed to quantify mechanical sensitivity in various conditions, including migraine. Digital and analogue algometers are used, but the concurrent validity between these algometers is unknown. Therefore, we assessed the concurrent validity between a digital and analogue algometer to determine PPTs in healthy participants and people with migraine. Methods Twenty-six healthy participants and twenty-nine people with migraine participated in the study. PPTs were measured interictally and bilaterally at the cephalic region (temporal muscle, C1 paraspinal muscles, and trapezius muscle) and extra-cephalic region (extensor carpi radialis muscle and tibialis anterior muscle). PPTs were first determined with a digital algometer, followed by an analogue algometer. Intraclass correlation coefficients (ICC3.1) and limits of agreement were calculated to quantify concurrent validity. Results The concurrent validity between algometers in both groups was moderate to excellent (ICC3.1 ranged from 0.82 to 0.99, with 95%CI: 0.65 to 0.99). Although PPTs measured with the analogue algometer were higher at most locations in both groups (p < 0.05), the mean differences between both devices were less than 18.3 kPa. The variation in methods, such as a hand-held switch (digital algometer) versus verbal commands (analogue algometer) to indicate when the threshold was reached, may explain these differences in scores. The limits of agreement varied per location and between healthy participants and people with migraine. Conclusion The concurrent validity between the digital and analogue algometer is excellent in healthy participants and moderate in people with migraine. Both types of algometer are well-suited for research and clinical practice but are not exchangeable within a study or patient follow-up.

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The tolerance to stretch is linked with endogenous modulation of pain

Scandinavian Journal of Pain ◽

10.1515/sjpain-2020-0010 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Morten Pallisgaard Støve ◽

Rogerio Pessoto Hirata ◽

Thorvaldur Skuli Palsson

Keyword(s):

Range Of Motion ◽

Pain Sensitivity ◽

Cold Pressor Test ◽

Cold Pressor ◽

Static Stretch ◽

Pain Thresholds ◽

Pressure Pain ◽

Pressor Test ◽

Pressure Pain Thresholds ◽

Exercise Induced

Abstract Objectives The effect of stretching on joint range of motion is well documented, and although sensory perception has significance for changes in the tolerance to stretch following stretching the underlining mechanisms responsible for these changes is insufficiently understood. The aim of this study was to examine the influence of endogenous pain inhibitory mechanisms on stretch tolerance and to investigate the relationship between range of motion and changes in pain sensitivity. Methods Nineteen healthy males participated in this randomized, repeated-measures crossover study, conducted on 2 separate days. Knee extension range of motion, passive resistive torque, and pressure pain thresholds were recorded before, after, and 10 min after each of four experimental conditions; (i) Exercise-induced hypoalgesia, (ii) two bouts of static stretching, (iii) resting, and (iv) a remote, painful stimulus induced by the cold pressor test. Results Exercise-induced hypoalgesia and cold pressor test caused an increase in range of motion (p<0.034) and pressure pain thresholds (p<0.027). Moderate correlations in pressure pain thresholds were found between exercise-induced hypoalgesia and static stretch (Rho>0.507, p=0.01) and exercise-induced hypoalgesia and the cold pressor test (Rho=0.562, p=0.01). A weak correlation in pressure pain thresholds and changes in range of motion were found following the cold pressor test (Rho=0.460, p=0.047). However, a potential carryover hypoalgesic effect may have affected the results of the static stretch. Conclusions These results suggest that stretch tolerance may be linked with endogenous modulation of pain. Present results suggest, that stretch tolerance may merely be a marker for pain sensitivity which may have clinical significance given that stretching is often prescribed in the rehabilitation of different musculoskeletal pain conditions where reduced endogenous pain inhibition is frequently seen.

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Changes in pain sensitivity and spinal stiffness in relation to responder status following spinal manipulative therapy in chronic low Back pain: a secondary explorative analysis of a randomized trial

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03873-3 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Casper Glissmann Nim ◽

Gregory Neil Kawchuk ◽

Berit Schiøttz-Christensen ◽

Søren O’Neill

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Randomized Trial ◽

Clinical Improvement ◽

Spinal Manipulation ◽

Pain Sensitivity ◽

Spinal Manipulative Therapy ◽

Low Back ◽

Manipulative Therapy ◽

Pressure Pain Thresholds

Abstract Background In a prior randomized trial, we demonstrated that participants receiving spinal manipulative therapy at a pain-sensitive segment instead of a stiff segment experienced increased mechanical pressure pain thresholds. We hypothesized that the targeted segment mediated this increase through a segment-dependent neurophysiological reflective pathway. Presently, it is not known if this decrease in pain sensitivity is associated with clinical improvement. Therefore, we performed an explorative analysis to examine if changes in experimental pain sensitivity (mechanical and thermal) and lumbar stiffness were further dependent on clinical improvement in disability and patient-reported low back pain. Methods This study is a secondary explorative analysis of data from the randomized trial that compared 132 participants with chronic low back pain who received lumbar spinal manipulative therapy applied at either i) the stiffest segment or ii) the segment having the lowest pain threshold (i.e., the most pain-sensitive segment). We collected data at baseline, after the fourth session of spinal manipulation, and at 14-days follow-up. Participants were dichotomized into responders/non-responders using different clinical variables (disability and patient-reported low back pain) with varying threshold values (0, 30, and 50% improvement). Mixed models were used to assess changes in experimental outcomes (stiffness and pain sensitivity). The fixed interaction terms were time, segment allocation, and responder status. Results We observed a significant increase in mechanical pressure pain thresholds for the group, which received spinal manipulative therapy at the most pain-sensitive segment independent of whether they improved clinically or not. Those who received spinal manipulation at the stiffest segment also demonstrated increased mechanical pain sensitivity, but only in the subgroup with clinical improvement. We did not observe any changes in lumbar stiffness. Conclusion Our results suggest the existence of two different mechanistic pathways associated with the spinal manipulation target. i) A decrease of mechanical pain sensitivity independent of clinical outcome (neurophysiological) and ii) a decrease as a reflection of the clinical outcome. Together, these observations may provide a novel framework that improves our understanding of why some respond to spinal manipulative therapy while others do not. Trial registration ClinicalTrials.gov identifier: NCT04086667 registered retrospectively September 11th 2019.

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Predicted Versus Non-Predicted Opioid Administration Using Preoperative Pain Sensitivity in Patients Undergoing Gynecological Surgery: A Randomized-Controlled Trial

Journal of Clinical Medicine ◽

10.3390/jcm10040585 ◽

2021 ◽

Vol 10 (4) ◽

pp. 585

Author(s):

Sun-Kyung Park ◽

Hansol Kim ◽

Seokha Yoo ◽

Won Ho Kim ◽

Young-Jin Lim ◽

...

Keyword(s):

Postoperative Pain ◽

Pain Sensitivity ◽

Control Group ◽

Gynecological Surgery ◽

Control Groups ◽

Preoperative Pain ◽

Pain Scores ◽

Pressure Pain Thresholds ◽

Opioid Administration ◽

And Control

Individualized administration of opioids based on preoperative pain sensitivity may improve postoperative pain profiles. This study aimed to examine whether a predicted administration of opioids could reduce opioid-related adverse effects after gynecological surgery. Patients were randomized to the predicted group or control group. Participants received a preoperative sensory test to measure pressure pain thresholds. Patients were treated with a higher or lower (15 or 10 μg/mL) dose of fentanyl via intravenous patient-controlled analgesia. The opioid dose was determined according to pain sensitivity in the predicted group, while it was determined regardless of pain sensitivity in the control group. The primary outcome was the incidence of nausea over the first 48 h postoperative period. Secondary outcomes included postoperative pain scores and opioid requirements. There was no difference in the incidence of nausea (40.0% vs. 52.5% in predicted and control groups, respectively; p = 0.191) and postoperative pain scores (3.3 vs. 3.5 in predicted and control groups, respectively; p = 0.691). However, opioid consumptions were lower in the predicted group compared to the control group (median 406.0 vs. 526.5 μg; p = 0.042). This study showed that offering a predicted dose of opioids according to pain sensitivity did not affect the incidence of nausea and pain scores.

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