Differences in sensory processing between chronic cervical zygapophysial joint pain patients with and without cervicogenic headache

Cephalalgia ◽  
2011 ◽  
Vol 31 (8) ◽  
pp. 953-963 ◽  
Author(s):  
Nicholas H L Chua ◽  
Hans A van Suijlekom ◽  
Kris C Vissers ◽  
Lars Arendt-Nielsen ◽  
Oliver H Wilder-Smith
Keyword(s):  
Joint Pain ◽  
Pain Threshold ◽  
Detection Threshold ◽  
Pressure Pain Threshold ◽  
Cervicogenic Headache ◽  
Pain Modulation ◽  
Zygapophysial Joint ◽  
Testing And Measurement ◽  
Threshold Testing ◽  
Pain Patients

Background: It is not known why some patients with underlying chronic nociceptive sources in the neck develop cervicogenic headache (CEH) and why others do not. This quantitative sensory testing (QST) study systematically explores the differences in sensory pain processing in 17 CEH patients with underlying chronic cervical zygapophysial joint pain compared to 10 patients with chronic cervical zygapophysial joint pain but without CEH. Methods: The QST protocol comprises pressure pain threshold testing, thermal detection threshold testing, electrical pain threshold testing and measurement of descending inhibitory modulation using the conditioned pain modulation (CPM) paradigm. Results: The main difference between patients with or without CEH was the lateralization of pressure hyperalgesia to the painful side of the head of CEH patients, accompanied by cold as well as warm relative hyperesthesia on the painful side of the head and neck. Discussion: From this hypothesis-generating study, our results suggest that rostral neuraxial spread of central sensitization, probably to the trigeminal spinal nucleus, plays a major role in the development of CEH.

scholarly journals Office-Cycling: A Promising Way to Raise Pain Thresholds and Increase Metabolism with Minimal Compromising of Work Performance

2018 ◽  
Vol 2018 ◽  
pp. 1-12 ◽  
Author(s):  
Rebecca Tronarp ◽  
André Nyberg ◽  
Mattias Hedlund ◽  
Charlotte K. Häger ◽  
Suzanne McDonough ◽  
...  
Keyword(s):  
Cognitive Performance ◽  
Work Performance ◽  
Pain Threshold ◽  
Pressure Pain Threshold ◽  
Pain Modulation ◽  
Moderate Intensity ◽  
Thermal Pain ◽  
Metabolic Expenditure ◽  
Pointing Precision ◽  
Mouse Pointing

Aim.Establishing the effects of low intensity cycling (LC), moderate intensity cycling (MC), and standing at a simulated office workstation on pain modulation, work performance, and metabolic expenditure.Methods.36 healthy adults (21 females), mean age 26.8 (SD 7.6) years, partook in this randomized3×3crossover trial with 75 minutes of LC on 20% of maximum aerobic power (MAP) output, 30 minutes of MC on 50% of MAP, and standing 30 minutes with 48-hour wash-out periods. Outcome measures were pain modulation (pressure pain threshold (PPT) and thermal pain threshold)), work performance (transcription, mouse pointing, and cognitive performance), and metabolic expenditure.Results.PPTs increased in all conditions. PPT trapezius showed the highest increase after LC, 39.3 kilopascals (kPa) (15.6; 78.6), compared to MC, 17.0 kPa (2.8; 49.9), and standing, 16.8 kPa (−5.6; 39.4),p=0.015. Transcription was reduced during LC and MC. Mouse pointing precision was best during standing and worst and slowest during MC. Cognitive performance did not differ between conditions. Metabolic expenditure rates were 1.4 (1.3; 1.7), 3.3 (2.3; 3.7), and 7.5 (5.8; 8.7) kcal/minute during standing, LC, and MC, respectively(p<0.001).Conclusions.LC seems to be the preferred option; it raised PPTs, more than doubled metabolic expenditure, whilst minimally influencing work performance.

Quantitative Sensory Testing in Patients with Multisomatoform Disorder with Chronic Pain as the Leading Bodily Symptom—a Matched Case–Control Study

Pain Medicine ◽  
2019 ◽  
Author(s):  
Johannes Achenbach ◽  
Anh-Thu Tran ◽  
Burkhardt Jaeger ◽  
Karl Kapitza ◽  
Michael Bernateck ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Quantitative Sensory Testing ◽  
Pain Threshold ◽  
Somatoform Disorders ◽  
Detection Threshold ◽  
Pressure Pain Threshold ◽  
Sensory Profile ◽  
Sensory Loss ◽  
Sensory Testing ◽  
Presenting Symptoms

Abstract Objective Chronic pain is a debilitating condition of multifactorial origin, often without physical findings to explain the presenting symptoms. Of the possible etiologies of persisting painful symptoms, somatoform disorders and functional somatic syndromes (FSS) are among the most challenging, with a prevalence of 8–20%. Many different somatoform disorders and FSS have overlapping symptoms, with pain being the most prevalent one. The concept of multisomatoform disorder (MSD) has been developed to acknowledge that fact. We hypothesized that the concept of MSD will be reflected in a distinct sensory profile of patients compared with healthy controls and possibly provide insight into the type and pathophysiology of the pain commonly experienced by patients. Design We performed comprehensive quantitative sensory testing (QST) in 151 patients and 149 matched controls. Results There were significant differences in the sensory profiles of patients compared with controls. Patients with MSD showed a combination of tactile and thermal hypesthesia combined with mechanical and cold hyperalgesia. This was true for measurements at test and control sites, with the exception of vibration detection threshold and mechanical pain threshold. Among the observed changes, a marked sensory loss of function, as evidenced by an increase in cold detection threshold, and a marked gain of function, as evidenced by a decrease of pressure pain threshold, were most notable. There was no evidence of concurrent medication influencing QST results. Conclusions The observed somatosensory profile of patients with MSD resembles that of patients suffering from neuropathic pain with evidence of central sensitization.

scholarly journals Effects of upper cervical translatoric mobilization on headache, quality of life, cervical mobility and pressure pain threshold in patients with cervicogenic headache: A randomized controlled trial.

2020 ◽  
Author(s):  
Miguel Malo-Urriés ◽  
José Miguel Tricás-Moreno ◽  
Elena Estébanez-de-Miguel ◽  
Elena Bueno-Gracia ◽  
Pablo Fanlo-Mazas ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Treatment Group ◽  
Pain Threshold ◽  
Pressure Pain Threshold ◽  
Cervicogenic Headache ◽  
Control Group ◽  
Pressure Pain ◽  
Upper Cervical ◽  
Related Quality

Abstract Objective The purpose of this study was to evaluate the effects of upper cervical translatoric spinal mobilization (UC-TSM) on headache, quality of life, cervical mobility and pressure pain threshold in subjects with cervicogenic headache (CEH). Methods Eighty-two volunteers (41.5 ± 15.3 years; 20 males and 62 females) with CEH participated in the study and were randomly assigned to control or treatment group. The treatment group received 3 sessions of UC-TSM and the control group remained the same sessions, in the same position and time but received no treatment. Primary outcomes were Headache Impact Test for headache-related quality of life and flexion-rotation test for upper cervical mobility. Secondary outcomes included intensity, frequency and duration of headache, general cervical mobility and pressure pain thresholds over cervical spine. They were measured at baseline, at the end of the treatment and one month after the intervention. Results UC-TSM group increased significantly headache-related quality of life (p < .001; d = .857). Headache intensity, frequency and duration improved in UC-TSM group (p = .000-.013), in contrast to control group which did not obtain significant changes (p = .234-.965). UC-TSM group presented significant increases in upper cervical mobility (p < .001). Between-group effect sizes were considered large at T1 (d = 0.90–1.21) and moderate to large at T2 (d = 0.78–1.17). Conclusions Three sessions of UC-TSM increased headache-related quality of life and upper cervical mobility in subjects with CEH. Intensity, duration and frequency of headache, cervical mobility and PPT also improved. Further research considering the limitations of the present clinical trial is required to confirm this tendency.

The impact of stress and anxiety on the pressure pain threshold of myofascial pain patients

2009 ◽  
Vol 36 (5) ◽  
pp. 313-321 ◽  
Author(s):  
G. M. VEDOLIN ◽  
V. V. LOBATO ◽  
P. C. R. CONTI ◽  
J. R. P. LAURIS
Keyword(s):  
Pain Threshold ◽  
Myofascial Pain ◽  
Pressure Pain Threshold ◽  
Pressure Pain ◽  
The Impact ◽  
Pain Patients

scholarly journals Reliability of the Conditioned Pain Modulation Paradigm to Assess Endogenous Inhibitory Pain Pathways

2012 ◽  
Vol 17 (2) ◽  
pp. 98-102 ◽  
Author(s):  
Gwyn N Lewis ◽  
Heales Luke ◽  
David A Rice ◽  
Keith Rome ◽  
Peter J McNair
Keyword(s):  
Pain Threshold ◽  
Intraclass Correlation ◽  
Cold Pressor Test ◽  
Pressure Pain Threshold ◽  
Cold Pressor ◽  
Pain Modulation ◽  
Conditioned Pain Modulation ◽  
Pressure Pain ◽  
Pressor Test ◽  
Conditioning Stimuli

BACKGROUND: Conditioned pain modulation paradigms are often used to assess the diffuse noxious inhibitory control (DNIC) system. DNICs provide one of the main supraspinal pain inhibitory pathways and are impaired in several chronic pain populations. Only one previous study has examined the psychometric properties of the conditioned pain modulation technique and this study did not evaluate intersession reliability.OBJECTIVES: To evaluate and compare the intra- and intersession reliability of two conditioned pain modulation paradigms using different conditioning stimuli, and to determine the time course of conditioned pain inhibition following stimulus removal.METHODS: An electronic pressure transducer was used to determine the pressure-pain threshold at the knee during painful conditioning of the opposite hand using the ischemic arm test and the cold pressor test. Assessments were completed twice on one day and repeated once approximately three days later.RESULTS: The two conditioning stimuli resulted in a similar increase in the pressure-pain threshold at the knee, reflecting presumed activation of the DNIC system. Intrasession intraclass correlation coefficients for the cold pressor (0.85) and ischemic arm tests (0.75) were excellent. The intersession intraclass correlation coefficient for the cold pressor test was good (0.66) but was poor for the ischemic arm test (−0.4). Inhibition of the pressure-pain threshold remained significant at 10 min following conditioning, but returned to baseline by 15 min.CONCLUSIONS: Within-session reliability of DNIC assessment using conditioned pain modulation paradigms was excellent, but the applicability of assessing pain modulation over multiple sessions was influenced by the conditioning stimulus. The cold pressor test was the superior technique.

Local hyperalgesia, normal endogenous modulation with pain report beyond its origin: a pilot study prompting further exploration into plantar fasciopathy

2020 ◽  
Vol 20 (2) ◽  
pp. 375-385
Author(s):  
Henrik Riel ◽  
Melanie L. Plinsinga ◽  
Rebecca Mellor ◽  
Shellie A. Boudreau ◽  
Viana Vuvan ◽  
...  
Keyword(s):  
Pain Intensity ◽  
Pain Threshold ◽  
Pressure Pain Threshold ◽  
Plantar Fascia ◽  
Pain Modulation ◽  
Conditioned Pain Modulation ◽  
Pain Processing ◽  
Pain Thresholds ◽  
Pressure Pain ◽  
Plantar Fasciopathy

AbstractBackground and aimsPersistent tendinopathies were previously considered solely as peripheral conditions affecting the local tendinous tissue until quantitative sensory testing identified involvement of altered pain processing. In similar fashion, pain in patients with persistent plantar fasciopathy may also involve more than local tissue. The aim of this pilot study was to investigate potential differences in conditioned pain modulation and pressure and thermal pain thresholds, between individuals with PF and healthy pain-free controls, as a precursor to a larger-scale study.MethodsWe assessed 16 individuals with plantar fasciopathy and 11 pain-free controls. Plantar fasciopathy diagnosis was: palpation pain of the medial calcaneal tubercle or the proximal plantar fascia, duration ≥3 months, pain intensity ≥2/10, and ultrasound-measured plantar fascia thickness ≥4 mm. Quantitative sensory tests were performed locally at the plantar heel and remotely on the ipsilateral elbow. Assessments included pain thresholds for pressure, heat and cold, and conditioned pain modulation measured as change in local resting pressure pain threshold with cold water hand immersion. Participants rated pain intensity at pain threshold. Additionally, the area and distribution of plantar fasciopathy pain was drawn on a digital body chart of the lower limbs. Descriptive analyses were performed and between-group differences/effects expressed as standardised mean differences (d).ResultsThere was no conditioned pain modulation difference between participants with plantar fasciopathy and controls (d = 0.1). Largest effects were on local pressure pain threshold and reported pain intensity on pressure pain threshold (d > 1.8) followed by pain intensity for heat and cold pain thresholds (d = 0.3–1.5). According to the digital body chart, pain area extended beyond the plantar heel.ConclusionsThe unlikelihood of a difference in conditioned pain modulation yet a pain area extending beyond the plantar heel provide a basis for exploring altered pain processing in a larger-scale study.ImplicationsThis was the first study to investigate the presence of altered pain processing in individuals with plantar fasciopathy using a conditioned pain modulation paradigm and thermal pain thresholds. We found no indication of an altered pain processing based on these measures, however, patients rated pain higher on thresholds compared to controls which may be important to clinical practice and warrants further exploration in the future.

Central and peripheral pain sensitization during an ultra-marathon competition

2018 ◽  
Vol 18 (4) ◽  
pp. 703-709 ◽  
Author(s):  
James W. Agnew ◽  
Steven B. Hammer ◽  
Alexandre L. Roy ◽  
Amina Rahmoune
Keyword(s):  
Pain Threshold ◽  
Pressure Pain Threshold ◽  
Pain Modulation ◽  
Conditioned Pain Modulation ◽  
Central Pain ◽  
Dominant Hand ◽  
Pressure Pain ◽  
Peripheral Pain ◽  
Pain Sensitization ◽  
Ultra Endurance

Abstract Background and aims The participation in ultra-marathons and other ultra-endurance events has increased exponentially over the past decade. There is insufficient data on variation in pain mechanisms in exercise overall but especially in the ultra-endurance athlete population. To further understand peripheral and central pain sensitization we have investigated pressure pain threshold and conditioned pain modulation during three separate ultra-marathon competitions. Methods Each ultra-marathon investigated was held in the state of Florida, USA, over flat, sandy and paved surfaces under generally warm to hot, humid conditions. Pressure pain threshold was measured utilizing a Baseline © Dolorimeter. The blunt end of the dolorimeter stylus was placed onto the distal dominant arm, equidistant between the distal radius and ulna, three times in a blinded manner to insure that the testing technician did not influence the subject’s responses. Conditioned pain modulation was measured immediately after the PPT measures by placing the non-dominant hand in a cool water bath maintained at 15°C. The same dolorimeter measurement was repeated two more times on the dominant arm while the non-dominant hand remained in the water. Data was analyzed with a paired t-test. Results Pressure pain threshold was significantly decreased (p<0.05) at 25, 50 and 100 miles. Conditioned pain modulation was also significantly decreased (p<0.05) at 25, 50 and 100 miles of an ultra-marathon competition. Conclusions Together these data suggest an increased peripheral and/or central pain sensitization starting at 25 miles and continuing throughout an ultra-marathon competition run in these conditions. This is the first study that provides evidence of a decreased peripheral pain threshold and decreased central pain inhibition from ultra-marathon running. Decreases in both the peripheral pain threshold and central inhibition may result from nociceptor plasticity, central sensitization or a combination of both. Implications Based on previous research that has indicated a central sensitization resulting from inflammation and the well-documented inflammatory response to the rigors of ultra-marathon competition, we suggest the decreased peripheral pain threshold and decreased descending pain inhibition results from this inflammatory response of running an ultra-marathon.

scholarly journals Conditioned pain modulation assessment using contact heat as conditioning stimulus and two different test stimuli

2019 ◽  
Vol 72 (3-4) ◽  
pp. 66-71
Author(s):  
Aleksandar Knezevic ◽  
Milena Kovacevic ◽  
Ljiljana Klicov ◽  
Magdalena Pantic ◽  
Jana Vasin ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Pain Threshold ◽  
Pressure Pain Threshold ◽  
Conditioning Stimulus ◽  
Pain Modulation ◽  
Conditioned Pain Modulation ◽  
Heat Pain ◽  
Contact Heat ◽  
Pain Thresholds ◽  
Heat Pain Threshold

Introduction. The objective of the study was to determine the potentials and reliability of conditioned pain modulation effect in healthy population by application of a conditioning contact heat stimulus, and heat and pressure applied to the low back region as a test stimulus. Material and Methods. The study included 33 healthy subjects (average age 25.73 ? 5.35 years). Pressure and heat pain thresholds were examined on the paravertebral musculature of the lower back as test stimuli. Contact heat was used on the contralateral forearm as a conditioning stimulus. Conditioned pain modulation was calculated as the difference between pain thresholds after and before conditioning stimulus application. To assess the reliability, identical testing was performed 14 ? 2 days later. Results. The pressure and heat pain thresholds, after the conditioning stimulus, were significantly higher compared to pain thresholds obtained before the conditioning stimulus (101,63 N/cm2 ? 45,21N/cm2 vs 82,15 N/cm2 ? 36,15 N/cm2, t = -7,528, p < 0,001 and 47,08?C ? 2,19o C vs 45,00 ? 3,05?C, t = -6,644, p < 0,001, respectively). The reli?ability of the same protocol, measured 14 ? 2 days after the previous testing, showed good reliability of the pressure pain threshold (intraclass correlation coefficient = 0,636, 95% confidence interval 0,240 - 0,825), and fair of the heat pain threshold (intraclass cor?relation coefficient = 0,435, 95% confidence interval - 0,070 - 0,713). Conclusion. Conditioned pain modulation was successfully induced by contact heat applied via a thermode, a conditioning stimulus. The reliability of this method of testing proved to be fair when it comes to the heat pain threshold and good when it comes to the pressure pain threshold.

Sign in / Sign up

Export Citation Format

Share Document