scholarly journals Within-session test-retest reliability of pressure pain threshold and mechanical temporal summation in healthy subjects

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0245278
Author(s):  
Catherine Mailloux ◽  
Louis-David Beaulieu ◽  
Timothy H. Wideman ◽  
Hugo Massé-Alarie
Keyword(s):  
Measurement Error ◽  
Temporal Summation ◽  
Pain Threshold ◽  
Pressure Pain Threshold ◽  
Low Back ◽  
Measurement Variability ◽  
Retest Reliability ◽  
Pressure Pain ◽  
Relative Reliability ◽  
Test Retest Reliability

Objective To determine the absolute and relative intra-rater within-session test-retest reliability of pressure pain threshold (PPT) and mechanical temporal summation of pain (TSP) at the low back and the forearm in healthy participants and to test the influence of the number and sequence of measurements on reliability metrics. Methods In 24 participants, three PPT and TSP measures were assessed at four sites (2 at the low back, 2 at the forearm) in two blocks of measurements separated by 20 minutes. The standard error of measurement, the minimal detectable change (MDC) and the intraclass correlation coefficient (ICC) were investigated for five different sequences of measurements (e.g. measurement 1, 1–2, 1-2-3). Results The MDC for the group (MDCgr) for PPT ranged from 28.71 to 50.56 kPa across the sites tested, whereas MDCgr for TSP varied from 0.33 to 0.57 out of 10 (numeric scale). Almost all ICC showed an excellent relative reliability (between 0.80 and 0.97), except when only the first measurement was considered (moderate). Although minimal differences in absolute PPT reliability were present between the different sequences, in general, using only the first measurement increase measurement error. Three TSP measures reduced the measurement error. Discussion We established that two measurements of PPT and three of TSP reduced the measurement error and demonstrated an excellent relative reliability. Our results could be used in future pain research to confirm the presence of true hypo/hyperalgesia for paradigms such as conditioned pain modulation or exercise-induced hypoalgesia, indicated by a change exceeding the measurement variability.

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

2013 ◽  
Vol 93 (6) ◽  
pp. 748-756 ◽  
Author(s):  
Ronaldo Fernando de Oliveira ◽  
Richard Eloin Liebano ◽  
Lucíola da Cunha Menezes Costa ◽  
Lívia Leticia Rissato ◽  
Leonardo Oliveira Pena Costa
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pain Intensity ◽  
Spinal Manipulation ◽  
Pain Threshold ◽  
Controlled Trial ◽  
Pressure Pain Threshold ◽  
Low Back ◽  
Pressure Pain ◽  
Upper Thoracic

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

scholarly journals A New Protocol to Evaluate the Effect of Topical Anesthesia

2014 ◽  
Vol 61 (4) ◽  
pp. 135-144 ◽  
Author(s):  
Thomas List ◽  
Katerina Mojir ◽  
Peter Svensson ◽  
Maria Pigg
Keyword(s):  
Pain Threshold ◽  
Intraclass Correlation ◽  
Pressure Pain Threshold ◽  
Test Site ◽  
Test Protocol ◽  
Double Blind ◽  
Retest Reliability ◽  
Needle Penetration ◽  
Before And After ◽  
Test Retest Reliability

Abstract This double-blind, placebo-controlled, randomized cross-over clinical experimental study tested the reliability, validity, and sensitivity to change of punctuate pain thresholds and self-reported pain on needle penetration. Female subjects without orofacial pain were tested in 2 sessions at 1- to 2-week intervals. The test site was the mucobuccal fold adjacent to the first upper right premolar. Active lidocaine hydrochloride 2% (Dynexan) or placebo gel was applied for 5 minutes, and sensory testing was performed before and after application. The standardized quantitative sensory test protocol included mechanical pain threshold (MPT), pressure pain threshold (PPT), mechanical pain sensitivity (MPS), and needle penetration sensitivity (NPS) assessments. Twenty-nine subjects, mean (SD) age 29.0 (10.2) years, completed the study. Test-retest reliability intraclass correlation coefficient at 10-minute intervals between examinations was MPT 0.69, PPT 0.79, MPS 0.72, and NPS 0.86. A high correlation was found between NPS and MPS (r = 0.84; P < .001), whereas NPS and PPT were not significantly correlated. The study found good to excellent test-retest reliability for all measures. None of the sensory measures detected changes in sensitivity following lidocaine 2% or placebo gel. Electronic von Frey assessments of MPT/MPS on oral mucosa have good validity.

Changes in Pressure Pain Threshold in Patients With Chronic Nonspecific Low Back Pain

Spine ◽  
2013 ◽  
Vol 38 (24) ◽  
pp. 2098-2107 ◽  
Author(s):  
Marta Imamura ◽  
Janini Chen ◽  
Suely Reiko Matsubayashi ◽  
Rosa A. Targino ◽  
Fábio Marcon Alfieri ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pain Threshold ◽  
Pressure Pain Threshold ◽  
Low Back ◽  
Pressure Pain

scholarly journals Spectroscopic differences in posterior insula in patients with chronic temporomandibular pain

2018 ◽  
Vol 18 (3) ◽  
pp. 351-361 ◽  
Author(s):  
Kristin Harfeldt ◽  
Louise Alexander ◽  
Julia Lam ◽  
Sven Månsson ◽  
Hans Westergren ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Temporal Summation ◽  
Pain Threshold ◽  
Pressure Pain Threshold ◽  
Mouth Opening ◽  
Insular Cortex ◽  
Pressure Pain ◽  
Metabolite Concentrations ◽  
Posterior Insula ◽  
New Evidence

Abstract Background and aims Chronic pain including temporomandibular disorder (TMD) pain involves a complex interplay between peripheral and central sensitization, endogenous modulatory pathways, cortical processing and integration and numerous psychological, behavioral and social factors. The aim of this study was to compare spectroscopic patterns of N-Acetyl-aspartate (NAA), total creatine (tCr), choline (Cho), myo-inositol (MI), glutamate (Glu), and the combination of Glu and glutamine in the posterior insula in patients with chronic generalized or regional chronic TMD pain (gTMD and rTMD, respectively) compared to healthy individuals (HI) in relation to clinical findings of TMD pain. Methods Thirty-six female patients with chronic rTMD or gTMD with at least 3 months duration were included in the study. Ten healthy women were included as controls. All participants completed a questionnaire that comprised assessment of degrees of depression, anxiety, stress, catastrophizing, pain intensity, disability and locations. A clinical Diagnostic Criteria for Temporomandibular Disorders examination that comprised assessment of pain locations, headache, mouth opening capacity, pain on mandibular movement, pain on palpation and temporomandibular joint noises was performed. Pressure-pain threshold (PPT) over the masseter muscle and temporal summation to pressure stimuli were assessed with an algometer. Within a week all participants underwent non-contrast enhanced MRI on a 3T MR scanner assessing T1-w and T2-w fluid attenuation inversion recovery. A single-voxel 1H-MRS examination using point-resolved spectroscopy was performed. The metabolite concentrations of NAA, tCr, Cho, MI, Glu and Glx were analyzed with the LC model. Metabolite levels were calculated as absolute concentrations, normalized to the water signal. Metabolite concentrations were used for statistical analysis from the LC model if the Cramér–Rao bounds were less than 20%. In addition, the ratios NAA/tCr, Cho/tCr, Glu/tCr and MI/tCr were calculated. Results The results showed significantly higher tCr levels within the posterior insula in patients with rTMD or gTMD pain than in HI (p=0.029). Cho was negatively correlated to maximum mouth opening capacity with or without pain (rs=−0.42, n=28, p=0.031 and rs=−0.48, n=28, p=0.034, respectively) as well as pressure-pain threshold on the hand (rs=−0.41, n=28, p=0.031). Glu was positively correlated to temporal summation to painful mechanical stimuli (rs=0.42, n=26, p=0.034). Conclusions The present study found that increased concentrations of Cho and Glu in the posterior insular cortex is related to clinical characteristics of chronic TMD pain, including generalized pain. These findings provide new evidence about the critical involvement of the posterior insular cortex and the neurobiology underlying TMD pain in both regional and generalized manifestations. Implications The findings in this study have indirect implications for the diagnosis and management of TMD patients. That said, the findings provide new evidence about the critical involvement of the posterior insular cortex and the neurobiology underlying TMD pain in both regional and generalized manifestations. It is also a further step towards understanding and accepting chronic pain as a disorder in itself.

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