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

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

Pain Research and Management ◽

10.1155/2012/610561 ◽

2012 ◽

Vol 17 (2) ◽

pp. 98-102 ◽

Cited By ~ 93

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.

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Central and peripheral pain sensitization during an ultra-marathon competition

Scandinavian Journal of Pain ◽

10.1515/sjpain-2018-0079 ◽

2018 ◽

Vol 18 (4) ◽

pp. 703-709 ◽

Cited By ~ 3

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.

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

Medicinski pregled ◽

10.2298/mpns1904066k: ◽

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.

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Test-retest reliability of pressure pain threshold and heat pain threshold as test stimuli for evaluation of conditioned pain modulation

Neurophysiologie Clinique ◽

10.1016/j.neucli.2021.06.005 ◽

2021 ◽

Author(s):

Milena Kovacevic ◽

Ljiljana Klicov ◽

Dragana Vuklis ◽

Randy Neblett ◽

Aleksandar Knezevic

Keyword(s):

Pain Threshold ◽

Pressure Pain Threshold ◽

Pain Modulation ◽

Conditioned Pain Modulation ◽

Heat Pain ◽

Retest Reliability ◽

Pressure Pain ◽

Heat Pain Threshold ◽

Test Retest Reliability

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Percutaneous Fascia Release for Treating Chronic Recurrent Gluteal Myofascial Pain—A Pilot Study of a New Technique

Rehabilitation Process and Outcome ◽

10.4137/rpo.s30483 ◽

2015 ◽

Vol 4 ◽

pp. RPO.S30483 ◽

Cited By ~ 1

Author(s):

Hsin-Shui Chen ◽

Ming-Ta Lin ◽

Chang-Zern Hong ◽

Yueh-Ling Hsieh ◽

Li-Wei Chou

Keyword(s):

Pilot Study ◽

Pain Intensity ◽

Pain Threshold ◽

Myofascial Pain ◽

Pressure Pain Threshold ◽

Small Sample ◽

Myofascial Trigger Points ◽

Pressure Pain ◽

Hip Abduction ◽

Abduction Strength

Objective To investigate the therapeutic effectiveness of percutaneous fascia release to treat chronic recurrent gluteal myofascial pain related to recurrent tendonitis or bursitis at the attachment sites. Methods Five patients (three males, two females; aged 48.6 ± 8.9 years) with myofascial trigger points in the gluteus medius muscle were treated. Outcome measures, including pain intensity, pressure pain threshold, and the relative strength of hip abduction, were assessed before, immediately after, and six months after the treatment. The data measured before and after treatment (different times) on visual analog scale, pressure pain threshold, and relative hip abduction strength were analyzed by Wilcoxon signed-rank test and paired t-test, respectively, for the comparisons between time points. Results Reduction in pain intensity and increase in the pressure pain threshold and the relative hip abduction strength were found in all five patients after treatment when compared with those of before treatment ( P < 0.05). Moreover, all of these improvements existed for at least six months ( P > 0.05). Conclusions Percutaneous fascia release of gluteal muscle insertion sites can be used to treat chronic gluteal pain related to subtrochanteric bursitis to avoid recurrence, if other treatment cannot control the recurrence, although this was demonstrated only on a small sample size without control and blind assessment in the pilot study.

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The Distinction of Hot Herbal Compress, Hot Compress, and Topical Diclofenac as Myofascial Pain Syndrome Treatment

Journal of Evidence-Based Integrative Medicine ◽

10.1177/2156587217753451 ◽

2018 ◽

Vol 23 ◽

pp. 215658721775345 ◽

Cited By ~ 1

Author(s):

Jurairat Boonruab ◽

Netraya Nimpitakpong ◽

Watchara Damjuti

Keyword(s):

Quality Of Life ◽

Pain Intensity ◽

Range Of Motion ◽

Pain Threshold ◽

Pressure Pain Threshold ◽

Pressure Pain ◽

Cervical Range Of Motion ◽

Topical Diclofenac ◽

Hot Compress

This randomized controlled trial aimed to investigate the distinctness after treatment among hot herbal compress, hot compress, and topical diclofenac. The registrants were equally divided into groups and received the different treatments including hot herbal compress, hot compress, and topical diclofenac group, which served as the control group. After treatment courses, Visual Analog Scale and 36-Item Short Form Health survey were, respectively, used to establish the level of pain intensity and quality of life. In addition, cervical range of motion and pressure pain threshold were also examined to identify the motional effects. All treatments showed significantly decreased level of pain intensity and increased cervical range of motion, while the intervention groups exhibited extraordinary capability compared with the topical diclofenac group in pressure pain threshold and quality of life. In summary, hot herbal compress holds promise to be an efficacious treatment parallel to hot compress and topical diclofenac.

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Myalgia in 30 Patients with Suspected Myopathy

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17072502 ◽

2020 ◽

Vol 17 (7) ◽

pp. 2502

Author(s):

Diana Lehmann Urban ◽

Elizabeth Lehmann ◽

Leila Motlagh Scholle ◽

Torsten Kraya

Keyword(s):

Pain Intensity ◽

Polymyalgia Rheumatica ◽

Pain Sensitivity ◽

Pain Threshold ◽

Neuromuscular Disorders ◽

Pressure Pain Threshold ◽

Neuromuscular Disorder ◽

Weak Correlation ◽

Pressure Pain ◽

Significant Difference

Background: In patients with neuromuscular disorder, only little data of myalgia frequency and characterization exists. To date, only a weak correlation between pain intensity and pressure pain threshold has been found, and it remains enigmatic whether high pain intensity levels are equivalent to high pain sensitivity levels in neuromuscular disorders. Methods: 30 sequential patients with suspected neuromuscular disorder and myalgia were analyzed with regard to myalgia characteristics and clinical findings, including symptoms of depression and anxiety and pain- threshold. Results: A neuromuscular disorder was diagnosed in 14/30 patients. Muscular pain fasciculation syndrome (MPFS) without evidence for myopathy or myositis was diagnosed in 10/30 patients and 6/30 patients were diagnosed with pure myalgia without evidence for a neuromuscular disorder (e.g., myopathy, myositis, MPFS, polymyalgia rheumatica). Highest median pain scores were found in patients with pure myalgia and polymyalgia rheumatica. Pressure pain threshold measurement showed a significant difference between patients and controls in the biceps brachii muscle. Conclusion: Only a weak correlation between pain intensity and pressure pain threshold has been suggested, which is concordant with our results. The hypothesis that high pain intensity levels are equivalent to high pain sensitivity levels was not demonstrated.

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Percutaneous Soft Tissue Release for Treating Chronic Recurrent Myofascial Pain Associated with Lateral Epicondylitis: 6 Case Studies

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2012/142941 ◽

2012 ◽

Vol 2012 ◽

pp. 1-7 ◽

Cited By ~ 4

Author(s):

Ming-Ta Lin ◽

Li-Wei Chou ◽

Hsin-Shui Chen ◽

Mu-Jung Kao

Keyword(s):

Soft Tissue ◽

Pain Intensity ◽

Pain Threshold ◽

Myofascial Pain ◽

Pressure Pain Threshold ◽

Lateral Epicondylitis ◽

Soft Tissue Release ◽

Recurrent Pain ◽

Myofascial Trigger Points ◽

Pressure Pain

Objective. The purpose of this pilot study is to investigate the effectiveness of the percutaneous soft tissue release for the treatment of recurrent myofascial pain in the forearm due to recurrent lateral epicondylitis.Methods. Six patients with chronic recurrent pain in the forearm with myofascial trigger points (MTrPs) due to chronic lateral epicondylitis were treated with percutaneous soft tissue release of Lin’s technique. Pain intensity (measured with a numerical pain rating scale), pressure pain threshold (measured with a pressure algometer), and grasping strength (measured with a hand dynamometer) were assessed before, immediately after, and 3 months and 12 months after the treatment.Results. For every individual case, the pain intensity was significantly reduced(P<0.01)and the pressure pain threshold and the grasping strength were significantly increased(P<0.01)immediately after the treatment. This significant effectiveness lasts for at least one year.Conclusions. It is suggested that percutaneous soft tissue release can be used for treating chronic recurrent lateral epicondylitis to avoid recurrence, if other treatment, such as oral anti-inflammatory medicine, physical therapy, or local steroid injection, cannot control the recurrent pain.

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

Physical Therapy ◽

10.2522/ptj.20120256 ◽

2013 ◽

Vol 93 (6) ◽

pp. 748-756 ◽

Cited By ~ 36

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.

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