Pressure pain thresholds in children before and after surgery: a prospective study

AbstractBackground and aimsThis prospective study aimed to assess pressure pain thresholds (PPTs) by pressure algometry and the correlation to postoperative pain in children undergoing orthopaedic surgery. We hypothesized, that the PPTs would decline immediately after elective orthopaedic surgery and return to baseline values at follow-up.MethodsThirty children aged 6–16 years were included. PPTs and intensity of pain (Numerical Rating Scale, NRS) were assessed 3–6 weeks before surgery (baseline), 1–2 h before surgery (Day 0), the first postoperative day (Day 1) and 6–12 weeks after surgery (Follow-up).ResultsA significant difference of PPTs between the four assessments was seen using the Friedman test for detecting differences across multiple tests and Wilcoxon signed-rank test with a Bonferroni adjustment. The changes in PPTs between baseline (PPTcrus = 248 kPa, PPTthenar = 195 kPa) and day 1 (PPTcrus = 146 kPa, PPTthenar = 161 kPa) showed a decline of PPTs as hypothesized (Zcrus = 2.373, p = 0.018; Zthenar = 0.55, p = 0.581). More surprisingly, a significant decrease in PPTs between baseline and day 0, just before surgery (PPTcrus = 171 kPa, PPTthenar = 179 kPa), was also measured (Zcrus = 2.475, p = 0.013; Zthenar = 2.414, p = 0.016). PPTs were positively correlated to higher age, weight and height; but not to NRS or opioid equivalent use.ConclusionsChildren undergoing orthopaedic surgery demonstrate significant changes in PPTs over time. The PPTs decrease significantly between baseline and day 0, further decreases the first day postoperatively and returns to baseline values at follow-up. This suggests that other factors than surgery modulate the threshold for pain.ImplicationsAwareness of pressure pain thresholds may help identify children with affected pain perception and hence improve future pain management in children undergoing orthopaedic surgery. Factors as for example anticipatory anxiety, psychological habitus, expected pain, catastrophizing, distraction, physical activity, patient education and preoperative pain medication might play a role in the perception of pain and need further investigation.

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The Relationship between Fibromyalgia and Pressure Pain Threshold in Patients with Dyspareunia

Pain Research and Management ◽

10.1155/2015/302404 ◽

2015 ◽

Vol 20 (3) ◽

pp. 137-140 ◽

Cited By ~ 7

Author(s):

Hasan Terzi ◽

Rabia Terzi ◽

Ahmet Kale

Keyword(s):

Beck Depression Inventory ◽

Pain Threshold ◽

Pressure Pain Threshold ◽

Control Group ◽

Tender Points ◽

Pain Thresholds ◽

Pressure Pain ◽

Pressure Pain Thresholds ◽

Pressure Algometer ◽

Significant Difference

OBJECTIVE: To evaluate the number of tender points, pressure pain threshold and presence of fibromyalgia among women with or without dyspareunia.METHODS: The present cross-sectional study included 40 patients with dyspareunia and 30 healthy controls. The participants were asked if they had engaged in sexual intercourse during the previous four weeks, and dyspareunia was rated from 0 to 3 based on the Marinoff Dyspareunia Scale. A pressure algometer (dolorimeter) was used to measure the pressure pain threshold. Fibromyalgia was diagnosed based on the 1990 American College of Rheumatology criteria. The depression status of the participants was assessed using the Beck Depression Inventory.RESULTS: No statistically significant difference was found with regard to age, body mass index, habits (alcohol use and smoking), educational status and occupational status between the two groups. Total myalgic score, total control score and tender point mean pain threshold were significantly lower in the group with dyspareunia. The number of tender points was significantly higher in patients with dyspareunia. The mean Beck Depression Inventory score was 14.7 ±8.4 in the dyspareunia group compared with 11.2 ±7.1 in the control group. Five (12.5%) of the patients with dyspareunia were diagnosed with fibromyalgia, whereas no patients in the control group were diagnosed with fibromyalgia. There was no significant difference between the two groups with regard to the presence of fibromyalgia.CONCLUSION: The finding of lower pressure pain thresholds and a higher number of tender points among patients with dyspareunia suggests that these patients may have increased generalized pain thresholds. Additional studies involving a larger number of patients are required to investigate the presence of central mechanisms in the pathogenesis of dyspareunia.

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Acupuncture for Frequent Migraine: A Randomized, Patient/Assessor Blinded, Controlled Trial with One-Year Follow-Up

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2015/920353 ◽

2015 ◽

Vol 2015 ◽

pp. 1-14 ◽

Cited By ~ 6

Author(s):

Yanyi Wang ◽

Charlie Changli Xue ◽

Robert Helme ◽

Cliff Da Costa ◽

Zhen Zheng

Keyword(s):

Controlled Trial ◽

Sham Acupuncture ◽

Manual Acupuncture ◽

Pain Thresholds ◽

Pressure Pain ◽

Pressure Pain Thresholds ◽

One Year ◽

The One

Objectives. This study aimed to evaluate the efficacy and safety of manual acupuncture as a prophylaxis for frequent migraine.Methods. Fifty frequent migraineurs were randomly allocated to receive 16 sessions of either real acupuncture (RA = 26) or sham acupuncture (SA = 24) during 20 weeks. The primary outcomes were days with migraine over four weeks, duration, and intensity of migraine and the number of responders with more than 50% reduction of migraine days. The secondary outcomes were the relief medication, quality of migraine, quality of life, and pressure pain thresholds.Results. The two groups were comparable at baseline. At the end of the treatment, when compared with the SA group, the RA group reported significant less migraine days (RA: 5.2 ± 5.0; SA: 10.1 ± 7.1;P=0.008), less severe migraine (RA: 2.18 ± 1.05; SA: 2.93 ± 0.61;P=0.004), more responders (RA: 19 versus SA: 7), and increased pressure pain thresholds. No other group difference was found. Group differences were maintained at the end of the three-month follow-up, but not at the one-year follow-up. No severe adverse event was reported. Blinding was successful.Discussion. Manual acupuncture was an effective and safe treatment for short-term relief of frequent migraine in adults. Larger trials are warranted.

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Pain perception is altered in patients with medication-overuse headache but can improve after detoxification

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2012.05.067 ◽

2012 ◽

Vol 3 (3) ◽

pp. 198-198

Author(s):

Signe Bruun Munksgaard ◽

Lars Bendtsen ◽

Rigmor Højland Jensen

Keyword(s):

Healthy Volunteers ◽

Central Sensitization ◽

Pain Perception ◽

Medication Overuse ◽

Medication Overuse Headache ◽

Primary Headaches ◽

Pain Thresholds ◽

Pressure Pain ◽

Pressure Pain Thresholds

Abstract Background Previously, central sensitization has been found in chronic, primary headaches but pain perception in MOH patients has only scarcely been studied. Aim To investigate pain perception before and during detoxification in patients with medication overuse headache (MOH). Methods 35 patients with MOH following structured detoxification programmes were tested before and 2, 6 and 12 months after withdrawal and 40 age and sex matched, healthy volunteers were tested for comparison. We measured cephalic and extra cephalic pressure pain thresholds (PPT) and supra-threshold pressure pain (STPP) as well as extra cephalic pain thresholds, supra-threshold pain and wind-up for electrical stimulation. Results At baseline, cephalic and extra cephalic PPTs were significantly lower in patients with MOH compared with healthy volunteers. Cephalic STPP was significantly higher in MOH patients compared with healthy volunteers but decreased significantly from baseline to the 6-month and 12-month follow-up. Supra-threshold pain for a single electrical stimulus was significantly higher in MOH patients compared with healthy volunteers. In contrast to healthy volunteers, patients with MOH did not exhibit wind-up before withdrawal. After 2 months, MOH patients had regained ability to wind-up and this persisted at 6-month and 12-month follow-up. Conclusions Patients with MOH have altered pain sensation and exhibit both allodynia and hyperalgesia indicating central sensitization. Withdrawal from medication overuse causes significant decrease in central sensitization. The ability to wind-up is altered in MOH patients, probably as a consequence of medication overuse, but it can be regained after withdrawal. These findings emphasize the need for detoxification in MOH.

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Pain intensity and pressure pain thresholds after a light dynamic physical load in patients with chronic neck-shoulder pain

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03298-y ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

A. Grimby-Ekman ◽

C. Ahlstrand ◽

B. Gerdle ◽

B. Larsson ◽

H. Sandén

Keyword(s):

Pain Intensity ◽

Shoulder Pain ◽

Perceived Exertion ◽

Rating Scale ◽

Physical Load ◽

Rating Of Perceived Exertion ◽

Pain Thresholds ◽

Pressure Pain ◽

Arm Cycling ◽

Pressure Pain Thresholds

Abstract Background To investigate the development of pain intensity and pressure pain thresholds during and 24 h after a light dynamic physical load among patients with chronic neck-shoulder pain. Methods Twenty-six patients with chronic neck-shoulder pain and 12 healthy controls were included. The participants arm-cycled on an ergometer. Effort was rated with the Borg Rating of Perceived Exertion scale (RPE), and pain intensity with an numeric rating scale (NRS). Pressure pain thresholds were measured by an algometer. Participants started a pain diary 1 week before the physical exercise and continued until 1 week after. Pain intensity was assessed before, during and the following two evenings after arm-cycling. Pressure pain thresholds were assessed before, 15 min after, 105 min after and 24 h after. Results The chronic pain group showed increased pain intensity during, and the following two evenings after the arm cycling, and decreased pain thresholds immediately after the arm cycling involving painful regions. In the patient group there were no impact on pain thresholds in the neck the following day. Conclusions Patients with chronic neck-shoulder pain reported increased pain intensity during and in the evenings after a light dynamic load involving painful regions. In addition, they showed decreased pain thresholds close to the exercise, indicating mechanical hyperalgesia.

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Modulation of central sensitisation by detoxification in MOH: Results of a 12-month detoxification study

Cephalalgia ◽

10.1177/0333102412475235 ◽

2013 ◽

Vol 33 (7) ◽

pp. 444-453 ◽

Cited By ~ 26

Author(s):

Signe B Munksgaard ◽

Lars Bendtsen ◽

Rigmor H Jensen

Keyword(s):

Temporal Summation ◽

Pain Perception ◽

Threshold Pressure ◽

Healthy Controls ◽

Central Sensitisation ◽

Pain Thresholds ◽

Pressure Pain ◽

Pain Scores ◽

Pressure Pain Thresholds

Background Human and animal models suggest that central sensitisation plays a role in medication-overuse headache (MOH). We aimed to study pain perception in MOH patients before and a year after withdrawal. Methods We examined pain perception in 35 MOH patients before and two, six and 12 months after detoxification. For baseline comparison, we tested 40 healthy controls. We measured cephalic and extra-cephalic pressure-pain thresholds and supra-threshold pressure-pain scores and extra-cephalic pain thresholds, supra-threshold pain scores and temporal summation for electrical stimulation. Results Of the 35 patients, 21 patients completed the entire study and remained cured of MOH. Statistically significant differences between patients and healthy controls were found in cephalic pressure-pain thresholds (137.3 kPa vs. 170 kPa, p < 0.05), extra-cephalic pressure pain thresholds (213.3 vs. 274.3 kPa, p < 0.05), in cephalic supra-threshold pressure-pain scores measured on a 100 mm visual analogue scale (61 vs. 27 mm, p < 0.05) and extra-cephalic supra-threshold pain scores for electrical stimulation (19.0 vs. 10.0 mm, p < 0.05). Cephalic supra-threshold pain scores decreased statistically significantly from 50.3 mm at baseline to 28.0 mm at the 12-month follow-up. In contrast to controls, temporal summation was not found in MOH patients before withdrawal, but after detoxification temporal summation normalised. Conclusion The central nervous system is sensitised in patients with MOH. For the first time we demonstrate that the pain perception continues to normalise up to a year after detoxification. This emphasises the importance of detoxification and follow-up to prevent relapse.

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Effects of Virtual Reality-Based Exercise Imagery on Pain in Healthy Individuals

BioMed Research International ◽

10.1155/2019/5021914 ◽

2019 ◽

Vol 2019 ◽

pp. 1-9 ◽

Cited By ~ 5

Author(s):

Kazuhiro Hayashi ◽

Shuichi Aono ◽

Yukiko Shiro ◽

Takahiro Ushida

Keyword(s):

Virtual Reality ◽

Controlled Trial ◽

Advanced Technology ◽

Heat Pain ◽

Pain Thresholds ◽

Pressure Pain ◽

Pressure Pain Thresholds ◽

Heat Pain Threshold ◽

Significant Difference ◽

Exercise Imagery

Objective. Virtual reality (VR) is an advanced technology that can be used to attenuate pain. The present study aimed to investigate which method was more effective for pain management: VR combined with exercise imagery or VR distraction. Methods. Fifty-two healthy students participated in this randomized cross-over controlled trial. One VR-based task aimed to passively use the imagery of driving a car as a distraction intervention (the driving group), whereas the other VR-based task aimed to use exercise imagery (running) to actively engage the participants in movement (the running group). The mechanical pressure pain thresholds of the quadriceps and forearm and the heat pain threshold of the hand of each subject were measured before, during, and after each VR task. The differences between the values at each time point and the differences between the groups were analyzed. Results. The pressure and heat pain thresholds were significantly greater during VR task than those before VR task in both driving and running groups. The changes in the pressure pain thresholds that occurred during VR task were significantly higher in the running group than in the driving group. The difference between groups gradually declined after VR task. Conversely, there was no significant difference in the changes in the heat pain thresholds between the groups both during VR task and after VR task. Conclusions. VR combined with exercise imagery has a greater effect on pressure pain thresholds, but not heat pain thresholds, than VR distraction.

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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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