scholarly journals Clinical Pressure Pain Threshold Testing in Neck Pain: Comparing Protocols, Responsiveness, and Association With Psychological Variables

2014 ◽  
Vol 94 (6) ◽  
pp. 827-837 ◽  
Author(s):  
David M. Walton ◽  
Lenerdene Levesque ◽  
Martin Payne ◽  
Julie Schick
Keyword(s):  
Neck Pain ◽  
Repeated Measures ◽  
Pain Threshold ◽  
Intraclass Correlation ◽  
Pressure Pain Threshold ◽  
Measurement Properties ◽  
Psychological Variables ◽  
Pressure Pain ◽  
Psychological Constructs ◽  
Significant Variance

Background Quantitative sensory testing, including pressure pain threshold (PPT), is seeing increased use in clinical practice. In order to facilitate clinical utility, knowledge of the properties of the tool and interpretation of results are required. Objectives This observational study used a clinical sample of people with mechanical neck pain to determine: (1) the influence of number of testing repetitions on measurement properties, (2) reliability and minimum clinically important difference, and (3) associations between PPT and key psychological constructs. Design This study was observational with both cross-sectional and prospective elements. Methods Experienced clinicians measured PPT in patients with mechanical neck pain following a standardized protocol. Subcohorts also provided repeated measures and completed scales of key psychological constructs. Results The total sample was 206 participants, but not all participants provided data for all analyses. Interrater and 1-week test-retest reliability were excellent (intraclass correlation coefficients [2,1]=.75–.95). Potentially important differences in reliability and PPT scores were found when using only 1 or 2 repeated measures compared with all 3. The PPT over a distal location (tibialis anterior muscle) was not adequately responsive in this sample, but the local site (upper trapezius muscle) was responsive and may be useful as part of a protocol to evaluate clinical change. Sensitivity values (range=0.08–0.50) and specificity values (range=0.82–0.97) for a range of change scores are presented. Depression, catastrophizing, and kinesiophobia were able to explain small but statistically significant variance in local PPT (3.9%–5.9%), but only catastrophizing and kinesiophobia explained significant variance in the distal PPT (3.6% and 2.9%, respectively). Limitations Limitations of the study include multiple raters, unknown recruitment rates, and unknown measurement properties at sites other than those tested here. Conclusions The results suggest that PPT is adequately reliable and that 3 measurements should be taken to maximize measurement properties. The variance explained by the psychological variables was small but significant for 3 constructs related to catastrophizing, depression, and fear of movement. Clinical implications for application and interpretation of PPT are discussed.

scholarly journals A novel metric of reliability in pressure pain threshold measurement

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Bernard Liew ◽  
Ho Yin Lee ◽  
David Rügamer ◽  
Alessandro Marco De Nunzio ◽  
Nicola R. Heneghan ◽  
...  
Keyword(s):  
Mixed Models ◽  
Variance Components ◽  
Pain Threshold ◽  
Intraclass Correlation ◽  
Pressure Pain Threshold ◽  
Total Variance ◽  
Lumbar Region ◽  
Pressure Pain ◽  
Pressure Algometer ◽  
Testing Protocols

AbstractThe inter-session Intraclass Correlation Coefficient (ICC) is a commonly investigated and clinically important metric of reliability for pressure pain threshold (PPT) measurement. However, current investigations do not account for inter-repetition variability when calculating inter-session ICC, even though a PPT measurement taken at different sessions must also imply different repetitions. The primary aim was to evaluate and report a novel metric of reliability in PPT measurement: the inter-session-repetition ICC. One rater recorded ten repetitions of PPT measurement over the lumbar region bilaterally at two sessions in twenty healthy adults using a pressure algometer. Variance components were computed using linear mixed-models and used to construct ICCs; most notably inter-session ICC and inter-session-repetition ICC. At 70.1% of the total variance, the source of greatest variability was between subjects ($${\sigma }_{subj}^{2}$$ σ subj 2 = 222.28 N2), whereas the source of least variability (1.5% total variance) was between sessions ($${\sigma }_{sess}^{2}$$ σ sess 2 = 4.83 N2). Derived inter-session and inter-session-repetition ICCs were 0.88 (95%CI: 0.77 to 0.94) and 0.73 (95%CI: 0.53 to 0.84) respectively. Inter-session-repetition ICC provides a more conservative estimate of reliability than inter-session ICC, with the magnitude of difference being clinically meaningful. Quantifying individual sources of variability enables ICC construction to be reflective of individual testing protocols.

Reliability of pressure pain threshold testing in healthy pain free young adults

2015 ◽  
Vol 9 (1) ◽  
pp. 38-41 ◽  
Author(s):  
Robert Waller ◽  
Leon Straker ◽  
Peter O’Sullivan ◽  
Michele Sterling ◽  
Anne Smith
Keyword(s):  
Lumbar Spine ◽  
Interrater Reliability ◽  
Statistical Power ◽  
Pain Threshold ◽  
A Priori ◽  
Intraclass Correlation ◽  
Pressure Pain Threshold ◽  
Systematic Bias ◽  
Pressure Pain ◽  
Study Support

AbstractBackground and aimsInvestigation of the multidimensional correlates of pressure pain threshold (PPT) requires the study of large cohorts, and thus the use of multiple raters, for sufficient statistical power. Although PPT testing has previously been shown to be reliable, the reliability of multiple raters and investigation for systematic bias between raters has not been reported.The aim of this study was to evaluate the intrarater and interrater reliability of PPT measurement by handheld algometer at the wrist, leg, cervical spine and lumbar spine. Additionally the study aimed to calculate sample sizes required for parallel and cross-over studies for various effect sizes accounting for measurement error.MethodsFive research assistants (RAs) each tested 20 pain free subjects at the wrist, leg, cervical and lumbar spine. Intraclass correlation coefficient (ICC), standard error of measurement (SEM) and systematic bias were calculated.ResultsBoth intrarater reliability (ICC = 0.81–0.99) and interrater reliability (ICC = 0.92–0.95) were excellent and intrarater SEM ranged from 79 to 100 kPa. There was systematic bias detected at three sites with no single rater tending to consistently rate higher or lower than others across all sites.ConclusionThe excellent ICCs observed in this study support the utility of using multiple RAs in large cohort studies using standardised protocols, with the caveat that an absence of any confounding of study estimates by rater is checked, due to systematic rater bias identified in this study.ImplicationsThorough training of raters using PPT results in excellent interrater reliability. Clinical trials using PPT as an outcome measure should utilise a priori sample size calculations.

Immediate Effects of Active Versus Passive Scapular Correction on Pain and Pressure Pain Threshold in Patients With Chronic Neck Pain

2014 ◽  
Vol 37 (9) ◽  
pp. 660-666 ◽  
Author(s):  
Enrique Lluch ◽  
Maria Dolores Arguisuelas ◽  
Otilia Calvente Quesada ◽  
Estibaliz Martínez Noguera ◽  
Marta Peiró Puchades ◽  
...  
Keyword(s):  
Neck Pain ◽  
Pain Threshold ◽  
Pressure Pain Threshold ◽  
Chronic Neck Pain ◽  
Pressure Pain

scholarly journals Cluster Analysis of an International Pressure Pain Threshold Database Identifies 4 Meaningful Subgroups of Adults With Mechanical Neck Pain

2017 ◽  
Vol 33 (5) ◽  
pp. 422-428 ◽  
Author(s):  
David M. Walton ◽  
Timothy S.H. Kwok ◽  
Swati Mehta ◽  
Eldon Loh ◽  
Ashley Smith ◽  
...  
Keyword(s):  
Cluster Analysis ◽  
Neck Pain ◽  
Pain Threshold ◽  
Pressure Pain Threshold ◽  
Pressure Pain ◽  
International Pressure

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.

scholarly journals Associations between pressure pain threshold in the neck and postural control in patients with dizziness or neck pain – a cross-sectional study

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Mari K. Knapstad ◽  
Frederik K. Goplen ◽  
Tove Ask ◽  
Jan S. Skouen ◽  
Stein Helge G. Nordahl
Keyword(s):  
Neck Pain ◽  
Postural Control ◽  
Inverse Relationship ◽  
Pain Threshold ◽  
Postural Sway ◽  
Pressure Pain Threshold ◽  
Pain Thresholds ◽  
Pressure Pain ◽  
Pressure Pain Thresholds ◽  
Lower Neck

Abstract Background It is theorized that neck pain may cause reduced postural control due to the known physiological connection between the receptors in the cervical spine and the vestibular system. The purpose of this study was to examine whether the pressure pain threshold in the neck is associated with postural sway in patients with dizziness or neck pain. Methods Consecutive patients with dizziness (n = 243) and neck pain (n = 129) were recruited from an otorhinolaryngological department and an outpatient spine clinic, respectively. All subjects underwent static posturography. Pressure pain thresholds were measured at four standardized points in the neck, and generalized pain was assessed using the American College of Rheumatology tender points. The relationship between postural sway and pressure pain threshold was analyzed by linear regression, and the covariates included age, sex, and generalized pain. Results In the dizzy group, there was a small, inverse relationship between pressure pain thresholds and sway area with eyes closed, after adjusting for age, sex, and generalized pain (bare platform; lower neck, p = 0.002, R2 = 0.068; upper neck, p = 0.038, R2 = 0.047; foam rubber mat; lower neck, p = 0.014, R2 = 0.085). The same inverse relationship was found between pressure pain thresholds in the neck and the Romberg ratio on a bare platform after adjusting for age, sex and generalized pain (upper neck, p = 0.15, R2 = 0.053; lower neck, p = 0.002, R2 = 0.069). Neither of these relationships were present in the neck pain group. Conclusion Our findings indicate that the pressure pain threshold in the neck is associated with postural sway in patients suffering from dizziness after adjusting for age, sex, and generalized pain, but only with closed eyes. The association was small and should be interpreted with caution. Trial registration Trial registration: Clinicaltrial.gov NCT03531619. Retrospectively registered 22 May 2018.

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