Pressure pain thresholds in university students with undertreated neck pain: comparison with asymptomatic individuals, reliability and measurement error

The reliability of pressure pain threshold in individuals with low back or neck pain: a systematic review

Background and Objective

Low-back and neck pain affect a great number of individuals worldwide. The pressure pain threshold has the potential to be a useful quantitative measure of mechanical pain in a clinical setting, if it proves to be reliable in this population. The objectives of this systematic review are to: (1) analyze the literature evaluating the reliability of pressure pain threshold (PPT) measurements in the assessment of neck and low-back pain, (2) summarize the evidence from these studies, and (3) characterize the limitations of PPT measurement.

Databases and Data Treatment

Relevant literature from PubMed and the Web of Science electronic databases were screened in a 3-step process according to inclusion/exclusion criteria. Relevant studies were assessed for risk of bias using the Quality Appraisal of Reliability Studies (QAREL) tool, and results of all studies were summarized and tabulated.

Results

Of 922 citations identified, 11 studies were deemed relevant for critical appraisal, and 8 studies were deemed to have low risk-of bias. Intra-rater reliability, reported in all studies (n = 637) and inter-rater reliability, reported in 2 studies (n = 200) were consistently reported to be good to excellent (ICC 0.75-0.99 and ICC 0.81-0.90, respectively). Studies were also found to have significant variation in PPT measurement procedures.

Conclusions

Though intra- and inter-rater reliability was found to be high in all studies, the variation in PPT measurement protocols could affect validity and absolute reliability. As such, it is recommended that standard guidelines be developed for clinical use.

Impact of a 10-min typing task in the development of trapezius myalgia: a preliminary observational study

Objectives. Computer use, as in typing, might contribute to trapezius myalgia (TM) development by increasing upper trapezius (UT) muscle fatigue. The purpose of this study is to investigate whether 10 min of performing a typing task by a population at risk would show significant changes in surface electromyography (sEMG) and pressure pain threshold (PPT) measurements. Supported and unsupported forearms postures are compared. Methods. Sixteen asymptomatic volunteers with minimum daily use of a computer of 5 h were randomized into two groups: fully supported forearms (n = 8) and unsupported forearms (n = 8). The protocol consisted of 10 min of a typing task, and the workstation was set according to the usual participant profile. sEMG and PPT readings were collected from both UT muscles. Results. PPT and sEMG readings were not significantly different among the two groups. Supported forearms had less reduction of PPT and a smaller increase in electrical activity. Conclusions. Ten minutes of typing seems insufficient to observe any significant changes that could lead to TM development.

Pressure sensitivity for head, face and neck in relation to soft tissue

Pressure sensitivity research on the head, face, and neck is critical to develop ways to reduce discomfort caused by pressure in head-related products. The aim of this paper is to provide information for designers to be able to reduce the pressure discomfort by studying the relation between pressure sensitivity and soft tissue in the head, face and neck. We collected pressure discomfort threshold (PDT) and pressure pain threshold (PPT) from 119 landmarks (unilateral) for 36 Chinese subjects. Moreover, soft tissue thickness data on the head, face and neck regions of 50 Chinese people was obtained through CT scanning while tissue deformation data under the PDT and PPT states was obtained from literature. The results of the three-elements correlation analysis revealed that soft tissue thickness is positively correlated with deformation but not an important factor in pressure sensitivity. Our high-precision pressure sensitivity maps confirm earlier findings of more rough pressure sensitivity studies, while also revealing additional fine scale sensitivity differences. Finally, based on the findings, a high-precision "recommended map" of the optimal stress-bearing area of the head, face and neck was generated.

A protocol for a randomized trial on pain neuroscience education vs. routine physical therapy in people with chronic neck pain

The aim of this study is to investigate the effects of combining routine physical therapy with pain neuroscience education (PNE) on psychosocial factors, physical performance, and the experienced pain in patients with chronic neck pain (CNP). This study is a double-blind randomized clinical trial in which patients will be randomly allocated to two groups, routine physical therapy with and without PNE. Patients will be assessed at the baseline, post intervention, and three months later. The results of this research will be used to establish effectiveness of treatment strategies for CNP. Due to the rigorous scientific methods used in this research, the suggested interventions would be clinically applicable in the health care systems.

Effect of manual therapy with exercise in patients with chronic cervical radiculopathy: a randomized clinical trial

BACKGROUND

Research that has examined the effects of cervical spine mobilization on hypoesthesia and hypersensitivity characteristics in patients with cervical radiculopathy is scarce. The aim of this study was to examine the short-term effects of vertebral mobilization on the sensory features in patients with cervical radiculopathy.

METHODS

Twenty-eight participants with chronic cervical radiculopathy were randomly allocated to (1) an experimental group [cervical vertebral mobilization technique and exercise] or (2) a comparison group [minimal superficial circular pressure on the skin and exercise]. Participants received a total of 6 sessions for 3-5 weeks. Numeric Pain Rating Scale (NPRS), Neck Disability Index (NDI), pressure pain threshold (PPT), heat/cold pain threshold (HPT/CPT), and active cervical range of motion (ROM) were measured at baseline immediately after the first session and after the sixth session.

RESULTS

The experimental group showed improvements from baseline to session 6 in NPRS [mean difference 2.6; 95% confidence interval: -4.6, -0.7], NDI [14; -23.3, -4.3], and active cervical ROM in extension [14°; 2.3, 25.5], rotation [16°; 8.8, 22.5], and lateral flexion to the affected side [10°; 2.3, 16.8]. Improvements were also found in PPT at the neck [124 kPa; 57, 191.1] and C7 level at the hand [99 kPa; 3.6, 194.9]. There were no changes in the HPT and CPT at any tested area (P>0.050).

CONCLUSIONS

Cervical vertebral mobilization for patients with chronic cervical radiculopathy reduced localized mechanical, but not thermal, pain hypersensitivity.

TRIAL REGISTRATION

ClinicalTrials.gov ( NCT03328351 ). Registered on November 1, 2017, retrospectively registered.