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Vesal M, Roohafza H, Feizi A, Asgari K, Shahoon H, Ani A, Adibi P. Pressure algometry in the general adult population: Age and sex differences. Medicine (Baltimore) 2024; 103:e39418. [PMID: 39183389 PMCID: PMC11346871 DOI: 10.1097/md.0000000000039418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 07/31/2024] [Accepted: 08/02/2024] [Indexed: 08/27/2024] Open
Abstract
Experimental pain studies have revealed inter-individual variations in pain perception that are influenced by age, sex, and country of origin. This study aimed to explore the age and sex differences in pressure pain thresholds within the Iranian general population. To assess the pressure pain thresholds, a handheld pressure algometer was applied bilaterally to the middle fingers of both hands. The participants also completed the short form of the McGill Pain Questionnaire to provide a clinical pain rating. This cross-sectional study included 1610 adult subjects (54.96% female, mean age 40.13 ± 10.18 years). The findings indicated that females generally exhibited lower pain thresholds than males when assessing pain detection and tolerance parameters (P < .001). Females also demonstrated a significant lower pressure thresholds and clinical pain ratings compared with men (P < .001). Additionally, significant differences were observed between age groups in terms of pain detection and tolerance thresholds (P = .02 and P = .03, respectively). However, the interaction between sex and age was not significant. No significant differences in pain detection thresholds were observed between the right and left hand (P = .11). This study underscores the potential utility of algometry as a valuable tool for objectifying pain in the Iranian population.
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Affiliation(s)
- Mina Vesal
- Department of Psychology, University of Isfahan, Isfahan, Iran
| | - Hamidreza Roohafza
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Awat Feizi
- Epidemiology and Biostatistics Department, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Karim Asgari
- Department of Psychology, University of Isfahan, Isfahan, Iran
| | - Hassan Shahoon
- Gastroenterology and Hepatology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Ani
- Department of Bioinformatics, School of Advanced Technologies in Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Peyman Adibi
- Gastroenterology and Hepatology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Zingg S, de Graaf M, Hilfiker R. Empowering patients with persistent pain: The potential of cognitive functional therapy in interdisciplinary care: A single-case experimental design. J Bodyw Mov Ther 2024; 38:211-253. [PMID: 38763565 DOI: 10.1016/j.jbmt.2023.11.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 11/24/2023] [Accepted: 11/26/2023] [Indexed: 05/21/2024]
Abstract
INTRODUCTION AND PURPOSE Persistent musculoskeletal pain (PMP) is multifactorial and causes both societal and financial burdens. Integration of multifactorial management in patients with PMP remains challenging. A single-case experimental design was performed on three patients suffering from high impact PMP (lumbar spine, shoulder and knee) to i) assess the potential for Cognitive Functional Therapy (CFT) in interdisciplinary care, ii) describe in detail the clinical journey patients experienced during the intervention, and iii) evaluate the changes and associations in relation to the outcome measures of pain, disability, maladaptive movement behavior, subjective overall improvement, health related quality of life and work status. These were monitored over one year, at the end of each of the six intervention modules. RESULTS After introducing the intervention systematic changes were seen, with medium to large changes (Non-overlap of All Pairs 0.67-1) for all outcome measures. Associations between changes of the outcome measures were large (r ≥ 0.50) and changes occurred concurrently. Minimally clinically important difference thresholds were exceeded for all outcome measures and two patients achieved relevant improvements related to work reintegration. DISCUSSION The positive results of this study are comparable with recent CFT studies. However, the difference regarding the number of sessions and duration of the intervention is evident. The length of the intervention in this study seemed to enable continuous significant improvements up until 12 months post onset and follow-up. CONCLUSION CFT in interdisciplinary care was effective for all measures. The detailed descriptions of the clinical processes aim to improve clinical care.
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Affiliation(s)
- Simone Zingg
- School of Health Professions, Division of Physiotherapy, Bern University of Applied Sciences, Bern, Switzerland.
| | | | - Roger Hilfiker
- Research and Independent Studies in Private Physiotherapy (RISE), Valais, Glis, Switzerland
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3
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War experiences and relationship problems predict pain sensitivity cross-sectionally among patients with chronic primary pain. J Psychosom Res 2023; 168:111209. [PMID: 36898316 DOI: 10.1016/j.jpsychores.2023.111209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 02/15/2023] [Accepted: 02/26/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND Most patients suffering from chronic pain are more susceptible to pain and pressure due to higher pain sensitivity. Since psychosocial factors play a central role in developing and maintaining chronic pain, investigating associations between pain sensitivity and psychosocial stressors promises to advance the biopsychosocial understanding of chronic pain. OBJECTIVES We aimed to replicate Studer et al.'s (2016) findings about associations of psychosocial stressors with pain sensitivity in a new sample of patients with chronic primary pain (ICD-11, MG30.0). METHODS A pain provocation test was used on both middle fingers and earlobes to assess pain sensitivity among 460 inpatients with chronic primary pain. Potentially life-threatening accidents, war experiences, relationship problems, certified inability to work, and adverse childhood experiences were assessed as potential psychosocial stressors. Structural equation modeling was used to investigate associations between psychosocial stressors and pain sensitivity. RESULTS We partially replicated Studer et al.'s findings. Similar to the original study, patients with chronic primary pain showed enhanced pain sensitivity values. Within the investigated group, war experiences (β = 0.160, p < .001) and relationship problems (β = 0.096, p = .014) were associated with higher pain sensitivity. In addition, the control variables of age, sex, and pain intensity also showed a predictive value for higher pain sensitivity. Unlike Studer et al., we could not identify a certified inability to work as a predictor of higher pain sensitivity. CONCLUSIONS This study showed that beyond age, sex, and pain intensity, the psychosocial stressors of war experiences and relationship problems were associated with higher pain sensitivity.
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Hwang UJ, Kwon OY. Influencing factors of pressure pain hypersensitivity of the upper trapezius in food service workers with nonspecific neck/shoulder myofascial pain: A cross-sectional study. Medicine (Baltimore) 2022; 101:e29696. [PMID: 35945777 PMCID: PMC9351888 DOI: 10.1097/md.0000000000029696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
It is unclear which factors contribute to the developing pressure pain hypersensitivity of the upper trapezius, a type of neurophysiological hyperexcitability. The present study investigated the relationship between physical and psychological factors and pressure pain hypersensitivity of the upper trapezius for each sex. In total, 154 individuals with neck/shoulder myofascial pain participated, among 372 food service workers. Participants completed a questionnaire (Beck Depression Inventory, and Borg Rating of Perceived Exertion scale) and were photographed to measure posture. Pressure pain sensitivity, 2 range of motions (cervical lateral bending and rotation), and 4 muscle strengths (serratus anterior, lower trapezius [LT], biceps, and glenohumeral external rotator) were measured by a pressure algometer, iPhone application, and handheld dynamometer, respectively. For each sex, forward multivariate logistic regression was used to test our a priori hypothesis among selected variables that a combination of psychosocial and physical factors contributed to the risk for pressure pain hypersensitivity. In multivariate analyses, LT strength (odds ratio = 0.94, 95% confidence interval = 0.91-0.97, P = .001) was the only significant influencing factor for pressure pain hypersensitivity in men. Dominant painful ipsilateral cervical rotation range of motion (odds ratio = 0.96, 95% confidence interval = 0.92-0.99, P = .037) was the only influencing factor for pressure pain hypersensitivity in women. LT strength and dominant painful ipsilateral cervical rotation range of motion could serve as guidelines for preventing and managing pressure pain hypersensitivity of the upper trapezius in food service workers with nonspecific neck/shoulder myofascial pain.
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Affiliation(s)
- Ui-Jae Hwang
- Department of Physical Therapy, Graduate School, Yonsei University, Wonju, Kangwon-Do, South Korea
| | - Oh-Yun Kwon
- Department of Physical Therapy, College of Health Science, Laboratory of Kinetic Ergocise Based on Movement Analysis, Yonsei University, Wonju, Kangwon-Do, South Korea
- *Correspondence: Oh-Yun Kwon, Department of Physical Therapy, Graduate School, Yonsei University, 234 Maeji-ri, Heungeop-Myeon, Wonju, Kangwon-Do, 220-710, Laboratory of Kinetic Ergocise based on Movement Analysis, Department of Physical Therapy, Graduate School, Yonsei University, Wonju, South Korea (e-mail: )
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den Boer C, Terluin B, van der Wouden JC, Blankenstein AH, van der Horst HE. Tests for central sensitization in general practice: a Delphi study. BMC FAMILY PRACTICE 2021; 22:206. [PMID: 34666688 PMCID: PMC8527602 DOI: 10.1186/s12875-021-01539-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 08/19/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Central sensitization (CS) may explain the persistence of symptoms in patients with chronic pain and persistent physical symptoms (PPS). There is a need for assessing CS in the consultation room. In a recently published systematic review, we made an inventory of tests for CS. In this study we aimed to assess which tests might have added value, might be feasible and thus be suitable for use in general practice. METHODS We conducted a Delphi study consisting of two e-mail rounds to reach consensus among experts in chronic pain and PPS. We invited 40 national and international experts on chronic pain and PPS, 27 agreed to participate. We selected 12 tests from our systematic review and additional searches; panellists added three more tests in the first round. We asked the panellists, both clinicians and researchers, to rate these 15 tests on technical feasibility for use in general practice, added value and to provide an overall judgement for suitability in general practice. RESULTS In two rounds the panellists reached consensus on 14 of the 15 tests: three were included, eleven excluded. Included were the Central Sensitization Inventory (CSI), pressure pain thresholds (PPTs) and monofilaments. No consensus was reached on the Sensory Hypersensitivity Scale. CONCLUSION In a Delphi study among an international panel of experts, three tests for measuring CS were considered to be suitable for use in general practice: the Central Sensitization Inventory (CSI), pressure pain thresholds (PPTs) and monofilaments.
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Affiliation(s)
- Carine den Boer
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam UMC, location VUmc, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Berend Terluin
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam UMC, location VUmc, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Johannes C van der Wouden
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam UMC, location VUmc, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Annette H Blankenstein
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam UMC, location VUmc, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Henriëtte E van der Horst
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam UMC, location VUmc, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
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Carta G, Seregni A, Casamassima A, Galli M, Geuna S, Pagliaro P, Zago M. Validation and Reliability of a Novel Vagus Nerve Neurodynamic Test and Its Effects on Heart Rate in Healthy Subjects: Little Differences Between Sexes. Front Neurosci 2021; 15:698470. [PMID: 34552462 PMCID: PMC8450330 DOI: 10.3389/fnins.2021.698470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 07/21/2021] [Indexed: 11/24/2022] Open
Abstract
Background The vagus nerve (VN), also called the pneumogastric nerve, connects the brainstem to organs contained in the chest and abdomen. Physiologically, VN stimulation can rapidly affect cardiac activity and heart rate (HR). VN neuropathy can increase the risk of arrhythmias and sudden death. Therefore, a selective test of VN function may be very useful. Since peripheral neurodynamic tests (NDT) are reliable for the assessment of neuropathies in somatic nerves, we aimed to validate a novel NDT to assess VN activity, namely, the VN-NTD. Methods In this cross-sectional double-blind, sex-balanced study, 30 participants (15 females) completed a checklist of autonomic dysfunction symptoms. During the VN-NDT administration, HR and symptoms (i.e., mechanical allodynia) were monitored in parallel to a real-time ultrasonography imaging (USI) and motion capture analysis of the neck. The VN-NDT impact on HR and its accuracy for autonomic symptoms reported in the last 7 days were tested. Results The VN-NDT induced a significant HR reduction of about 12 and 8 bpm in males and females [t(1, 119) = 2.425; p < 0.017; ηp2 = 0.047, 95% confidence interval (CI): 0.93–9.18], respectively. No adverse events were observed during VN-NDT. A substantial interexaminer agreement between the evaluators in symptoms induction by VN-NDT was detected [F(1, 119) = 0.540; p = 0.464; ηp2 = 0.005, low effect]. Notably, mechanical allodynia accuracy for gastrointestinal dysfunctions was excellent (p < 0.05; 95% CI: 0.52–0.73; p < 0.001; 95% CI: 0.81–0.96). Conclusions The novel VN-NDT is a valid and accurate test capable of detecting VN activation with high sensitivity. Data provided are suitable for both sexes as a hallmark of HR variation due to VN normal response. The proposed VN-NDT may be reliable as daily routine neurological examination tests for the evaluation of neuropathic signs related to neuroinflammation of the VN. Clinical Trial Registration www.ClinicalTrials.gov, identifier NCT04192877.
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Affiliation(s)
- Giacomo Carta
- Human Anatomy, Department of Biological and Clinical Sciences, University of Turin, Turin, Italy.,Neuroscience Institute Cavalieri Ottolenghi (NICO), University of Turin, Turin, Italy.,Department of Rehabilitation, Sesto Hospital, ASST Nord Milano, Milan, Italy
| | - Agnese Seregni
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milan, Italy
| | - Andrea Casamassima
- General Surgery Department, S. Maria delle Stelle Hospital, ASST Melegnano e Martesana Melzo, Milan, Italy
| | - Manuela Galli
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milan, Italy
| | - Stefano Geuna
- Human Anatomy, Department of Biological and Clinical Sciences, University of Turin, Turin, Italy.,Neuroscience Institute Cavalieri Ottolenghi (NICO), University of Turin, Turin, Italy
| | - Pasquale Pagliaro
- Human Physiology, Department of Biological and Clinical Sciences, University of Turin, Turin, Italy
| | - Matteo Zago
- Department of Mechanics, Politecnico di Milano, Lecco, Italy
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Mansur NSB, Pereira VF, Cunha HCM, Nunes CG, Ferreira DS, Sato VN, Yamada AF, Matsunaga FT, Belloti JC, Tamaoki MJS. DIAGNOSIS OF THE ACHILLES INSERTIONAL TENDINOPATHIES BY ALGOMETRY. PAIN MEDICINE 2021; 22:2670-2675. [PMID: 34387348 DOI: 10.1093/pm/pnab255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Diagnosis of Achilles insertional tendinopathies (AIT) is based on pain by tendon palpation. However, there is no consensus or standard regarding the amount of force to be used during the evaluation. The algometry is a method of measuring the pressure applied in a specific region and can be a method for determining diagnosis values. GOAL To determine a cut-off value for Pain Threshold (PT) in the assessment of AIT. DESIGN This is a prospective case-control study of diagnostic accuracy, to develop a diagnostic criterion. METHODS Forty asymptomatic individuals and forty patients with insertional Achilles tendinopathy, matched by age and sex, were evaluated, and submitted to algometry for PT and for Visual Analogical Scale (VAS) levels with 3 kg/f at the insertion of the calcaneal tendon by two different evaluators. Inter-observer reproducibility was accessed through the interclass correlation index (ICC). Sensitivity and specificity calculation of PT and of VAS were calculated and plotted on a ROC (Receiver Operator Characteristic) curve. RESULTS The lowest ICC found was 0.788. Regarding the diagnosis through TP, the 4.08 kg/f mark showed the best relation between sensitivity and specificity (92.5% and 92.5%, respectively). Algometry values lower than 4.08 were considered positive for disease. For the diagnosis of TIA through VAS with 3 kg/f, the value of 2.98 was determined (sensitivity of 92.5% and specificity of 97.5%). CONCLUSION The algometry showed to be a simple and reliable method for diagnosing AIT. Values for PT under 4.08 kg/f were found predictors of the disease.
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Affiliation(s)
| | - Vinícius Felipe Pereira
- Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Federal University of São Paulo
| | | | - Carlos Gilberto Nunes
- Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Federal University of São Paulo
| | - Danilo Santos Ferreira
- Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Federal University of São Paulo
| | - Vitor Neves Sato
- Department of Radiology, Escola Paulista de Medicina, Federal University of São Paulo
| | | | - Fabio Teruo Matsunaga
- Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Federal University of São Paulo
| | - João Carlos Belloti
- Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Federal University of São Paulo
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Discordance between radiographic findings, pain, and superficial temperature in knee osteoarthritis. Reumatologia 2020; 58:375-380. [PMID: 33456080 PMCID: PMC7792543 DOI: 10.5114/reum.2020.102002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 11/27/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Knee pain is an imprecise marker of radiographic evidence of osteoarthritis (OA). These patients are more likely to develop central sensitisation to pain, a risk factor for chronic pain. Objectives The aim of this study was to examine the associations among radiographic evidence of OA, self-reported pain, pressure pain thresholds (PPT), and superficial knee temperature in individuals with knee OA. Material and methods This cross-sectional study enrolled 25 patients with knee OA with clinic and radiographic diagnosis of bilateral OA (Kellgren-Lawrence grading scale 1–4 in X-ray images), but symptoms of pain and discomfort in only one of the knees, with pain perception in the symptomatic knee equal to or above 4 in a visual analogue scale. Volunteers underwent an evaluation including demographic data, superficial knee temperature (infrared thermography, mean superficial temperature of the region of the knee) and PPT (digital algometry at longus adductor, vastus lateralis, vastus medialis and tibialis anterior muscles, patellar tendon, and centre of the patella). Results Comparisons between symptomatic and asymptomatic knees revealed no differences regarding Kellgren-Lawrence classification, knee superficial temperature, or PPT. Significant weak and moderate associations were found between radiographic classification of OA and PPT of both knees in almost all sites evaluated. Nonetheless, superficial temperature of the knee was not associated with PPT or Kellgren-Lawrence grading scale. Conclusions Patients with bilateral knee OA presented no differences in symptomatic and asymptomatic knees regarding radiographic evidence, knee temperature, and PPT, indicating that central sensitisation may be present in them. Radiographic classification of OA was significantly associated with PPT in both knees.
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Cámara RJA, Gharbo RK, Egloff N. Age and Gender as Factors of Pressure Sensitivity of Pain-Free Persons: Are They Meaningful? J Pain Res 2020; 13:1849-1859. [PMID: 32765059 PMCID: PMC7382585 DOI: 10.2147/jpr.s248664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 07/07/2020] [Indexed: 01/18/2023] Open
Abstract
Purpose Prior findings suggest that women and elderly persons are more sensitive to pressure than men and younger persons; however, the magnitudes of these differences are substantially inconsistent. We answered the question whether the higher sensitivity of women and elderly persons is quantitatively meaningful. Specifically, we investigated if it is large enough to hamper the diagnosis, classification and follow-up of pain conditions by clinicians. Materials and Methods From each age stratum (18–20, 21–30, 31–40, 41–50, 51–60, 61–70, 71–80, and >80 years), 40 pain-free women and 40 pain-free men were recruited. They rated the intensity of pressure of ten Newtons over ten seconds on an analogue zero to ten rating scale. The pressure was applied on their middle fingers and ear lobes with a threshold algometer. Centile curves visualized the sex- and age-dependent fluctuation of pressure sensitivity. Results Over the entire age range from 20 to 80 years, the median curves fluctuated within the interval of less than two points. The distance between the median curves of men and women was also less than two points. On the average, the median difference was half a point on the finger (p = 0.249) and the ear lobe (p = 0.083). Conclusion Less than two points is below the minimal clinically important difference for a zero to ten analogue pain rating scale; differences smaller than one point are even below the resolution of the scale. Sex differences and age fluctuations of pressure sensitivity are negligible.
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Affiliation(s)
| | | | - Niklaus Egloff
- Department of Neurology, Division of Psychosomatic Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
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10
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Stewart JA, Mailler-Burch S, Müller D, Studer M, von Känel R, grosse Holtforth M, Schwegler K, Egloff N. Rethinking the criteria for fibromyalgia in 2019: the ABC indicators. J Pain Res 2019; 12:2115-2124. [PMID: 31372029 PMCID: PMC6630090 DOI: 10.2147/jpr.s205299] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 05/16/2019] [Indexed: 01/18/2023] Open
Abstract
PURPOSE Diagnostic criteria for fibromyalgia have been subject to debate and controversy for many years. The preliminary diagnostic criteria introduced in 2010 and 2011 have been criticized for different reasons, including questionable diagnostic specificity and a lack of an etiopathogenetic foundation. The "ABC indicators" presented in this study reflect a further development of the 2011 criteria and refer to (A) algesia, (B) bilateral, axial-symmetric pain distribution, and (C) chronic distress. PATIENTS AND METHODS We compared the diagnostic performance of the ABC indicators with that of the 2011 criteria by analyzing the data of 409 inpatients with chronic functional pain divided into two subgroups of pain patients: Those with whole-body pain and those with pain not involving the whole body. Under the premise that FM phenotypically represents a whole-body pain disorder, sensitivity, specificity, correct classification and diagnostic odds ratios were calculated. RESULTS The 2011 criteria demonstrated a specificity of 68.1%, a sensitivity of 75.5%, a correct classification of 71.0% and a diagnostic odds ratio of 6.56 (CI: 4.17-10.31). The ABC indicators achieved a specificity of 88.3%, a sensitivity of 62.3%, a correct classification of 78.6%, and a diagnostic odds ratio of 12.47 (CI: 7.30-21.28). CONCLUSION The ABC fibromyalgia indicators demonstrated better specificity, lower sensitivity, and better overall diagnostic effectiveness than the original 2011 criteria.
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Affiliation(s)
- Julian A Stewart
- Department of Neurology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Simone Mailler-Burch
- Department of Neurology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Darius Müller
- Department of Neurology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martina Studer
- Department of Neurology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roland von Känel
- Department of Clinical Research, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Martin grosse Holtforth
- Department of Neurology, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Psychology, University of Bern, Bern, Switzerland
| | - Kyrill Schwegler
- Department of Neurology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Niklaus Egloff
- Department of Neurology, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Clinical Research, Bern University Hospital, University of Bern, Bern, Switzerland
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11
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Superficial temperature and pain tolerance in patients with chronic low back pain. J Bodyw Mov Ther 2019; 23:583-587. [DOI: 10.1016/j.jbmt.2019.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 05/04/2019] [Indexed: 11/20/2022]
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12
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Alqarni A, Manlapaz D, Baxter D, Tumilty S, Mani R. Test procedures to assess somatosensory abnormalities in individuals with neck pain: a systematic review of psychometric properties. PHYSICAL THERAPY REVIEWS 2018. [DOI: 10.1080/10833196.2018.1512737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Abdullah Alqarni
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Donald Manlapaz
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - David Baxter
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Steve Tumilty
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Ramakrishnan Mani
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
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13
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Almeida SC, George SZ, Leite RDV, Oliveira AS, Chaves TC. Cluster subgroups based on overall pressure pain sensitivity and psychosocial factors in chronic musculoskeletal pain: Differences in clinical outcomes. Physiother Theory Pract 2018; 35:1218-1232. [PMID: 29771165 DOI: 10.1080/09593985.2018.1474512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Objective: We aimed to empirically derive psychosocial and pain sensitivity subgroups using cluster analysis within a sample of individuals with chronic musculoskeletal pain (CMP) and to investigate derived subgroups for differences in pain and disability outcomes. Methods: Eighty female participants with CMP answered psychosocial and disability scales and were assessed for pressure pain sensitivity. A cluster analysis was used to derive subgroups, and analysis of variance (ANOVA) was used to investigate differences between subgroups. Results: Psychosocial factors (kinesiophobia, pain catastrophizing, anxiety, and depression) and overall pressure pain threshold (PPT) were entered into the cluster analysis. Three subgroups were empirically derived: cluster 1 (high pain sensitivity and high psychosocial distress; n = 12) characterized by low overall PPT and high psychosocial scores; cluster 2 (high pain sensitivity and intermediate psychosocial distress; n = 39) characterized by low overall PPT and intermediate psychosocial scores; and cluster 3 (low pain sensitivity and low psychosocial distress; n = 29) characterized by high overall PPT and low psychosocial scores compared to the other subgroups. Cluster 1 showed higher values for mean pain intensity (F(2,77) = 10.58, p < 0.001) compared with cluster 3, and cluster 1 showed higher values for disability (F(2,77) = 3.81, p = 0.03) compared with both clusters 2 and 3. Conclusions: Only cluster 1 was distinct from cluster 3 according to both pain and disability outcomes. Pain catastrophizing, depression, and anxiety were the psychosocial variables that best differentiated the subgroups. Overall, these results call attention to the importance of considering pain sensitivity and psychosocial variables to obtain a more comprehensive characterization of CMP patients' subtypes.
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Affiliation(s)
- Suzana C Almeida
- Physical Therapy, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Steven Z George
- Duke Clinical Research Institute, Duke University, Durham NC, USA.,Department of Orthopaedic Surgery, Duke University, Durham NC, USA
| | - Raquel D V Leite
- Post Graduate Program on Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Anamaria S Oliveira
- Post Graduate Program on Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil.,Department of Biomechanics, Medicine and Rehabilitation of the Musculoskeletal System, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Thais C Chaves
- Post Graduate Program on Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil.,Department of Neurosciences and Behavioral Sciences Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
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14
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Psychosoziale Stressoren und Schmerzempfindlichkeit bei chronischer Schmerzstörung mit somatischen und psychischen Faktoren (F45.41). Schmerz 2016; 31:40-46. [DOI: 10.1007/s00482-016-0159-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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15
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Liu R, Gu X, Zhang J, Yu L, Chen W, Wang K, Svensson P. Test-retest reliability of a new technique with pressure algometry applied to teeth in healthy Chinese individuals. Eur J Oral Sci 2016; 124:259-65. [PMID: 27017942 DOI: 10.1111/eos.12264] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2016] [Indexed: 02/05/2023]
Abstract
Pressure pain thresholds (PPTs) have been shown to be useful measures of mechanical pain sensitivity in deep tissues. However, clinical methods for measuring mechanical allodynia or hyperalgesia in teeth have not been reported. The aim of this study was to assess the reliability of PPTs in periodontal ligament of healthy Chinese participants. Twenty healthy young adults participated. Pressure pain thresholds were measured at six teeth and in two directions. The tests included three consecutive trials, in two separate sessions, which were performed on the first day by one examiner. After 1-3 wk, an identical protocol was carried out by two examiners, also in two separate sessions. There were no significant differences between repeated measures for all teeth. The PPTs had excellent reliability with high intraclass coefficients (ICCs) across different sessions (ICC: 0.871-0.956), days (ICC: 0.879-0.951), and examiners (ICC: 0.845-0.950). Pressure pain thresholds applied to the teeth have excellent intra- and inter-examiner agreement in healthy participants. This method may be proposed as an easy and reliable technique to assess mechanical pain sensitivity (e.g. mechanical allodynia and hyperalgesia) in the periodontal ligament, which is associated with endodontic or periodontal conditions.
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Affiliation(s)
- Ran Liu
- Orofacial Pain & TMD Research Unit, Institute of Stomatology, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Xinyu Gu
- Orofacial Pain & TMD Research Unit, Institute of Stomatology, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Jinglu Zhang
- Orofacial Pain & TMD Research Unit, Institute of Stomatology, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China.,Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University; Department of Polyclinic, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Linfeng Yu
- Orofacial Pain & TMD Research Unit, Institute of Stomatology, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Wenjing Chen
- Orofacial Pain & TMD Research Unit, Institute of Stomatology, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Kelun Wang
- Center for Sensory-Motor Interaction (SMI), Aalborg University, Aalborg, Denmark
| | - Peter Svensson
- Section of Orofacial Pain and Jaw Function, School of Dentistry, Aarhus University, Aarhus, Denmark.,Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
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16
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Cost-Saving Early Diagnosis of Functional Pain in Nonmalignant Pain: A Noninferiority Study of Diagnostic Accuracy. PAIN RESEARCH AND TREATMENT 2016; 2016:5964250. [PMID: 27088013 PMCID: PMC4819101 DOI: 10.1155/2016/5964250] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 01/20/2016] [Accepted: 02/01/2016] [Indexed: 11/17/2022]
Abstract
Objectives. We compared two index screening tests for early diagnosis of functional pain: pressure pain measurement by electronic diagnostic equipment, which is accurate but too specialized for primary health care, versus peg testing, which is cost-saving and more easily manageable but of unknown sensitivity and specificity. Early distinction of functional (altered pain perception; nervous sensitization) from neuropathic or nociceptive pain improves pain management. Methods. Clinicians blinded for the index screening tests assessed the reference standard of this noninferiority diagnostic accuracy study, namely, comprehensive medical history taking with all previous findings and treatment outcomes. All consenting patients referred to a university hospital for nonmalignant musculoskeletal pain participated. The main analysis compared the receiver operating characteristic (ROC) curves of both index screening tests. Results. The area under the ROC curve for peg testing was not inferior to that of electronic equipment: it was at least 95% as large for finger measures (two-sided p = 0.038) and at least equally as large for ear measures (two-sided p = 0.003). Conclusions. Routine diagnostic testing by peg, which is accessible for general practitioners, is at least as accurate as specialized equipment. This may shorten time-to-treatment in general practices, thereby improving the prognosis and quality of life.
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17
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Measuring mechanical pain: the refinement and standardization of pressure pain threshold measurements. Behav Res Methods 2015; 47:216-27. [PMID: 24570335 DOI: 10.3758/s13428-014-0453-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pain thresholds are widely used in behavioral research, but unlike other pain modalities, a standardized assessment of pressure pain remains a challenge. In this research, we describe the application of an automatic pressure algometer with a linear increase in force. Ergonomically designed fixation devices were developed to increase the accuracy and to shorten the time of each measurement. Ten healthy volunteers were included in a pilot study to test the algometry method. Pressure pain thresholds (PPTs) were investigated over 2 experimental days in three nonconsecutive runs at 29 measurement sites. During the experiment, subjects reported their subjective sleepiness, level of state-anxiety, psychological status and the perceived pain intensity of each measurement. Pain intensity ratings indicate that instructions were followed. State-anxiety and subjective sleepiness levels were low throughout the experiment. The method has proven to be suitable for standardized PPT measurements across the body in an ergonomic, safe, and user-friendly fashion.
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18
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Ferrari MLG, Thuraisingam S, von Känel R, Egloff N. Expectations and effects of a single yoga session on pain perception. Int J Yoga 2015; 8:154-7. [PMID: 26170598 PMCID: PMC4479896 DOI: 10.4103/0973-6131.158486] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Several studies show yoga may benefit chronic pain management. We investigated the effect of a single yoga session on the perception of pain, measured by a standardized pain provocation test in healthy yoga participants while also comparing pain perception to participants’ own expectations. Materials and Methods: Ninety yoga participants were recruited at hatha yoga schools in Switzerland. Pain perception was measured with a standardized algometric pain provocation test; i.e., a calibrated peg was applied for 10 seconds after which the participant rated pain intensity on a 0–10 numerical rating scale. The test was applied to the middle finger, ear lobe, and second toe before and after a 60-minute yoga session. Results: Sixty out of 90 (66.7%) yoga participants expected a reduced pain perception after the yoga session. However, 36 (40%) participants actually experienced less pain after compared to before the yoga session. But overall, pain perception statistically did not significantly change from before to after the yoga session at any of the three body locations assessed. The expectations and also the previous yoga experience did not significantly influence the participants’ pain perception. Conclusions: Regardless of the high positive expectations on the influence of yoga on pain, a single yoga session does not significantly influence pain perception induced by a pain provocation test. Hypoalgesic effects of yoga should be explained otherwise.
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Affiliation(s)
- Marie-Louise Gander Ferrari
- Department of General Internal Medicine, Division of Psychosomatic Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Silvia Thuraisingam
- Department of General Internal Medicine, Division of Psychosomatic Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Roland von Känel
- Department of General Internal Medicine, Division of Psychosomatic Medicine, Inselspital, Bern University Hospital, Bern, Switzerland ; Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Niklaus Egloff
- Department of General Internal Medicine, Division of Psychosomatic Medicine, Inselspital, Bern University Hospital, Bern, Switzerland ; Department of Clinical Research, University of Bern, Bern, Switzerland
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19
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Egloff N, von Känel R, Müller V, Egle UT, Kokinogenis G, Lederbogen S, Durrer B, Stauber S. Implications of proposed fibromyalgia criteria across other functional pain syndromes. Scand J Rheumatol 2015; 44:416-24. [DOI: 10.3109/03009742.2015.1010103] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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20
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O’Neill S, Graven-Nielsen T, Manniche C, Arendt-Nielsen L. Reliability and validity of a simple and clinically applicable pain stimulus: sustained mechanical pressure with a spring-clamp. Chiropr Man Therap 2014. [DOI: 10.1186/s12998-014-0030-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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21
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Medial tibial pain pressure threshold algometry in runners. Knee Surg Sports Traumatol Arthrosc 2014; 22:1549-55. [PMID: 23740326 DOI: 10.1007/s00167-013-2558-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Accepted: 05/29/2013] [Indexed: 12/25/2022]
Abstract
PURPOSE Pressure algometry (PA) may provide an objective and standardised tool in assessing palpation pain over the tibia. The purpose of this study was to analyse the intra-rater repeatability of PA and to determine whether tibial tenderness in healthy runners differ from runners with medial tibial stress syndrome (MTSS). METHODS Pressure algometry was performed on 20 asymptomatic runners (40 legs) and 9 MTSS patients (14 symptomatic legs) at standardised locations along the medial border of the tibia. Intra-rater reliability was assessed in 10 randomly selected asymptomatic runners through repeated measurements 2 weeks later. RESULTS Intra-rater reliability was moderate to excellent (ICC 0.53-0.90) in asymptomatic runners. Pain pressure threshold (PPT) was significantly reduced at 2/9-5/9 of the distance from the medial malleolus to the medial tibial condyle (p = 0.002-0.022). There was evidence of a statistically significant association between both height and weight, and PPT from the 3/9 (r = 0.416, p = 0.008) to 7/9 (r = 0.334, p = 0.035) and 3/9 (r = 0.448, p = 0.004) to 6/9 (r = 0.337, p = 0.034) area, respectively. In both MTSS patients and healthy runners, there was evidence of lower PPT in females compared to males (p = 0.0001-0.049) and a negative association between age and PPT (p = 0.001-0.033). MTSS patients had significantly lower PPT at the 3/9 site (p = 0.048) compared to asymptomatic runners. CONCLUSION Pain pressure threshold algometry can be incorporated into MTSS clinical assessment to objectively assess pain and monitor progress. The presence of reduced medial tibial PPT in asymptomatic runners suggests that clinicians may not need to await resolution of medial tibia tenderness before allowing return to sport in MTSS patients.
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22
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Egloff N, Cámara RJA, von Känel R, Klingler N, Marti E, Ferrari MLG. Hypersensitivity and hyperalgesia in somatoform pain disorders. Gen Hosp Psychiatry 2014; 36:284-90. [PMID: 24650586 DOI: 10.1016/j.genhosppsych.2014.01.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 01/10/2014] [Accepted: 01/23/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE In psychiatry, pain disorders not explained by structural lesions have been classified for decades as somatoform pain disorders, the underlying concept being somatization. In a parallel move, somatic medicine has defined an expanding group of similar pain disorders, known as functional pain syndromes. Functional pain syndromes are characterized by enhanced pain sensitivity. The aim of our study was to investigate the proportion of patients with somatoform pain disorders who also meet the criteria of functional pain syndromes and the extent to which patients with somatoform pain disorders also show enhanced pain sensitivity. METHODS Data on pain sensitivity in 120 hospitalized patients were obtained by means of two algometric methods. The group of patients with somatoform pain disorders was further divided into two subsets: patients with and those without a co-diagnosis of a functional pain syndrome. Patients with nociceptive pain served as control group. RESULTS Of the 120 in-patients selected, 67 fulfilled the criteria of a somatoform pain disorder of which 41 (61%) also met the co-diagnosis of a functional pain syndrome. Patients with somatoform pain disorder differed from controls in that they showed enhanced pain sensitivity, irrespective of whether a functional pain syndrome was concomitantly present (P<.001). CONCLUSIONS Somatoform pain disorders show considerable overlap with functional pain syndromes, including enhanced pain sensitivity. This suggests the relevance of integrating somatosensory aspects of pain into a modified understanding of somatoform pain disorders.
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Affiliation(s)
- Niklaus Egloff
- Department of General Internal Medicine, Division of Psychosomatic Medicine, Inselspital, Bern University Hospital, CH-3010 Bern, Switzerland; Department of Clinical Research, University of Bern, 3012 Bern, Switzerland.
| | - Rafael J A Cámara
- Institute of Medical Biostatistics, Epidemiology, and Informatics, University Medical Centre of Johannes Gutenberg University, D-55131 Mainz, Germany
| | - Roland von Känel
- Department of General Internal Medicine, Division of Psychosomatic Medicine, Inselspital, Bern University Hospital, CH-3010 Bern, Switzerland; Department of Clinical Research, University of Bern, 3012 Bern, Switzerland
| | - Nicole Klingler
- Department of General Internal Medicine, Division of Psychosomatic Medicine, Inselspital, Bern University Hospital, CH-3010 Bern, Switzerland
| | - Elizabeth Marti
- Department of General Internal Medicine and Clinic for Orthopedics, Inselspital, Bern University Hospital, CH-3010 Bern, Switzerland
| | - Marie-Louise Gander Ferrari
- Department of General Internal Medicine, Division of Psychosomatic Medicine, Inselspital, Bern University Hospital, CH-3010 Bern, Switzerland; Department of Clinical Research, University of Bern, 3012 Bern, Switzerland
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23
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von Känel R, Müller-Hartmannsgruber V, Kokinogenis G, Egloff N. Vitamin D and central hypersensitivity in patients with chronic pain. PAIN MEDICINE 2014; 15:1609-18. [PMID: 24730754 DOI: 10.1111/pme.12454] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Low vitamin D is implicated in various chronic pain conditions with, however, inconclusive findings. Vitamin D might play an important role in mechanisms being involved in central processing of evoked pain stimuli but less so for spontaneous clinical pain. OBJECTIVE This study aims to examine the relation between low serum levels of 25-hydroxyvitamin D3 (25-OH D) and mechanical pain sensitivity. DESIGN We studied 174 patients (mean age 48 years, 53% women) with chronic pain. A standardized pain provocation test was applied, and pain intensity was rated on a numerical analogue scale (0-10). The widespread pain index and symptom severity score (including fatigue, waking unrefreshed, and cognitive symptoms) following the 2010 American College of Rheumatology preliminary diagnostic criteria for fibromyalgia were also assessed. Serum 25-OH D levels were measured with a chemiluminescent immunoassay. RESULTS Vitamin deficiency (25-OH D < 50 nmol/L) was present in 71% of chronic pain patients; another 21% had insufficient vitamin D (25-OH D < 75 nmol/L). After adjustment for demographic and clinical variables, there was a mean ± standard error of the mean increase in pain intensity of 0.61 ± 0.25 for each 25 nmol/L decrease in 25-OH D (P = 0.011). Lower 25-OH D levels were also related to greater symptom severity (r = -0.21, P = 0.008) but not to the widespread pain index (P = 0.83) and fibromyalgia (P = 0.51). CONCLUSIONS The findings suggest a role of low vitamin D levels for heightened central sensitivity, particularly augmented pain processing upon mechanical stimulation in chronic pain patients. Vitamin D seems comparably less important for self-reports of spontaneous chronic pain.
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Affiliation(s)
- Roland von Känel
- Department of General Internal Medicine, Division of Psychosomatic Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Clinical Research, University of Bern, Bern, Switzerland
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Schliessbach J, Siegenthaler A, Streitberger K, Eichenberger U, Nüesch E, Jüni P, Arendt-Nielsen L, Curatolo M. The prevalence of widespread central hypersensitivity in chronic pain patients. Eur J Pain 2013; 17:1502-10. [PMID: 23703952 DOI: 10.1002/j.1532-2149.2013.00332.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND Chronic pain is associated with generalized hypersensitivity and impaired endogenous pain modulation (conditioned pain modulation; CPM). Despite extensive research, their prevalence in chronic pain patients is unknown. This study investigated the prevalence and potential determinants of widespread central hypersensitivity and described the distribution of CPM in chronic pain patients. METHODS We examined 464 consecutive chronic pain patients for generalized hypersensitivity and CPM using pressure algometry at the second toe and cold pressor test. Potential determinants of generalized central hypersensitivity were studied using uni- and multivariate regression analyses. Prevalence of generalized central hypersensitivity was calculated for the 5th, 10th and 25th percentile of normative values for pressure algometry obtained by a previous large study on healthy volunteers. CPM was addressed on a descriptive basis, since normative values are not available. RESULTS Depending on the percentile of normative values considered, generalized central hypersensitivity affected 17.5-35.3% of patients. 23.7% of patients showed no increase in pressure pain threshold after cold pressor test. Generalized central hypersensitivity was more frequent and CPM less effective in women than in men. Unclearly classifiable pain syndromes showed higher frequencies of generalized central hypersensitivity than other pain syndromes. CONCLUSIONS Although prevalent in chronic pain, generalized central hypersensitivity is not present in every patient. An individual assessment is therefore required in order to detect altered pain processing. The broad basic knowledge about central hypersensitivity now needs to be translated into concrete clinical consequences, so that patients can be offered an individually tailored mechanism-based treatment.
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Affiliation(s)
- J Schliessbach
- University Department of Anesthesiology and Pain Therapy, Inselspital Bern, Switzerland
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