Relative and absolute test-retest reliabilities of pressure pain threshold in patients with knee osteoarthritis

Words matter: Effects of instructional cues on pressure pain threshold values in healthy people

BACKGROUND

Pressure pain threshold (PPT) measurements require standardised verbal instructional cues to ensure that the increasing pressure is stopped at the correct time consistently. This study aimed to compare how PPT values and their test-retest reliability were affected by different instructional cues.

METHODS

At two separate sessions, two PPT measurements were taken at the anterior knee for each of four different instructional cues: the cue of the German Neuropathic Research Network instructions ('DFNS'), the point where pressure first feels uncomfortable ('Uncomfortable'), 3/10 on the numerical pain rating scale ('3NPRS'), and where pain relates to an image from the pictorial-enhanced NPRS scale ('Pictorial'). Linear mixed modeling was used to quantify differences between pairs of instructional cues. Test-retest reliability was estimated using intraclass correlation coefficients (ICC[2,1] and ICC[2,k]).

RESULTS

Twenty participants were recruited. The cue resulting in greatest PPT value was DFNS (394.32 kPa, 95%CI [286.32 to 543.06]), followed by Pictorial (342.49 kPa, 95%CI [248.68 to 471.68]), then Uncomfortable (311.85 kPa, 95%CI [226.43 to 429.48]), and lastly 3NPRS (289.78 kPa, 95%CI [210.41 to 399.09]). Five of six pairwise contrasts were statistically significant. Regardless of the cues, the point estimates of ICC (2,1) ranged from 0.80 to 0.86, and the ICC (2,k) values ranged from 0.89 to 0.93. No statistically significant differences were found between any pairwise contrasts of reliability indices.

CONCLUSION

Words matter when instructing people when to stop testing in pressure algometry. Clinicians should use the same instructional cue when assessing pain thresholds to ensure reliability.

Revitalizing Postoperative Pain Management in Enhanced Recovery After Surgery via Inter-departmental Collaboration Toward Precision Medicine: A Narrative Review

This narrative review explores the crucial aspects of postoperative pain management within the framework of Enhanced Recovery After Surgery (ERAS). It emphasizes the significance of effective and secure pain management, highlighting its impact on patient well-being, surgical outcomes, and hospital stays. The inadequacy of perioperative pain relief increases the risk of persistent postoperative pain, emphasizing the need to challenge the notion that pain is expected after surgery. The goals of postoperative pain management extend beyond mere relief, encompassing comfortable sleep, pain-free rest, and liberation from pain during initial recovery. Inadequate pain management can lead to complications such as heightened postoperative bleeding and an increased risk of thrombosis. The review delves into various analgesic methods, their complications, and safety measures. ERAS programs, focused on reducing complications and medical costs, emphasize the importance of judicious postoperative pain management and active rehabilitation. The review discusses complications associated with analgesic methods like opioids, epidural analgesia, and adjuvant analgesics. Collaboration within the perioperative management team is crucial for effective postoperative pain relief. Interdepartmental collaboration is essential for evaluating surgical procedures, analgesic methods, and crisis management strategies. The review concludes by integrating precision medicine into postoperative pain management, emphasizing the potential of genetic information in assessing pain sensitivity. It underscores the importance of inter-departmental collaboration and information gathering for the successful implementation of precision medicine tailored to each facility's perioperative management systems. Additionally, the impact of artificial intelligence (AI) on preoperative risk assessment and innovative monitoring techniques is discussed, paving the way for the advancement of precision medicine in postoperative pain management.

Assessing the impact of preferred web app-based music-listening on pain processing at the central nervous level in older black adults with low back pain: An fNIRS study

BACKGROUND

Low back pain (LBP) disproportionately affects older black adults, often leading to inadequate treatment due to clinician biases. Objective pain measures are imperative, and Functional Near-Infrared Spectroscopy (fNIRS) shows promise for pain detection.

AIM

To determine the impact of listening to home-based preferred web app-based music on underlying pain processing mechanisms at the central nervous level in older black adults aged ≥65 with LBP.

METHODS

Twenty older black adults with LBP listened to preferred music twice daily for four days using the MUSIC CARE® app. Neuroimaging data were collected using fNIRS. Data were transformed to changes in oxy-hemoglobin and deoxy-hemoglobin concentrations and analyzed.

RESULTS

Significant cortical activation pattern differences were observed between pre-and post-intervention scans, particularly in somatosensory regions. Post-intervention scans showed significantly reduced hemodynamic activities.

CONCLUSION

Preferred music listening has the potential to alleviate pain, and fNIRS emerges as a promising tool for exploring cortical-level pain-related neural circuits.

Minimal important change and difference for knee osteoarthritis outcome measurement tools after non-surgical interventions: a systematic review

OBJECTIVES

To systematically review and provide estimates of the minimal important change (MIC) and difference (MID) for outcome tools in people with knee osteoarthritis (OA) after non-surgical interventions. Design A systematic review.

DATA SOURCES

MEDLINE, CINAHL, Web of Science, Scopus and Cochrane databases were searched up to 21 September 2021.

ELIGIBILITY CRITERIA

We included studies that calculated MIC and MID using any calculation method including anchor, consensus and distribution methods, for any knee OA outcome tool after non-surgical interventions.

DATA EXTRACTION AND SYNTHESIS

We extracted reported MIC, MID and minimum detectable change (MDC) estimates. We used quality assessment tools appropriate to the studies' methods to screen out low-quality studies. Values were combined to produce a median and range, for each method.

RESULTS

Forty-eight studies were eligible (anchor-k=12, consensus-k=1 and distribution-k=35). MIC values for 13 outcome tools including Knee injury and Osteoarthritis Outcome Score (KOOS)-pain, activities of daily living (ADL), quality of life (QOL) and Western Ontario and McMaster Universities Arthritis Index (WOMAC)-function were estimated using 5 high-quality anchor studies. MID values for 23 tools including KOOS-pain, ADL, QOL and WOMAC-function, stiffness and total were estimated using 6 high-quality anchor studies. One moderate quality consensus study reported MIC for pain, function and global assessment. MDC values from distribution method estimates for 126 tools including KOOS-QOL and WOMAC-total were estimated using 38 good-to-fair-quality studies.

CONCLUSION

Median MIC, MID and MDC estimates were reported for outcome tools in people with knee OA after non-surgical interventions. The results of this review clarify the current understanding of MIC, MID and MDC in the knee OA population. However, some estimates suggest considerable heterogeneity and require careful interpretation.

PROSPERO REGISTRATION NUMBER

CRD42020215952.

Novice assessors demonstrate good intra-rater agreement and reliability when determining pressure pain thresholds; a cross-sectional study

Background

Experienced assessors show good intra-rater reproducibility (within-session and between-session agreement and reliability) when using an algometer to determine pressure pain thresholds (PPT). However, it is unknown whether novice assessors perform equally well. This study aimed to determine within and between-session agreement and reliability of PPT measurements performed by novice assessors and explored whether these parameters differed per assessor and algometer type.

Methods

Ten novice assessors measured PPTs over four test locations (tibialis anterior muscle, rectus femoris muscle, extensor carpi radialis brevis muscle and paraspinal muscles C5-C6) in 178 healthy participants, using either a Somedic Type II digital algometer (10 raters; 88 participants) or a Wagner Force Ten FDX 25 digital algometer (nine raters; 90 participants). Prior to the experiment, the novice assessors practiced PPTs for 3 h per algometer. Each assessor measured a different subsample of ~9 participants. For both the individual assessor and for all assessors combined (i.e., the group representing novice assessors), the standard error of measurement (SEM) and coefficient of variation (CV) were calculated to reflect within and between-session agreement. Reliability was assessed using intraclass correlation coefficients (ICC_1,1).

Results

Within-session agreement expressed as SEM ranged from 42 to 74 kPa, depending on the test location and device. Between-session agreement, expressed as SEM, ranged from 36 to 76 kPa and the CV ranged from 9-16% per body location. Individual assessors differed from the mean group results, ranging from -55 to +32 kPa or from -9.5 to +6.6 percentage points. Reliability was good to excellent (ICC_1,1: 0.87 to 0.95). Results were similar for both types of algometers.

Conclusions

Following 3 h of algometer practice, there were slight differences between assessors, but reproducibility in determining PPTs was overall good.

Validity of the Central Sensitization Inventory (CSI) through Rasch analysis in patients with knee osteoarthritis

INTRODUCTION/OBJECTIVE

Central sensitization (CS) is a known contributor to chronic pain in people with knee osteoarthritis (KOA) and is commonly measured by psychophysical testing or patient-reported methods such as the Central Sensitization Inventory (CSI). However, previous studies have shown a weak association between the two. We therefore sought to evaluate the validity of the CSI through Rasch analysis in patients with KOA.

METHOD

We performed a secondary analysis of a multicenter cohort study with patients with KOA consulting orthopedic surgeons. Rasch analysis was conducted considering person factors of age, sex, BMI, pain intensity, pain catastrophizing, and quantitative sensory test findings using pressure pain thresholds and temporal summation to assess how the CSI fits to the Rasch model (supporting validity). We used RUMM2030 software to model fit estimates, making adjustments as required to achieve model fit (P > 0.05).

RESULTS

Data from 293 patients were included (58.7% female, mean age 63.6 years, 49.1% obese) Initial evaluation with Rasch modelling indicated misfit. Eleven of 25 items on the CSI displayed disordered thresholds which were rescored by collapsing response categories until the thresholds demonstrated sequential progression. Reanalysis demonstrated persistent model misfit so a subtest was developed to address local dependency of 6 items. Thereafter, model fit was achieved (P = 0.071, indicating not differing from Rasch model) and acceptable unidimensionality (P = 0.068 with 95% CI 0.043-0.093).

CONCLUSIONS

The CSI was able to be fit to the Rasch model after rescoring while retaining all 25 items. The unidimensionality validates CS as measured by the CSI as a singular construct. Key Points • The Central Sensitization Inventory (CSI) was able to be fit to the Rasch model after rescoring while retaining all 25 items. • The unidimensionality of the CSI validates CS as a singular construct. • Our results suggest rescoring of the CSI for people with KOA, but it should be confirmed and replicated in larger samples prior to clinical use.

Absolute and relative reliability of pain sensitivity and functional outcomes of the affected shoulder among women with pain after breast cancer treatment

OBJECTIVE

Breast cancer survivors (BCS) are often characterized by decreased pressure pain thresholds (PPT), range of motion (ROM) and strength in and around the shoulder affected by the treatment. This intra-rater reliability study was to establish the relative and absolute reliability of PPT's, active ROM and maximal isokinetic muscle strength (MIMS) of the affected shoulder in BCS with persistent pain after treatment.

METHODS

Twenty-one BCS participated in the study. The PPTs of 17 locations and pain intensity were assessed using a pressure algometer and a numeric rating scale. The ROM was measured using a universal goniometer and MIMS was measured using an isokinetic dynamometer. Relative reliability was estimated using intra class correlation coefficient (ICC), and absolute reliability using standard error of measurement (SEM). Minimum detectable change (MDC) was calculated from SEM.

RESULTS

The ICCs for PPTs ranged from 0.88-0.97, with SEM values ranging from 12.0 to 28.2 kPa and MDC ranging from 33.2 to 78.2 kPa. The ICCs for ROM ranged from 0.66-0.97, with SEM values ranging from 3.0 to 7.5° and MDC ranging from 8.4 to 20.8°. Finally, ICCs for MIMS ranged from 0.62-0.92, with SEM values ranging from 0.03 to 0.07 Nm/Kg FFM and MDC ranging from 0.09 to 0.19 Nm/kg FFM.

CONCLUSION

The results of this study indicate that PPTs, ROM and MIMS can be measured reliably on the affected shoulder in BCS with pain after treatment. This offer the possibility of using these measures to assess the effectiveness of interventions in this population.

Neuromuscular exercise and pain neuroscience education compared with pain neuroscience education alone in patients with chronic pain after primary total knee arthroplasty: study protocol for the NEPNEP randomized controlled trial

BACKGROUND

Total knee arthroplasty (TKA) is considered an effective treatment for pain relief and improved physical performances in end-stage knee osteoarthritis. However, several studies have reported less favorable outcomes after TKA with chronic pain rates of approximately 20%. Exercise might be an effective treatment strategy for chronic pain following TKA, but no randomized controlled trials have evaluated its effect. Therefore, the purpose of this randomized controlled trial is to investigate whether a 12-week neuromuscular exercise (NEuroMuscular EXercise training program for patients with knee or hip osteoarthritis assigned for total joint replacement; NEMEX-TJR) program combined with pain neuroscience education (PNE) provides greater pain relief and improvement in physical performances than PNE alone at 12 months follow-up in a population of patients with chronic pain after primary TKA.

METHODS

For this randomized controlled superiority trial, 120 patients with moderate-to-severe chronic pain after TKA are recruited from Aalborg University Hospital, Denmark. Patients are randomly assigned in a 1:1 ratio to one of two interventions: (a) NEMEX-TJR twice weekly for 12 weeks combined with two sessions of PNE or (b) two sessions of PNE given over 6 weeks. Assessment is performed at baseline before intervention and at 3, 6, and 12 months after initiation of the intervention. Outcome assessors are blinded toward group allocation. The primary outcome is the change in the Knee Injury and Osteoarthritis Outcome Score₄ (KOOS₄), defined as the mean score for the KOOS subscales pain, symptoms, activities of daily living, and quality of life. Secondary outcomes include all KOOS subscale scores and scores for PainDETECT, the Fear-Avoidance Beliefs Questionnaire, Global Perceived Effect, the Pain Catastrophizing Scale, pain intensities, temporal summation, conditioned pain modulation, and pressure pain thresholds. Physical performances are measured with walking, stair climbing, and chair standing tests as well as tests of muscle strength and power.

DISCUSSION

The findings will be useful in establishing effective treatment strategies for chronic pain after TKA. The randomized controlled trial involves rigorous scientific methods and uses clinically applicable interventions. The study interventions are conducted in clinical settings, thereby enhancing the possibility of future implementation of the treatments in the health care systems.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT03886259. Registered 22 March 2019. Ethics committee registration: N-20180046.