Measuring mechanical pain: The refinement and standardization of pressure pain threshold measurements

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.

[1]  L. Derogatis Brief Symptom Inventory , 2011 .

[2]  D. Hermes,et al.  Treatment anxiety in oral and maxillofacial surgery. Results of a German multi-centre trial. , 2007, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

[3]  C. Spielberger,et al.  Manual for the State-Trait Anxiety Inventory , 1970 .

[4]  L. Arendt-Nielsen,et al.  Effect of chronic and experimental jaw muscle pain on pain-pressure thresholds and stimulus-response curves. , 1995, Journal of orofacial pain.

[5]  L. Bonjardim,et al.  Evaluation of low-level laser therapy effectiveness on the pain and masticatory performance of patients with myofascial pain , 2012, Lasers in Medical Science.

[6]  H. Göbel,et al.  Die laterale Asymmetrie der menschlichen Schmerzempfindlichkeit , 1987, Der Schmerz.

[7]  J. Croisier,et al.  Pressure pain thresholds of tender point sites in patients with fibromyalgia and in healthy controls , 2004, European journal of pain.

[8]  R Nordemar,et al.  A comparison of pressure pain thresholds in different tissues and body regions. Long-term reliability of pressure algometry in healthy volunteers. , 1993, Scandinavian journal of rehabilitation medicine.

[9]  G. Tepper,et al.  Auricular acupuncture effectively reduces state anxiety before dental treatment—a randomised controlled trial , 2012, Clinical Oral Investigations.

[10]  E. Kosek,et al.  Segmental and plurisegmental modulation of pressure pain thresholds during static muscle contractions in healthy individuals , 2003, European journal of pain.

[11]  Jason S. Eldrige,et al.  Knee Extensor Strength Is Associated with Pressure Pain Thresholds in Adults with Fibromyalgia , 2013, PloS one.

[12]  L. Arendt-Nielsen,et al.  Enhanced temporal summation of pressure pain in the trapezius muscle after delayed onset muscle soreness , 2006, Experimental Brain Research.

[13]  D. Hermes,et al.  Behandlungsangst in der Mund-, Kiefer- und Gesichtschirurgie , 2006, Mund-, Kiefer- und Gesichtschirurgie.

[14]  S. Gibson,et al.  A psychophysical evaluation of the relationship between trait anxiety, pain perception, and induced state anxiety. , 2005, The journal of pain : official journal of the American Pain Society.

[15]  Chava Peretz,et al.  Spatial summation of pressure pain: effect of body region , 2003, Pain.

[16]  S. Hunter,et al.  Anxiety and stress can predict pain perception following a cognitive stress , 2010, Physiology & Behavior.

[17]  Marjolein P. M. Kammers,et al.  Visual Distortion of Body Size Modulates Pain Perception , 2011, Psychological science.

[18]  Donald B. Rubin,et al.  Interpersonal expectancy effects: the first 345 studies , 1978, Behavioral and Brain Sciences.

[19]  Ferdi Başkurt,et al.  Comparison of Pressure Pain Threshold, Grip Strength, Dexterity and Touch Pressure of Dominant and Non-Dominant Hands within and Between Right- and Left-Handed Subjects , 2004, Journal of Korean medical science.

[20]  Christina Brogårdh,et al.  Tender or not tender: test-retest repeatability of pressure pain thresholds in the trapezius and deltoid muscles of healthy women. , 2004, Journal of rehabilitation medicine.

[21]  E. Chantelau,et al.  Pressure pain thresholds at the diabetic Charcot-foot: an exploratory study. , 2012, Journal of musculoskeletal & neuronal interactions.

[22]  T. Jensen,et al.  Measurements of human pressure-pain thresholds on fingers and toes , 1989, Pain.

[23]  G. Essick,et al.  Reliability and reproducibility of novel methodology for assessment of pressure pain sensitivity in pelvis. , 2012, The journal of pain : official journal of the American Pain Society.

[24]  T. Spector,et al.  Determinants of pressure pain threshold in adult twins: evidence that shared environmental influences predominate , 1997, Pain.

[25]  Annika Åström,et al.  Load pattern and pressure pain threshold in the upper trapezius muscle and psychosocial factors in medical secretaries with and without shoulder/neck disorders , 1997, International archives of occupational and environmental health.

[26]  A. Fischer Pressure algometry over normal muscles. Standard values, validity and reproducibility of pressure threshold , 1987, Pain.

[27]  H. Critchley,et al.  On the generalised embodiment of pain: How interoceptive sensitivity modulates cutaneous pain perception , 2012, PAIN®.

[28]  C. Graversen,et al.  Quantitative Sensory Testing Predicts Pregabalin Efficacy in Painful Chronic Pancreatitis , 2013, PloS one.

[29]  Z. Dvir,et al.  Reproducibility Indices Applied to Cervical Pressure Pain Threshold Measurements in Healthy Subjects , 2004, The Clinical journal of pain.

[30]  G. Norman,et al.  Tender points in fibromyalgia , 1988, Pain.

[31]  L. Arendt-Nielsen,et al.  Efficacy of multimodal, systematic non-surgical treatment of knee osteoarthritis for patients not eligible for a total knee replacement: a study protocol of a randomised controlled trial , 2012, BMJ Open.

[32]  Michael M. Zimkowski,et al.  Design and Evaluation of a Computer-Controlled Pressure Algometer , 2011 .

[33]  L. Arendt-Nielsen,et al.  Spatial and temporal summation of pain evoked by mechanical pressure stimulation , 2009, European journal of pain.

[34]  F. M. Levine,et al.  The effects of experimenter gender on pain report in male and female subjects , 1991, Pain.

[35]  S. Gibson,et al.  A Review of Age Differences in the Neurophysiology of Nociception and the Perceptual Experience of Pain , 2004, The Clinical journal of pain.

[36]  K. Sluka,et al.  Pressure and Activity-related Allodynia in Delayed-onset Muscle Pain , 2011, The Clinical journal of pain.

[37]  Thomas Graven-Nielsen,et al.  Moving coil pressure algometer produces consistent force gradient and repeated stimulation , 2012, 2012 Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[38]  Alban Y. Neziri,et al.  Reference values of mechanical and thermal pain tests in a pain-free population. , 2011, European journal of pain.

[39]  Vanessa K. Bohns,et al.  It hurts when I do this (or you do that): Posture and pain tolerance , 2012 .

[40]  S. George,et al.  Fear of pain, pain catastrophizing, and acute pain perception: relative prediction and timing of assessment. , 2008, The journal of pain : official journal of the American Pain Society.

[41]  J. Rhudy,et al.  Gender differences in pain: do emotions play a role? , 2005, Gender medicine.

[42]  P C O'Brien,et al.  Comparison of algorithms of testing for use in automated evaluation of sensation , 1990, Neurology.

[43]  P C O'Brien,et al.  Cool, warm, and heat‐pain detection thresholds , 1993, Neurology.

[44]  Lars Arendt-Nielsen,et al.  Experimental and clinical applications of quantitative sensory testing applied to skin, muscles and viscera. , 2009, The journal of pain : official journal of the American Pain Society.

[45]  J. Rhudy,et al.  Fear and anxiety: divergent effects on human pain thresholds , 2000, Pain.

[46]  J D Greenspan,et al.  Stimulus features relevant to the perception of sharpness and mechanically evoked cutaneous pain. , 1991, Somatosensory & motor research.

[47]  T. Åkerstedt,et al.  Subjective and objective sleepiness in the active individual. , 1990, The International journal of neuroscience.

[48]  Lars Arendt-Nielsen,et al.  Effects of Adipose Thickness and Muscle Hardness on Pressure Pain Sensitivity: Correction , 2011, The Clinical journal of pain.

[49]  S. Lautenbacher,et al.  Pain Thresholds as a Putative Functional Test for Cerebral Laterality in Major Depressive Disorder and Panic Disorder1 , 2003, Neuropsychobiology.

[50]  Ulf Lindblom,et al.  Pressure-pain threshold in human temporal region. Evaluation of a new pressure algometer , 1986, Pain.

[51]  David H. Jones,et al.  Test-retest reliability of pressure pain threshold measurements of the upper limb and torso in young healthy women. , 2007, The journal of pain : official journal of the American Pain Society.

[52]  M. Curatolo,et al.  Algometry with a clothes peg compared to an electronic pressure algometer: a randomized cross-sectional study in pain patients , 2011, BMC musculoskeletal disorders.

[53]  R. Treede,et al.  Quantitative sensory testing: a comprehensive protocol for clinical trials , 2006, European journal of pain.

[54]  J. Schoenen,et al.  Cephalic and extracephalic pressure pain thresholds in chronic tension-type headache , 1991, Pain.

[55]  M. Kunz,et al.  Hypervigilance as Predictor of Postoperative Acute Pain: Its Predictive Potency Compared With Experimental Pain Sensitivity, Cortisol Reactivity, and Affective State , 2009, The Clinical journal of pain.

[56]  T. List,et al.  Influence of pressure rates on the reliability of a pressure threshold meter. , 1991, Journal of craniomandibular disorders : facial & oral pain.

[57]  S. George,et al.  Fear of pain, not pain catastrophizing, predicts acute pain intensity, but neither factor predicts tolerance or blood pressure reactivity: An experimental investigation in pain‐free individuals , 2006 .

[58]  C. Spielberger,et al.  Manual for the state-trait anxiety inventory (form Y) : "self-evaluation questionnaire" , 1983 .

[59]  H. Buchanan,et al.  Evaluation of pain threshold using a simple pressure algometer , 1987, Clinical Rheumatology.

[60]  S. Ziemer,et al.  A Practical Concept for Preoperative Management of Patients With Impaired Primary Hemostasis , 2004, Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis.

[61]  E. Kosek,et al.  The effects of static muscular contraction on blood pressure, heart rate, pain ratings and pressure pain thresholds in healthy individuals and patients with fibromyalgia , 2007, European journal of pain.

[62]  J C Arezzo,et al.  Quantitative sensory testing , 2003, Neurology.

[63]  Takala Ep Pressure pain threshold on upper trapezius and levator scapulae muscles. Repeatability and relation to subjective symptoms in a working population. , 1990 .

[64]  C. Spielberger Manual for the State-Trait Anxiety Inventory (STAI) (Form Y , 1983 .

[65]  W. Sands,et al.  Reliability and Validity of a Pressure Algometer , 2009, Journal of strength and conditioning research.

[66]  L. Sharpe,et al.  The role of threat-expectancy in acute pain: effects on attentional bias, coping strategy effectiveness and response to pain , 2005, Pain.

[67]  E. Nussbaum,et al.  Reliability of clinical pressure-pain algometric measurements obtained on consecutive days. , 1998, Physical therapy.

[68]  R I M Dunbar,et al.  Social laughter is correlated with an elevated pain threshold , 2012, Proceedings of the Royal Society B: Biological Sciences.

[69]  J. Nørregaard,et al.  A narrative review on classification of pain conditions of the upper extremities. , 1999, Scandinavian journal of rehabilitation medicine.

[70]  J. Ekholm,et al.  Modulation of pressure pain thresholds during and following isometric contraction , 1995, Pain.

[71]  R. C. Oldfield The assessment and analysis of handedness: the Edinburgh inventory. , 1971, Neuropsychologia.

[72]  L. Arendt-Nielsen,et al.  Tissue characteristics during temporal summation of pressure-evoked pain , 2012, Experimental Brain Research.