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PubMed1982

The clinical significance of pain threshold measurements.

Pain is an experience common to us all. There are various methods of attempting to measure pain in an individual. Pain threshold would appear to be the most useful of these as it is atraumatic and repeatable over long periods in healthy individuals. Various factors affect pain threshold such as anxiety. There are a number of ways of measuring pain threshold the requirement for these being similar, for example producing no tissue damage. Pain threshold appears to change in various clinical conditions such as osteoarthrosis of the hip once the painful condition is relieved the threshold may revert back to normal. Other painful conditions such as rheumatiod arthritis do not appear to alter the pain threshold. Pain threshold does not appear to be altered by analgesic drugs, however other drugs may alter the pain threshold.

Age Factors↗
PubMed2001

Tactile threshold and pressure pain threshold during treatment of orofacial pain: an explorative study.

The aim of the present study was to evaluate the pressure pain threshold (PPT), tactile threshold (TT) and pain intensity as measured on a Visual Analogue Scale (VAS) in patients with pain in the orofacial region. Twenty-six patients with myogenous pain (7 ss), myogenous and capsular pain (11 ss) or neuropathic pain (8 ss) participated in the study. At baseline, the PPT was evaluated using an algometer and the TT using von Frey hairs. In addition, the pain intensity was rated on a VAS scale and the psychological profile made using the SCL-90 questionnaire. In some of the patients, the measurement procedure was conducted I week later, immediately before active treatment started. As active treatment, patients with myogenous or capsular pain received physical therapy in addition to conscious relaxation of the masticatory system, while patients with neuropathic pain were treated using tricyclic antidepressant medication. After 4 to 6 weeks, the measurements were repeated. Statistical evaluation using a linear mixed model revealed no significant changes in TT. In patients with myogenous and capsular pain, as well as in patients with neuropathic pain, the PPT increased after active treatment, while it decreased in the group with pure myogenous pain. The VAS score decreased in all groups. Regarding psychological profiles, a variety of characteristics were observed and the scale for sleeping problems was especially elevated in a majority of the patients.

Adult↗
PubMedDate not supplied

Thermal sensory decision theory indices and pain threshold in chronic pain patients and healthy volunteers.

Fifty-five low back pain patients and 47 healthy volunteers judged the intensity of calibrated thermal stimuli. The method of constant stimuli yielded a pain threshold, and sensory decision theory (SDT) methods provided two independent indices of perceptual performance: discriminability, P(A), the ability to differentiate among various stimulus intensities; and report criterion, B, the tendency to use a particular response. Compared to healthy volunteers, chronic pain patients were far poorer discriminators [lower P(A)]. In addition, the chronic pain patients were more stoical (higher B) and had higher thresholds for reporting both very faint pain and pain. The poor discriminability in patients could be due to attenuation of afferent neural input. The higher criterion suggests that the thermal stimuli were perceived as being innocuous relative to their clinical pain. Comparison of SDT indices with the threshold measures revealed that the pain threshold was highly correlated to the subject's criterion for reporting pain, B, and unrelated to discriminability, P(A).

Adaptation, Physiological↗
PubMed1993

Pressure pain threshold in pain-free subjects, in patients with chronic regional pain syndromes, and in patients with fibromyalgia syndrome.

OBJECTIVE: We hypothesized that change in pain threshold to pressure reflects a generalized change in the pain system affecting both tender and control points. METHODS: We assessed 18 tender points and 4 control points using an algometer in 60 patients with generalized fibromyalgia/fibrositis syndrome, 60 patients with localized chronic pain syndromes, and in 60 pain-free subjects. RESULTS: A significant correlation was found between myalgia scores at tender points and control points in these subjects. CONCLUSION: These results suggest that there is a diffuse change in pain modulation in fibromyalgia, as hypothesized, but the tender point is still clinically useful.

Adult↗
PubMed2006

The initial effects of a Mulligan's mobilization with movement technique on range of movement and pressure pain threshold in pain-limited shoulders.

There is little known about the specific manual therapy techniques used to treat painfully limited shoulders and their effects on range of movement (ROM) and pressure pain threshold (PPT). The objective of this study was to investigate the initial effects of a Mulligan's mobilization with movement (MWM) technique on shoulder ROM in the plane of the scapula and PPT in participants with anterior shoulder pain. A repeated measures, double-blind randomized-controlled trial with a crossover design was conducted with 24 subjects (11 males and 13 females). ROM and PPT were measured before and after the application of MWM, sham and control conditions. Significant and clinically meaningful improvements in both ROM (15.3%, F (2,46)=16.31 P=0.00) and PPT (20.2%, F(2,46)=3.44, P=0.04) occurred immediately after post treatment. The results indicate that this specific manual therapy treatment has an immediate positive effect on both ROM and pain in subjects with painful limitation of shoulder movement. Further study is needed to evaluate the duration of such effects and the mechanism by which this occurs.

Adult↗
PubMed1999

Acute pain threshold in subjects with chronic pain following spinal cord injury.

Studies of pain perception in patients with chronic pain have yielded contradictory results. While several studies found that acute pain threshold is raised in chronic pain subjects, others showed that these subjects exhibit a decreased pain threshold compared to pain free subjects. The aim of this study was to further examine this topic by studying pain perception in subjects with chronic pain following partial or complete spinal cord injury (SCI). We found a significant elevation of heat-pain threshold (measured above the level of lesion) in complete SCI subjects with chronic pain (CSCIP) as opposed to complete SCI subjects without pain, incomplete SCI subjects with (ISCIP) and without chronic pain and normal controls. This elevation of pain threshold was completely reversed following a complete relief of the chronic pain by DREZ lesion. Moreover, the CSCIP exhibited significantly higher scores in the McGill pain questionnaire compared to ISCIP, indicative of a more intense chronic pain perceived by these subjects. In addition, the chronic pain below the level of spinal lesion, reported by CSCIP originated from a significantly larger body area than that of ISCIP. These results indicate that a critical level of chronic pain must be perceived in order to induce an elevation in acute pain threshold.

Acute Disease↗
PubMed2004

Decreased pain threshold in children with growing pains.

OBJECTIVE: To investigate whether children with recurrent musculoskeletal pain termed growing pains (GP) have lower pain thresholds than children without GP. METHODS: We measured the pain threshold of 44 children with GP and 46 controls. Pain thresholds were measured by use of a Fisher type dolorimeter with pressure applied to areas associated with increased tenderness in fibromyalgia (FM), control points, and anterior tibia, the usual region of pain in children with GP. Unpaired Student's t test and chi-square tests were used to compare the pain threshold and number of tender points in patients and controls. RESULTS: The pain threshold in characteristic tender points of FM, control points, and anterior tibia in the children with GP was significantly lower in children with GP (3.5 +/- 0.6 kg/cm2 in GP versus 4.0 +/- 0.7 in controls, p < 0.001, 3.8 +/- 0.7 versus 4.4 +/- 0.8, p = 0.005; 5.1 +/- 1.1 versus 5.9 +/- 1.5, p = 0.004). Children with GP had a significantly greater number of tender points in response to an applied pressure of 4 kg/cm2. CONCLUSION: Children with GP have more tender points and lower pain thresholds than children without GP indicating that GP may represent a variant of a noninflammatory pain syndrome in younger children.

Child↗
PubMed2003

Acute oral pain intensity and pain threshold assessed by intensity matching to pain induced by electrical stimuli.

AIMS: To investigate a recently developed pain-intensity matching device (Painmatcher) in terms of reproducibility, pain intensity, and unpleasantness experienced by healthy individuals upon pain threshold assessment, as well as differences in pain threshold between genders and between healthy individuals and patients with acute oral pain, and the relation between pain-intensity assessments by the Painmatcher and a visual analog scale (VAS) in the patients. METHODS: Forty healthy individuals and 28 patients with acute oral pain participated. The Painmatcher produces an eventually noxious stimulus by increasing electrical impulses between 2 fingers. Pain thresholds were assessed twice in the healthy individuals and the provoked pain intensity and unpleasantness were recorded on a VAS. In the patients, pain threshold and ongoing pain were assessed with the Painmatcher and the ongoing pain was recorded on a VAS. RESULTS: Painmatcher scores for the 2 pain threshold assessments were equally correlated in the healthy individuals and patients. VAS scores for ongoing pain and pain caused by the Painmatcher when the ongoing pain intensity was assessed were positively correlated. In the healthy individuals, the degree of unpleasantness was higher than the pain intensity at the pain threshold. The patients had a lower pain threshold than the healthy individuals. CONCLUSION: This study indicates that patients with acute oral pain have lower Painmatcher pain thresholds than healthy individuals, suggesting a general decrease in nociceptive thresholds in these patients. The Painmatcher seems to be as valid as a VAS for acute oral pain assessment. The Painmatcher pain threshold is highly reproducible but associated with unpleasantness.

Acute Disease↗
PubMed1962

Pain threshold and discrimination of pain intensity during brief exposure to intense noise.

Neither pain threshold nor the capacity to discriminate intensity of mild pain was significantly altered during simultaneous stimulation by intense "white" noise. These observations indicate that the reported clinical usefulness of such auditory stimulation during painful therapeutic procedures does not result from an alteration in the capacity to perceive pain.

Acoustic Stimulation↗
PubMed1972

Pain threshold and arthritis.

Pain threshold was measured in 106 patients with rheumatoid arthritis, 50 with ankylosing spondylitis, and 50 normal controls using Keele's algometer. In rheumatoid arthritis patients with a low pain threshold had more severe pain for a greater part of the day and required more tablets for pain relief. In ankylosing spondylitis the pain threshold was higher and was not related to pain or analgesic requirements. There was no evidence that pain threshold affected the course or outcome of rheumatoid arthritis in any way.

Absenteeism↗
PubMed2000

Pressure pain threshold in children with recurrent abdominal pain.

BACKGROUND: Experimental studies on humans have shown that recurrent pain is associated with altered pain perception. We measured the pressure pain threshold in regions of the body surface in a group of children who had recurrent abdominal pain and in a group of children with chronic or recurrent disease but with no pain. METHODS: Each group consisted of 45 boys and 55 girls ranging in age from 5 to 15.8 years. The regions of the body were the trapezius, deltoid, and supraspinous muscles, nine areas on the abdominal wall, and the median part of the tibias. Using an algometer, pressure was applied through a rubber disc with a surface area of 1 cm2 at a rate of 0.5 kg/cm2/s. The pressure values recorded with the algometer when the children communicated that they started to feel pain were considered as pressure pain thresholds. RESULTS: The pain thresholds were reduced in all regions investigated in children with recurrent pain. The median thresholds for all regions of the patients with and without pain were 1.60 and 2.2 kg/cm2, respectively. The diseases of children with pain did not influence the pain thresholds. CONCLUSION: There was an association between recurrent abdominal pain and a lower pressure pain threshold, with no influence of the type of disease, and there was a central nervous system alteration in the perception of pain in these patients.

Abdominal Muscles↗
PubMed1979

Modification of human pain threshold by specific tactile receptors.

The effects of conditioning vibrotactile stimulation of particular tactile receptor groups on thresholds to painful electric stimuli were studied in seven healthy adults. Preferentially Pacinian afferents were activated with conditioning sinusoidal vibration of 240 Hz at 20 and 200 micrometers amplitudes and preferentially non-Pacinian tactile fibers were activated with conditioning sinusoidal vibration of 20 Hz at 200 and 400 micrometers amplitudes. None of the subjects showed pain threshold elevation during activation of non-Pacinian tactile fibers. However, 6 of the 7 subjects showed significant pain threshold elevation with conditioning vibration stimulus of 240 Hz at 200 micrometers amplitude, and 4 subjects showed significantly elevated pain thresholds with conditioning stimulus of 240 Hz at 20 micrometers amplitude. It is concluded that the activation of Pacinian afferents causes inhibition of pain conducting pathways.

Adult↗
PubMed1995

Role of testosterone on pain threshold in rats.

Pain thresholds were recorded in rats by progressive increase in electrical stimulation to induce tail withdrawal, vocalisation and vocalisation after discharge. It was observed that castration resulted in significant reduction of pain threshold which however returned to normal level on substitution with testosterone therapy.

Animals↗
PubMed1994

Altered heat pain thresholds and cerebral event-related potentials following painful CO2 laser stimulation in subjects with fibromyalgia syndrome.

A decrease in mechanical pressure pain thresholds, particularly over pre-designated tender points, is one of the defining characteristics of fibromyalgia syndrome (FS); however, changes in thermal pain sensitivity have not been investigated. The present study examined heat pain thresholds and cerebral event-related potentials following CO2 laser stimulation in 10 subjects with FS and 10 age-matched control volunteers. The results indicate that patients with FS exhibit a significant reduction in heat pain threshold when tested on the dorsal surface of the hand. In accordance with previous research, we also found a decrease in mechanical pain threshold over pre-designated tender points and at control sites as well as a significantly larger mechanically induced neurogenic flare response. These measures were highly correlated with thermal pain threshold even though different anatomical sites were stimulated. Hence, it seems likely that FS patients display a multimodal change in pain sensitivity which is generalized rather than anatomically restricted. Patients with FS also displayed a significant increase in the peak-to-peak amplitude of the cerebral potential evoked by CO2 laser stimulation at pain threshold intensity and 1.5 times pain threshold intensity. These findings suggest a greater activation of central nervous system (CNS) pathways following noxious input. Putative explanations for the increased CNS response are discussed, including mechanisms of peripheral nociceptor sensitization, altered CNS function and the role of psychological factors.

Adult↗