Pressure pain algometry — A call for standardisation of methods
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Audun Stubhaug
Algometry has been used in both experimental pain research and in clinical research for many years. It has been shown to be useful for the study of regional analgesia [1]. Pressure algometry has been shown to be sensitive for the analgesic effect of opioids [2], corticosteroids [3], and paracetamol [4] in healthy volunteers.
Algometry is also useful in the clinic. Nikolajsen and co-workers found that pressure pain thresholds predicted stump pain and phantom pain after amputation [5].
Pressure pain (algometry) is particularly useful in musculoskeletal pain [6] and bone pain [7] and is diagnostic for fibromyalgia [8]. Pain threshold and tolerance assessed with a specially designed algometer were significantly associated with average measures of clinical pain in fibromyalgia [9], chronic fatigue [9], and rheumatoid arthritis [10].
The nociceptors involved in pressure pain are probably different for short-lasting dynamic pressure and tonic pressure for 120 s [11].
One recurring discussion has been on the choice of outcome: pain threshold versus pain tolerance or pain ratings to painful stimuli? This has been examined in healthy volunteers by Lacourt et al. and is presented in the present issue of the Scandinavian Journal of Pain [12]. The objective of the study was to investigate the reliability (test–retest) and the interrelationship between pressure-pain threshold (PPth), pressure-pain tolerance, and pressure-pain ratings. They conclude that PPth, subjective ratings of moderate intensity suprathreshold stimuli, and subjective ratings of the maximum intensity are distinct aspects of pain responsiveness. They recommend including a measure of each of these three dimensions of pain when assessing pressure pain responsiveness. They also found good test–retest reliability between second and third pressure pain threshold measurement. We should, however, bear in mind that this does not prove such stability over time (from day to day). Last, the authors recommend that when it is desirable to collapse pressure pain threshold on several body points into one mean value, they suggest to average over bilateral body points only, since individual thresholds vary significantly between body sites in the same individual.
Learning from this and previous studies, we might find pressure algometry useful both in future pain research [13] and in clinical evaluation of painful conditions. Equipment and test algorithms should be better standardised. Lacourt and colleagues used an examiner dependent method that only works well in much trained examiners [12]. Computer-controlled equipment that eliminates examiner-bias has been developed [14,15,16], and this is probably necessary to fully exploit the potential of pressure pain testing.
DOI of refers to article: 10.1016/j.sjpain.2011.10.003.
References
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© 2011 Scandinavian Association for the Study of Pain
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Artikel in diesem Heft
- Editorial comment
- Keeping an open mind: Achieving balance between too liberal and too restrictive prescription of opioids for chronic non-cancer pain: Using a two-edged sword
- Educational case report
- Chronic non-cancer pain and the long-term efficacy and safety of opioids: Some blind men and an elephant?
- Editorial comment
- National versions of fibromyalgia questionnaire: Translated protocols or validated instruments?
- Original experimental
- Validation of a Finnish version of the Fibromyalgia Impact Questionnaire (Finn-FIQ)
- Editorial comment
- The impact of chronic pain—European patients’ perspective over 12 months
- Original experimental
- The impact of chronic pain—European patients’ perspective over 12 months
- Editorial comment
- Pressure pain algometry — A call for standardisation of methods
- Original experimental
- Experimental pressure-pain assessments: Test-retest reliability, convergence and dimensionality
- Editorial comment
- High prevalence of posttraumatic stress disorder (PTSD) and pain sensitization in two Scandinavian samples of patients referred for pain rehabilitation
- Clinical pain research
- The traumatised chronic pain patient—Prevalence of posttraumatic stress disorder - PTSD and pain sensitisation in two Scandinavian samples referred for pain rehabilitation
- Editorial comment
- Local infiltration analgesia (LIA) and repeated bolus or continuous infusion peripheral nerve blocks for acute postoperative pain: Be ware of local anaesthetic toxicity, especially in elderly patients with cardiac co-morbidities!
- Clinical pain research
- A randomized study comparing plasma concentration of ropivacaine after local infiltration analgesia and femoral block in primary total knee arthroplasty
- Editorial comment
- Computer work can cause deep tissue hyperalgesia: Implications for prevention and treatment
- Original experimental
- Deep tissue hyperalgesia after computer work
