Assessment of deep dynamic mechanical sensitivity in individuals with tension-type headache: The dynamic pressure algometry.

BACKGROUND: To explore the validity of dynamic pressure algometry for evaluating deep dynamic mechanical sensitivity by assessing its association with headache features and widespread pressure sensitivity in tension-type headache (TTH). METHODS: One hundred and eighty-eight subjects with TTH (70% women) participated. Deep dynamic sensitivity was assessed with a dynamic pressure algometry set (Aalborg University, Denmark© ) consisting of 11 different rollers including fixed levels from 500 g to 5300 g. Each roller was moved at a speed of 0.5 cm/s over a 60-mm horizontal line covering the temporalis muscle. Dynamic pain threshold (DPT-level of the first painful roller) was determined and pain intensity during DPT was rated on a numerical pain rate scale (NPRS, 0-10). Headache clinical features were collected on a headache diary. As gold standard, static pressure pain thresholds (PPT) were assessed over temporalis, C5/C6 joint, second metacarpal, and tibialis anterior muscle. RESULTS: Side-to-side consistency between DPT (r = 0.843, p < 0.001) and pain evoked (r = 0.712; p < 0.001) by dynamic algometer was observed. DPT was moderately associated with widespread PPTs (0.526 > r > 0.656, all p < 0.001). Furthermore, pain during DPT was negatively associated with widespread PPTs (-0.370 < r < -0.162, all p < 0.05). DISCUSSION: Dynamic pressure algometry was a valid tool for assessing deep dynamic mechanical sensitivity in TTH. DPT was associated with widespread pressure sensitivity independently of the frequency of headaches supporting that deep dynamic pressure sensitivity within the trigeminal area is consistent with widespread pressure sensitivity. Assessing deep static and dynamic somatic tissue pain sensitivity may provide new opportunities for differentiated diagnostics and possibly a new tool for assessing treatment effects. SIGNIFICANCE: The current study found that dynamic pressure algometry in the temporalis muscle was associated with widespread pressure pain sensitivity in individuals with tension-type headache. The association was independent of the frequency of headaches. Assessing deep static and dynamic somatic tissue pain sensitivity may provide new opportunities for differentiated diagnostics and possibly a tool for assessing treatment effects.

Effectiveness of manual therapy versus surgery in pain processing due to carpal tunnel syndrome: A randomized clinical trial.

BACKGROUND: People with carpal tunnel syndrome (CTS) exhibit widespread pressure pain and thermal pain hypersensitivity as a manifestation of central sensitization. The aim of our study was to compare the effectiveness of manual therapy versus surgery for improving pain and nociceptive gain processing in people with CTS. METHODS: The trial was conducted at a local regional Hospital in Madrid, Spain from August 2014 to February 2015. In this randomized parallel-group, blinded, clinical trial, 100 women with CTS were randomly allocated to either manual therapy (n = 50), who received three sessions (once/week) of manual therapies including desensitization manoeuvres of the central nervous system, or surgical intervention (n = 50) group. Outcomes including pressure pain thresholds (PPT), thermal pain thresholds (HPT or CPT), and pain intensity which were assessed at baseline, and 3, 6, 9 and 12 months after the intervention by an assessor unaware of group assignment. Analysis was by intention to treat with mixed ANCOVAs adjusted for baseline scores. RESULTS: At 12 months, 95 women completed the follow-up. Patients receiving manual therapy exhibited higher increases in PPT over the carpal tunnel at 3, 6 and 9 months (all, p < 0.01) and higher decrease of pain intensity at 3 month follow-up (p < 0.001) than those receiving surgery. No significant differences were observed between groups for the remaining outcomes. CONCLUSIONS: Manual therapy and surgery have similar effects on decreasing widespread pressure pain sensitivity and pain intensity in women with CTS. Neither manual therapy nor surgery resulted in changes in thermal pain sensitivity. SIGNIFICANCE: The current study found that manual therapy and surgery exhibited similar effects on decreasing widespread pressure pain sensitivity and pain intensity in women with carpal tunnel syndrome at medium- and long-term follow-ups investigating changes in nociceptive gain processing after treatment in carpal tunnel syndrome.

[Association between the frequency and duration, but not the intensity, of headache with mechanical hypersensitivity and the health of patients with tension-type headache]. / Asociacion de la frecuencia y duracion, pero no la intensidad, de la cefalea con la hipersensibilidad mecanica y la salud en pacientes con cefalea de tension.

INTRODUCTION: The association between headache clinical parameters and other health-related and neuro-physiological outcomes is controversial. AIM: To investigate the association between headache frequency, duration and intensity with cranio-cervical pressure sensitivity considering the interaction of health-related and physical outcomes. PATIENTS AND METHODS: Seventy-two individuals with tension type headache were included. A 1-month diary was used to assess headache frequency, duration and intensity. Pressure pain thresholds (PPT) and peri-cranial tenderness to palpation, health-related quality of life (Short Form-36), disability, depression, and cervical range of motion were the outcomes. All outcomes were introduced into hierarchic logistic regression models to assess potential associations. RESULTS: Several associations between headache frequency and duration, but not intensity, with the remaining variables were found. Regression analysis showed that PPT over the temporalis muscle, bodily pain, age and physical role explained the 22.3% of the headache frequency, whereas general health, PPT over the upper trapezius and headache frequency explained 20% of headache duration (p < 0.001). CONCLUSIONS: This study found that headache frequency and duration, but not headache intensity, were associated with neurophysiological outcomes, e.g., cranio-cervical pressure sensitivity, and bodily pain in tension type headache. Other variables including age, physical role and general health were also associated with headache frequency and duration.

TITLE: Asociacion de la frecuencia y duracion, pero no la intensidad, de la cefalea con la hipersensibilidad mecanica y la salud en pacientes con cefalea de tension.Introduccion. La asociacion entre las variables clinicas de la cefalea y otras variables neurofisiologicas o de salud es controvertida. Objetivo. Determinar la asociacion de la frecuencia, duracion e intensidad del dolor con la sensibilidad mecanica craneocervical, considerando el efecto de otras variables de salud y fisicas. Pacientes y metodos. Se incluyeron 72 pacientes con cefalea de tension. Se mantuvo un diario mensual para determinar la frecuencia, duracion e intensidad del dolor. Se calcularon los umbrales de dolor a la presion (UDP) y la sensibilidad a la palpacion sobre la region craneocervical, calidad de vida (Short Form-36), discapacidad, depresion y movilidad cervical. Se introdujeron todas las variables en modelos de regresion logistica jerarquica para determinar las interacciones. Resultados. Se encontraron correlaciones entre la frecuencia y duracion de la cefalea, pero no la intensidad, con el resto de variables. El analisis de regresion mostro que la combinacion del UDP sobre el temporal, dolor corporal, edad y rol fisico explicaba el 22,3% de la varianza de la frecuencia, mientras que la combinacion de salud general, UDP sobre el trapecio superior y frecuencia del dolor explicaba el 20% de la varianza de la duracion (p < 0,001). Conclusiones. Este estudio ha encontrado que la frecuencia y la duracion de la cefalea, pero no la intensidad, se encuentran asociadas con variables neurofisiologicas, como el UDP sobre el cuello/cabeza o la percepcion de dolor generalizado en la cefalea tensional. Otras variables, como la edad, el rol fisico y la salud general tambien mostraron una asociacion con la frecuencia y la duracion de la cefalea.

Puntos gatillo miofasciales en el músculo glúteo medio en pacientes con lumbalgia mecánica: análisis topográfico / Myofascial trigger points in the gluteus medius muscle in patients with mechanical low back pain: Topographic analysis

Introducción: El dolor lumbar de causa mecánica es una patología prevalente, siendo una de las causas asociadas el dolor en la zona glútea. El síndrome de dolor miofascial es uno de los cuadros dolorosos crónicos más frecuente del sistema músculo-esquelético y se encuentra representado por los puntos gatillo miofasciales (PGM). El objetivo de nuestro estudio fue determinar qué zona del músculo glúteo medio se encuentra más afectada por la presencia de PGM activos en pacientes con dolor lumbar inespecífico de origen mecánico. Método: Se realizó una serie de casos en la que se exploró a 13 pacientes con dolor lumbar de origen mecánico. Se evaluó la presencia de PGM activos y los umbrales de dolor a la presión (UDP) sobre el músculo glúteo medio. Se elaboró un mapa topográfico del músculo glúteo medio mediante 9 puntos para determinar la zona anatómica más afectada. Resultados: La intensidad media del dolor fue de 6,4 ± 1,7 cm y el tiempo medio de duración del dolor fue de 6,2 ± 4,1 años. Cada paciente con dolor lumbar mostró una media ± DE de PGM activos sobre el músculo glúteo medio de 5,6 ± 1,3. No se encontró asociación alguna entre el número de PGM activos sobre el glúteo medio y el tiempo de duración de los síntomas (r = 0,191; p = 0,622) o la intensidad del dolor (r = 0,026; p = 0,932). Los PGM activos sobre el glúteo medio se encontraron más frecuentemente en las fibras más posteriores y superiores del músculo (puntos 1-2-4), aunque las fibras antero-superiores (punto 3) y medias (punto 5) también albergaron gran cantidad de PGM activos. No existieron diferencias significativas en los UDP entre los distintos puntos. Conclusiones: El presente estudio encontró que las fibras posteriores y superiores del músculo glúteo medio se encuentran más afectadas por PGM activos en pacientes con dolor lumbar de origen mecánico

Introduction: Mechanical low back pain is one of the most prevalent pain conditions and is associated with pain in the gluteal region. Myofascial pain syndrome is a common condition associated with musculoskeletal pain which is mainly represented by myofascial trigger points (MTrPs). The aim of this study was to determine which area of the gluteus medius muscle is the most affected by active MTrPs in patients with low back pain. Methods: A case series that included 13 patients with mechanical low back pain was performed. Active MTrPs and pressure pain thresholds (PPT) were assessed on the gluteus medius muscle. A topographical map of the gluteus medius muscle was elaborated using 9 points around the muscle to determine the most affected anatomical zone. Results: The intensity of low back pain was 6.4 ± 1.7 cm and mean time with pain was 6.2 ± 4.1 years. Each low back pain patient exhibited a mean ± SD number of active MTrPs of 5.6 ± 1.3 on the gluteus medius. No association was found between the number of active MTrPs on the gluteus medius and the duration of pain history (r = 0-191; P = 0.622) or the intensity of pain (r = 0.026; P = 0.932). Active MTrPs within the gluteus medius muscle were most frequently found in the posterior and superior fibers of the muscle (points 1-2-4). Active TrPs were also found in the anterior and superior (point 3) and medium fibers (point 5) of the muscle. No significant differences were found on PPT between points. Conclusions: In the current study, it was found that the posterior and superior fibers of the gluteus medius muscle were the most affected by active MTrPs in patients with mechanical low back pain