Chronic musculoskeletal pain is linked with sensitization, initially in the peripheral structures and often later sensitization of central mechanisms


Chronic musculoskeletal pain is linked with sensitization, initially in the peripheral structures and often later sensitization of central mechanisms[1]. The degree of sensitization can be estimated using standardized quantitative sensory testing (QST)[5]. The initial protocols for QST mainly focused on peripheral sensitization in neuropathic pain but modern QST protocols for musculoskeletal pain focuses on three main aspects: widespread hyperalgesia, facilitation of pain in the central nervous system and the central nervous systems ability to inhibit pain.

Cuff algometry provides standardized QST protocols focusing on bilateral pressure pain thresholds, temporal summation of pain (TSP) and conditioning pain modulation (CPM). Cuff algometry is an evidence-based research tool, which has shown good to excellent within and between day reliability in healthy subjects and patients with chronic musculoskeletal pain (ICC > 0.7)[2, 7] and is using widely to study pain mechanisms in both healthy subjects and patients with chronic pain. Customizable protocols can be tailored to fit your specific protocol, if the standardized protocols are not sufficient.

Widespread hyperalgesia, facilitated TSP and impaired CPM have been study in pain patients ranging from adolescence with patellofemoral pain[4], to patients with knee osteoarthritis[8] to patients with fibromyalgia [3] using cuff algometry.

Studies focusing on phenotyping of pain patients have shown that groups of patients with facilitated TSP and impaired CPM assessed by cuff algometry have more widespread pain in a general chronic pain patient population[6]. Further, the same methodology, have been used to screen patients with knee osteoarthritis before total knee replacement and patients with facilitated TSP and impaired CPM seems in higher risk of developing chronic postoperative pain 1 year following surgery[8]. Further, preoperative widespread hyperalgesia measured by cuff algometry have been associated with the development of chronic postoperative pain following total knee replacement[8] and preoperative TSP has been associated with postoperative pain following total hip replacement[9].

Reference Database

References to cuff pressure algometry is provided through Zotero, which is an online free reference manager that allow groups of people to collaborate on collections of references on research topics.

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  1. Graven-Nielsen T, Arendt-Nielsen L. Assessment of mechanisms in localized and widespread musculoskeletal pain. Nature Reviews Rheumatology 2010;6:599-606.
  2. Graven-Nielsen T, Vaegter HB, Finocchietti S, Handberg G, Arendt-Nielsen L. Assessment of musculoskeletal pain sensitivity and temporal summation by cuff pressure algometry: A reliability study. Pain 2015.
  3. Jespersen A, Dreyer L, Kendall S, Graven-Nielsen T, Arendt-Nielsen L, Bliddal H, Danneskiold-Samsoe B. Computerized cuff pressure algometry: a new method to assess deep-tissue hypersensitivity in fibromyalgia. Pain 2007;131:57-62.
  4. Rathleff MS, Petersen KK, Arendt-Nielsen L, Thorborg K, Graven-Nielsen T. Impaired Conditioned Pain Modulation in Young Female Adults with Long-Standing Patellofemoral Pain: A Single Blinded Cross-Sectional Study. Pain Medicine 2015:pnv017.
  5. Rolke R, Baron R, Maier Ca, Tölle T, Treede R, Beyer A, Binder A, Birbaumer N, Birklein F, Bötefür I. Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): standardized protocol and reference values. Pain 2006;123:231-243.
  6. Vaegter HB, Graven-Nielsen T. Pain modulatory phenotypes differentiate subgroups with different clinical and experimental pain sensitivity. Pain 2016.
  7. Y. Imai, K.K. Petersen, C.D. Mørch, L. Arendt Nielsen. Comparison of test-retest reliability and magnitude of conditioned pain modulation with different combinations of test and conditioning stimuli. In preparation.
  8. K.K. Petersen, T. Graven-Nielsen, O. Simonsen, M.B. Laursen, L. Arendt-Nielsen. Preoperative Pain Mechanisms Assessed by Cuff Algometry are Associated with Chronic Postoperative Pain Relief after Total Knee Replacement. Pain 2016. Epub ahead of Print.
  9. M. Izumi, K.K. Petersen, M.B. Laursen, L. Arendt-Nielsen, T. Graven-Nielsen. Facilitated temporal summation of pain predicts pain at week 6 after hip arthroplasty. Submitted to Arthritis and Rheumatology