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

Research

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.

The entire library link [Library Link] can be used to access all publications on cuff pressure algometry.

These papers have also been grouped into the following main areas:

  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

Experimental Protocol

STIMULUS RESPONSE

A stimulus-dependent protocol in which the pressure is linearly increased while the subject rates the pain or stops the stimulation. From these stimulus response curves the system can automatically calculate pain detection thresholds (PDT), pain tolerance threshold (PTT), as well as the pressure required to elicit a given VAS score from the subject.

This test reflects the general pain sensitivity.

TEMPORAL SUMMATION

A response-dependent protocol in which pressure stimuli of the same intensity ( typically the individual PTT) is applied repetitively while the subjects rates the pain intensity. Temporal summation is then determined based on the subjects´ individual pain response to the stimuli. Standard and evidence-based protocols are available.

This test reflects the degree of cuff induced temporal summation, which has been demonstrated to be unregulated in various chronic pain conditions.

SPATIAL SUMMATION

Spatial summation can be performed both with response-dependent and stimulus-dependent protocols. With spatial summation the same protocol ( e.g. PDT/PTT) is performed repeatedly with two cuffs with a different surface stimulation area ( or two equally sized cuffs placed next to each other).

This test will add additional information as it reflects the degree of cuff induced spatial summation.

CONDITIONED PAIN MODULATION

Conditioned pain modulation is performed using two cuffs at two different extremities. One cuff is used for conditioning and inflated to a constant painful pressure stimulation, while the other cuff is used for stimulus-response assessment.

The cuff conditioning pain modulation protocol is used for assessment of the defending pain control system.

The image shows a complete PN-CPAR-90-99-002 CPAR starter package consisting of:

#  2 x PN-CPAR-80-01-001 CPAR Cuff

# 1 x PN-CPAR-80-02-001 CPAR Driver

# 1 x PN-CPAR-80-03-001 VAS Meter

# 1 x PN-CPAR-80-04-001 Control Software

# 1 x PN-CPAR-80-99-001 Control Computer

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