Basic aspects of musculoskeletal pain: from acute to chronic pain

Arendt-Nielsen, Lars; Fernández‐de‐las‐Peñas, César; Graven‐Nielsen, Thomas

doi:10.1179/106698111x13129729551903

Cited by 137 publications

(136 citation statements)

References 67 publications

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“…Chronic pain is more common in women than men, including chronic low back pain (Berkley 1997; Greenspan et al 2007; Boyan et al 2013; Martel et al 2013). Females have greater central excitability on a number of measures—temporal summation, secondary hyperalgesia, referred pain (Peters et al 1992; Leffler et al 2002; Sarlani et al 2007; Shah et al 2008; Knudsen and Drummond 2009; Meeus et al 2010; Arendt-Nielsen et al 2011) and decreased inhibition—CPM (Arendt-Nielsen et al 2010; Popescu et al 2010; Martel et al 2013; Roussel et al 2013). Indeed, in an animal model of muscle pain, female mice developed widespread hyperalgesia, while males developed localized hyperalgesia; female mice had longer-lasting hyperalgesia, and hyperalgesia was easier to induce in female mice (Gregory et al 2013).…”

Section: Discussionmentioning

confidence: 99%

Central sensitization and changes in conditioned pain modulation in people with chronic nonspecific low back pain: a case–control study

et al. 2015

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Quantitative sensory testing is widely used in human research to investigate the state of the peripheral and central nervous system contributions in pain processing. It is a valuable tool to help identify central sensitization and may be important in the treatment of low back pain. The aim of this study was to evaluate changes in local and segmental hypersensitivity and endogenous pain inhibition in people with chronic nonspecific low back pain. Thirty patients with chronic low back pain and thirty healthy subjects were studied. Pressure pain thresholds (PPTs) were measured from the lumbar region and over the tibialis anterior muscle (TA). A cold pressor test was used to assess the activation of conditioned pain modulation (CPM), and PPTs in the lumbar region were recorded 30 s after immersion of participant’s foot in a bucket with cold water. People with chronic low back pain have significantly lower PPT than controls at both the lumbar region [89.5 kPa (mean difference) 95 % CI 40.9–131.1 kPa] and TA [59.45 kPa (mean difference) 95 % CI 13.49–105.42 kPa]. During CPM, people with chronic low back pain have significantly lower PPT than controls in lumbar region [118.6 kPa (mean difference) 95 % CI 77.9–159.2 kPa]. Women had significantly lower PPTs than men in both lumbar region [101.7 kPa (mean difference) 95 % CI 37.9–165.7 kPa] and over the TA [189.7 kPa (mean difference) 95 % CI 14.2–145.2 kPa]. There was no significant difference in PPTs in men between healthy controls and those with low back pain, suggesting the significant differences are mediated primarily by difference between women.

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Section: Discussionmentioning

confidence: 99%

Central sensitization and changes in conditioned pain modulation in people with chronic nonspecific low back pain: a case–control study

et al. 2015

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“…The pain localization is generally poor from a joint and the surrounding structures, and it is therefore difficult to associate the pain to tendons, ligaments, or bones or to the joint and its capsules. OA patients demonstrating more than one location or one condition of pain often express pain symptoms being more diffuse and spreading to larger areas [40] supporting the notion that central sensitization may be present in these patients [41].…”

Section: Manifestations Of Central Sensitization In Joint Painmentioning

confidence: 95%

Altered Central Sensitization and Pain Modulation in the CNS in Chronic Joint Pain

Arendt‐Nielsen

Skou

Nielsen

et al. 2015

Curr Osteoporos Rep

Self Cite

145

136

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Musculoskeletal pain disorders are the second largest contributor to global disability underlining the significance of effective treatments. However, treating chronic musculoskeletal pain, and chronic joint pain (osteoarthritis (OA)) in particular, is challenging as the underlying peripheral and central pain mechanisms are not fully understood, and safe and efficient analgesic drugs are not available. The pain associated with joint pain is highly individual, and features from radiological imaging have not demonstrated robust associations with the pain manifestations. In recent years, a variety of human quantitative pain assessment tools (quantitative sensory testing (QST)) have been developed providing new opportunities for profiling patients and reaching a greater understanding of the mechanisms involved in chronic joint pain. As joint pain is a complex interaction between many different pain mechanisms, available tools are important for patent profiling and providing the basic knowledge for development of new drugs and for developing pain management regimes.

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“…Nociceptors in periosteum have shown to respond well to pressure stimulation, however muscle stimulation have been suggested more likely to succumb to hypersensitization [20]. Hypersensitization plays a part in many chronic pain disorders such as fibromyalgia syndrome (FMS), which has been associated with substantial decrease in pain threshold [21, 22].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Pressure Pain Threshold as a Measure of Perceived Stress and High Job Strain

2017

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ObjectiveTo investigate whether pressure pain threshold (PPT), determined by pressure algometry, can be used as an objective measure of perceived stress and job strain.MethodsWe used cross-sectional base line data collected during 1994 to 1995 within the Project on Research and Intervention in Monotonous work (PRIM), which included 3123 employees from a variety of Danish companies. Questionnaire data included 18 items on stress symptoms, 23 items from the Karasek scale on job strain, and information on discomfort in specified anatomical regions was also collected. Clinical examinations included pressure pain algometry measurements of PPT on the trapezius and supraspinatus muscles and the tibia. Associations of stress symptoms and job strain with PPT of each site was analyzed for men and women separately with adjustment for age body mass index, and discomfort in the anatomical region closest to the point of pressure algometry using multivariable linear regression.ResultsWe found significant inverse associations between perceived stress and PPT in both genders in models adjusting for age and body mass index: the higher level of perceived stress, the lower the threshold. For job strain, associations were weaker and only present in men. In men all associations were attenuated when adjusting for reported discomfort in regions close to the site of pressure algometry. The distributions of PPT among stressed and non-stressed persons were strongly overlapping.ConclusionsDespite significant associations between perceived stress and PPT, the discriminative capability of PPT to distinguish individuals with and without stress is low. PPT measured by pressure algometry seems not applicable as a diagnostic tool of a state of mental stress.

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Basic aspects of musculoskeletal pain: from acute to chronic pain

Cited by 137 publications

References 67 publications

Central sensitization and changes in conditioned pain modulation in people with chronic nonspecific low back pain: a case–control study

Central sensitization and changes in conditioned pain modulation in people with chronic nonspecific low back pain: a case–control study

Altered Central Sensitization and Pain Modulation in the CNS in Chronic Joint Pain

Evaluation of Pressure Pain Threshold as a Measure of Perceived Stress and High Job Strain

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