The Current Perception Threshold Test Differentiates Categories of Mechanical Neck Disorder

Uddin, Zakir; MacDermid, Joy C.; Galea, Victoria; Gross, Anita; Pierrynowski, M.R.

doi:10.2519/jospt.2014.4691

Cited by 15 publications

(17 citation statements)

References 75 publications

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“…In multivariate modeling of all QST with potential predictor, it was the only one to demonstrate a significant relationship with physical health status. Our previous studies supported consistency, moderate construct and discriminative validity, good specificity, and moderate sensitivity of CPT in neck disorders [ 47 , 60 ]. Since previous studies have suggested that CPT has moderate reliability, this may have mitigated the strength of the associations.…”

Section: Discussionsupporting

confidence: 76%

“…CPT) was not correlated to pain, function or health status at any of the three sites tested by bivariate correlations. We used 5Hz CPT, which is neuroselective to assess small fibers (C fiber) that carry pain information [ 47 , 48 , 54 ]. In multivariate modeling of all QST with potential predictor, it was the only one to demonstrate a significant relationship with physical health status.…”

Section: Discussionmentioning

confidence: 99%

“…CPT testing [ 47 - 54 ] was performed using the Rapid Current Perception Threshold (R-CPT) protocol of the Neurometer CPT/C (Neurotron, Incorporated, Baltimore, MD, USA). The R-CPT test protocol requires the subject to self-administer electrical stimuli, increasing in intensity through a series of 25 predetermined levels.…”

Section: Methodsmentioning

confidence: 99%

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Psychophysical and Patient Factors as Determinants of Pain, Function and Health Status in Shoulder Disorders

Uddin

MacDermid

Moro

et al. 2016

TOORTHJ

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Objective:To estimate the extent to which psychophysical quantitative sensory test (QST) and patient factors (gender, age and comorbidity) predict pain, function and health status in people with shoulder disorders. To determine if there are gender differences for QST measures in current perception threshold (CPT), vibration threshold (VT) and pressure pain (PP) threshold and tolerance.Design:A cross-sectional study design.Setting:MacHAND Clinical Research Lab at McMaster University.Subjects:34 surgical and 10 nonsurgical participants with shoulder pain were recruited.Method:Participants completed the following patient reported outcomes: pain (Numeric Pain Rating, Pain Catastrophizing Scale, Shoulder Pain and Disability Index) and health status (Short Form-12). Participants completed QST at 4 standardized locations and then an upper extremity performance-based endurance test (FIT-HaNSA). Pearson r’s were computed to determine the relationships between QST variables and patient factors with either pain, function or health status. Eight regression models were built to analysis QST’s and patient factors separately as predictors of either pain, function or health status. An independent sample t-test was done to evaluate the gender effect on QST.Results:Greater PP threshold and PP tolerance was significantly correlated with higher shoulder functional performance on the FIT-HANSA (r =0.31-0.44) and lower self-reported shoulder disability (r = -0.32 to -0.36). Higher comorbidity was consistently correlated (r =0.31-0.46) with more pain, and less function and health status. Older age was correlated to more pain intensity and less function (r =0.31-0.57). In multivariate models, patient factors contributed significantly to pain, function or health status models (r2 =0.19-0.36); whereas QST did not. QST was significantly different between males and females [in PP threshold (3.9 vs. 6.2, p < .001) and PP tolerance (7.6 vs. 2.6, p < .001) and CPT (1.6 vs. 2.3, p =.02)].Conclusion:Psychophysical dimensions and patient factors (gender, age and comorbidity) affect self-reported and performance-based outcome measures in people with shoulder disorders.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

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Psychophysical and Patient Factors as Determinants of Pain, Function and Health Status in Shoulder Disorders

Uddin

MacDermid

Moro

et al. 2016

TOORTHJ

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“…Dynamic and static QST have been widely applied to measure pain sensitivity in clinical pain populations and to further infer the underlying mechanisms. 6 , 8 , 56 – 58 For instance, PPT and TSP to mechanical stimuli have been predictive of factors associated with the fear-avoidance model, such as pain catastrophizing and pain-related disability. 8 This supports the application of QST and its relevance to diverse aspects of the pain experience.…”

Section: Discussionmentioning

confidence: 99%

“…Dynamic and static QST have been widely applied to measure pain sensitivity in clinical pain populations and to further infer the underlying mechanisms. 6,8,[56][57][58] For instance, PPT and TSP to mechanical stimuli have been predictive of factors Figure 3 Boxplots showing median (black bars) and 25th-75th percentiles (IQR boxes) of (A) local pain ratings between men and women from the saline infusion at 80 mL/ hr and (B) pressure pain thresholds (PPT) at the deltoid muscle are shown by sex-specific MSS quartiles. Significant sex-MSS interactions were observed for both conditions; yet the follow-up stratified analyses by sex only show the significant difference on saline infusion at 80 mL/hr in women between MSS quartiles (eg, 4th = highest sensory sensitivity) and the referent MSS quartile (1st, lowest) (*p≤0.05).…”

Section: Dynamic Versus Static Qstmentioning

confidence: 99%

<p>Multisensory Sensitivity is Related to Deep-Tissue but Not Cutaneous Pain Sensitivity in Healthy Individuals</p>

Wang¹,

Merkle²,

Lee³

et al. 2020

JPR

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Purpose: Some individuals with chronic pain find daily life sensations (eg, noise, light, or touch) aversive. This amplification of multisensory sensations has been associated with centrally mediated plasticity; for example, greater multisensory sensitivity (MSS) occurs in patients with fibromyalgia than rheumatoid arthritis. However, whether MSS preferentially relates to pain measures which reflect central influences (eg, dynamic quantitative sensory testing (QST) or referred pain), or whether the MSS-pain relationship requires priming from chronic pain, is unknown. Thus, this cross-sectional study investigated the relationships between MSS assessed in a pain-free state and evoked pain sensitivity. Methods: Experimental intramuscular infusion pain and multiple static and dynamic QST were assessed in 465 healthy, pain-free adults: pain thresholds using pressure (PPTs) and heat (HPTs), temporal summation of pain (TSP) using pressure, heat or punctate stimuli, and conditioned pain modulation (CPM) using pressure or heat test stimuli. MSS was assessed using 7 items from Barsky's Somatosensory Amplification Scale. Differences in pain and QST between sex-specific MSS quartiles were assessed, adjusting for multiple comparisons. All participants completed at least one intramuscular infusion condition, but not all were asked to complete each QST (n=166-465). Results: Both static and dynamic QST differed between highest and lowest MSS quartiles using pressure stimuli: lower PPTs (adjusted-p<0.01); increased pressure TSP (adjusted-p=0.02); lower pressure CPM (adjusted-p=0.01). However, none of the heat or punctate QST measures (HPTs, TSP, or CPM) differed between MSS quartiles (adjusted-p>0.05). Odds of experiencing TSP or referred pain was not greater, whereas CPM was 8-fold less likely, in those with highest MSS. Conclusion: Normal variation in non-noxious MSS is related to both static and dynamic pain sensitivity, without sensitization associated with chronic pain, but is dependent on the QST stimulus. Thus, common influences on MSS and pain sensitivity may involve central mechanisms but are likely more complex than previously recognized.

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Evaluating the novel added value of neurophysiological pain sensitivity within the fear‐avoidance model of pain

Uddin

Woznowski-Vu

Flegg

et al. 2019

European Journal of Pain

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Background The fear‐avoidance model (FAM) is a leading theoretical paradigm for explaining persistent pain following musculoskeletal injury. The model suggests that as injuries heal, pain‐related outcomes are increasingly determined by psychological, rather than physiological factors. Increasing literature, however, suggests that neurophysiological processes related to pain sensitivity also play an important role in chronicity. To date, there has been limited research that has specifically explored the role of pain sensitivity within the FAM. This study addresses this gap by evaluating whether clinical measures of pain sensitivity help explain FAM‐related outcomes, beyond model‐relevant psychological predictors. Methods The study sample consisted of 80 adults with chronic and widespread musculoskeletal pain. Participants completed a single testing session that included measures of all of the major constructs of the FAM, including pain catastrophizing, pain‐related fear, activity avoidance (self‐report and functional measures), pain‐related disability, depression and pain severity, as well as a battery of quantitative sensory testing that included measures of pressure pain threshold and temporal summation of mechanical pain across eight body sites. Results A series of hierarchical regression analyses revealed that after controlling for the psychological predictors of the FAM, indices of pain sensitivity significantly predicted 4 of the 5 FAM‐related outcomes (p < 0.05). Depression was the only outcome not significantly predicted by pain sensitivity. Interestingly, measures of pain sensitivity, but not FAM psychological factors, predicted the functional measure of activity avoidance. Conclusions These findings provide further evidence for the importance of neurophysiological factors within the FAM and have important clinical and theoretical implications. Significance This study provides evidence for the unique and added value of neurophysiological factors within the Fear Avoidance Model of pain and for the importance of integrating both sensory and psychological factors within both theoretical paradigms and clinical management strategies.

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The Current Perception Threshold Test Differentiates Categories of Mechanical Neck Disorder

Abstract: T T CONCLUSION:CPT testing has moderate discriminatory accuracy, specificity, and sensitivity for classification of MND categories into neck pain with or without neurological signs.

Cited by 15 publications

References 75 publications

Psychophysical and Patient Factors as Determinants of Pain, Function and Health Status in Shoulder Disorders

Psychophysical and Patient Factors as Determinants of Pain, Function and Health Status in Shoulder Disorders

<p>Multisensory Sensitivity is Related to Deep-Tissue but Not Cutaneous Pain Sensitivity in Healthy Individuals</p>

Evaluating the novel added value of neurophysiological pain sensitivity within the fear‐avoidance model of pain

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