Algometry

Download File ---> https://urluss.com/2tD4Er

Methods: The study design comprised 2 phases. Phase 1: 5 undergraduate physical therapists were trained in algometry at a predefined angle, at a rate of 5 Newtons (N)/s, to the first dorsal interosseous muscle. Each observer then underwent a competency test of the application speed. The aim was to achieve repeated applications at 5 N/s without visual feedback from the algometer. Phase 2: the 5 observers measured PPT of 13 healthy volunteers, at the first dorsal interosseous muscle. The sequence of observer measurements for each participant was randomized. Mean PPT values for each observer were analyzed using repeated measures analysis of variance, intraclass correlation coefficient (ICC2,1), and standard error of measurement, with 95% confidence intervals (CIs).

Chronic musculoskeletal pain is linked with sensitization, and standardized methods for assessment are needed. This study investigated (1) the test-retest reliability of computer-controlled cuff-pressure algometry (pain thresholds and temporal pain summation) on the arm and leg and (2) conditioned pain modulation (CPM) assessed by cuff algometry. The influences of age and gender were evaluated. On 2 different days, cuff pain threshold (cPPT), cuff pain tolerance (cPTT), and temporal summation of pain (TSP) by visual analog scale scores to 10 repeated cuff stimulations at cPTT intensity, as well as pressure pain threshold with handheld pressure algometry, were assessed in 136 healthy subjects. In one session, cuff pain sensitivity was also assessed before and after cold pressor-induced CPM. Good-to-excellent intraclass correlations (0.60-0.90) were demonstrated for manual and cuff algometry, and no systematic bias between sessions was found for cPPT, cPTT, and TSP on the leg and for cPTT and TSP on the arm. Cuff pressure pain threshold and cPTT were higher in men compared with women (P < 0.05). Middle-aged subjects had higher pressure pain threshold, but lower cPPT and cPTT, compared with younger subjects (P < 0.05). Temporal summation of pain was increased in women compared with men (P < 0.05). Cuff algometry was sensitive to CPM demonstrated as increased cPPT and cPTT and reduced TSP (P < 0.05). Reliability and sensitivity of computer-controlled cuff algometry for pain assessment is comparable with manual pressure algometry and constitutes a user-independent method for assessment of pain. Difference in age-related pain sensitivity between manual and cuff algometry should be further investigated.

Pain threshold is evaluated by methods including cuff algometry, pressure algometry, andalgometry with electric stimulation8, 9). Results in the literature suggestelectronic and pressure algometers have comparable reliability10, 11). Unfortunately,the costs of electronic pressure algometers limit their use in routine clinical practice.However, pressure algometers are inexpensive, more convenient, and more widelyavailable12). Moreover, pressurealgometry methods can be used for clinical research to measure the efficacy of therapeuticinterventions for the treatment of pain as well as general psychophysiological research8).

Algometry is easy to perform in clinical settings9), as equipment, training, time, and physical space requirements areminimal. Algometry has been demonstrated to be adequately reliable for research whenhigh-precision instruments are used in healthy subjects or patients33,34,35). However, Arendt-Nielsen et al.36) and Neogi et al.37) report that knee OA duration and radiographic findings are notassociated with the PPT. On the other hand, Imamura et al.38) and Lee et al.39)demonstrate that OA patients have lower PPTs than controls across multiple body sites. Also,Wyle et al.30) support the inclusion ofpressure algometry in studies assessing pain perception abnormalities in OA. Thus, it can beconcluded that the PPT can be used in research.

The assessment of the function of the masticatory motor system included clinical examination and pressure algometry. Clinical examination involving visual and auscultatory assessment as well as palpation made it possible to qualitatively and quantitatively evaluate the function of the masticatory system. The clinical index of temporomandibular dysfunction (Di) was used for the analysis of the data obtained from the clinical study (Table 3). The interpretation of the results of the clinical index of temporomandibular dysfunction (Di), based on the total number of points obtained during the tests, was performed according to the following model (Table 4) [7].

The analysis of the mean total values of pain defined according to the Visual Analogue Scale (VAS) during the test showed an increase in pain in direct proportion to the severity of temporomandibular dysfunction (P < 0.0000; Figure 1). Gender was not a factor affecting the results (P < 0.85643). The lowest level of pain was recorded in the group with no dysfunction (Di 0 = 2.13 VAS; P < 0.0000). Significantly higher algometry measurements were found in the groups with mild dysfunction (Di 1 = 6.79 VAS; P < 0.0000), moderate dysfunction (Di 2 = 18.26 VAS; P < 0.0000), and severe dysfunction (Di 3 = 34.85 VAS; P < 0.0000).

A regression analysis of the results of algometry and the clinical examination of masticatory motor system dysfunction according to the Di algorithm showed precise correlations between both tests (Table 6). The analysis showed that in algometric tests the mean pain value was a better predictor in terms of functional disorders (rs = 0.7532; P < 0.0000) than the mean absolute difference in pain between the right and left sides (rs = 0.5529; P < 0.0000).

A mathematical analysis of the ROC curve made it possible to compare the sensitivity and specificity of diagnostics tests within the entire range and showed the highest diagnostic efficiency of pressure algometry for the mean pain value (Table 7). The area under the ROC curve, indicating the discriminatory efficiency for asymptomatic subjects and patients with temporomandibular dysfunction according to the Di index, was slightly larger for this variable than in other cases (area under ROC curve (AUC) = 0.8572; standard error of mean (SEM) = 0.0531; P < 0.1532). The 7.4 VAS cut-off point marked 95.3% specificity for this variable in identifying healthy subjects and 58.4% sensitivity in identifying subjects with symptoms of dysfunctions (accuracy 68.1%). Assuming a comparable sensitivity (74.9%) and specificity (74.2%) of a diagnostic test, there was test accuracy of 74.5% at the 4.2 VAS cut-off point.

High accuracy and precision of pressure algometry was also confirmed in a study by Bernhardt et al. [9]. The study, conducted on a group of 15 healthy volunteers and 15 patients with masticatory motor system dysfunctions, showed high accuracy and repeatability of measurements made using two pressure algometers, with the intraclass correlation coefficient within a range between 0.73 and 0.99.

The occurrence of the symptom of increased pain on palpation in the structures of the masticatory system in patients with functional disorders has been the subject of numerous studies. Mohn et al. [10] examined the occurrence of pain under experimental conditions in response to transcutaneous electrical stimulation and pressure algometry. Patients with temporomandibular disorders experienced greater pain in response to electrical stimulation and an increase in pain during an isometric contraction, which was not observed in healthy subjects. According to the authors, the increase in pain during an isometric contraction may indicate centralisation of pain sensitivity in patients with temporomandibular dysfunction.

The possibility of using pressure algometry in the process of diagnosing masticatory system dysfunctions was also confirmed by Visscher et al. [13]. The authors conducted research on a group of 250 respondents, of which 148 manifested subjective pain symptoms, and demonstrated the usefulness of pressure algometry. Their clinical study was based on the principles of a blind sample and involved evaluating through palpation the masseter and temporal muscles as well as the temporomandibular joints. Regression analysis showed that the diagnostic effectiveness of algometry was similar to that of palpation (r2 = 0.22 and r2 = 0.21, resp.). The highest sensitivity to pain was observed in the masseter muscles and the temporomandibular joints, and the lowest in the temporal muscles.

MNTs measured along the ventral abdominal wall after midline celiotomy were 9.3 N/cm2, compared to baseline values of 12.0 N/cm2, which supports the clinical use of pressure algometry to detect pain in horses [31]. Differences in MNT values after intramuscular injections of sodium and procaine benzylpenicillin demonstrate the utility of pressure algometry in assessing tissue sensitivity (Table 15) [28].

Sensitivity due to microchip injection compared to sham (needle only) and control sites have also been measured with pressure algometry (Table 16) [20]. Small, statistically significant changes in MNT values could be measured, but the clinical relevance of these changes is unknown.

Additional treatments for back pain that have been assessed with pressure algometry include tail traction, static magnetic blankets and extracorporeal shockwave therapy. In horses with clinical signs of back pain, tail traction produced significant increases in MNT values measured in the thoracic (83%), lumbar (50%) and pelvic (52%) regions, compared to baseline values [21]. In a blinded, placebo-controlled crossover study evaluating the effects of static magnetic therapy as applied in a blanket in horses without back pain, there were no significant differences noted between the active and sham treatment groups [40]. A double-blind, placebo-controlled, crossover study assessing the treatment of back pain with pulsed electromagnetic therapy applied within a blanket that consisted of two 10-day treatment session reported that active treatment only produced