Ann Rehabil Med.  2011 Jun;35(3):412-417. 10.5535/arm.2011.35.3.412.

Reliability and Usefulness of the Pressure Pain Threshold Measurement in Patients with Myofascial Pain

• Park G
• Kim CW
• Park SB
• Kim MJ
• Jang SH

• KMID: 2266862
• DOI: http://doi.org/10.5535/arm.2011.35.3.412

Abstract

OBJECTIVE
To assess the usefulness of a pressure algometer to measure pressure pain threshold (PPT) for diagnosis of myofascial pain syndrome (MPS) in the upper extremity and trunk muscles. METHOD: A group of 221 desk workers complaining of upper body pain participated in this study. Five physiatrists made the diagnosis of MPS using physical examination and PPT measurements. PPT measurements were determined for several muscles in the back and upper extremities. Mean PPT data for gender, side, and dominant hand groups were analyzed. Sensitivity and specificity of Fischer's standard method were evaluated. PPT cut-off values for each muscle group were determined using an ROC curve.
RESULTS
Cronbach's alpha for each muscle was very high. The PPT in men was higher than in females, and the PPT in the left side was higher than in the right side for all muscles tested (p<0.05). There was no significant difference in PPT for all muscles between dominant and non-dominant hand groups. Diagnosis of MPS based on Fischer's standard showed relatively high specificity and poor sensitivity.
CONCLUSION
The digital pressure algometer showed high reliability. PPT might be a useful parameter for assessing a treatment's effect, but not for use in diagnosis or even as a screening method.

Keyword

Pressure algometer; Pressure pain threshold; Reliability

MeSH Terms

Female
Hand
Humans
Male
Mass Screening
Muscles
Myofascial Pain Syndromes
Pain Threshold
Physical Examination
Sensitivity and Specificity
Upper Extremity

Reference

1. Ohara H, Nakagiri S, Itani T, Wake K, Aoyama H. Occupational health hazards resulting from elevated work rate situations. J Hum Ergol (Tokyo). 1976; 5:173–182. PMID: 143492.

2. Onishi N, Nomura H, Sakai K, Yamamoto T, Hirayama K, Itani T. Shoulder muscle tenderness and physical features of female industrial workers. J Hum Ergol (Tokyo). 1976; 5:87–102. PMID: 1030453.

3. Bechtol CO. Grip test; the use of a dynamometer with adjustable handle spacing. J Bone Joint Surg Am. 1954; 36:820–824. PMID: 13174611.

4. Sola AE, Bonica JJ. Myofascial pain syndromes. The management of pain. 1990. 2nd ed. Philadelphia: Lea & Febiger;p. 352.

5. Hogeweg JA, Langereis MJ, Bernards AT, Faber JA, Helders PJ. Algometry. Measuring pain threshold, method and characteristics in healthy subject. Scand J Rehabil Med. 1992; 24:99–103. PMID: 1604268.

6. Fischer AA. Pressure threshold meter: its use for quantification of tender spots. Arch Phys Med Rehabil. 1986; 67:836–838. PMID: 3778185.

7. Han TR, Kim JH, Chun MH, Choi KH. Pain threshold using a pressure algometer in normal Korean young adults. J Korean Acad Rehabil Med. 1994; 18:219–226.

8. Lee GH, Park SB, Lee SG, Lee KM, Roh SC, Song J. Pressure threshold, grip and pinch strength in female telephone operators. J Korean Acad Rehabil Med. 1997; 21:589–593.

9. Buchanan HM, Midgley JA. Evaluation of pain threshold using a simple pressure algometer. Clinical Rheumatology. 1987; 6:510–517. PMID: 3449302.

10. Chesterton LS, Barlas P, Foster NE, Baxter GD, Wright CC. Gender differences in pressure pain threshold in healthy humans. Pain. 2003; 101:259–266. PMID: 12583868.

11. Chung SC, Um BY, Kim HS. Evaluation of pressure pain threshold in head and neck muscles by electronic algometer: intrarater and interrater reliability. Cranio. 1992; 10:28–34. PMID: 1302649.

12. Chesterton LS, Sim J, Wright CC, Foster NE. Interrater reliability of algometry in measuring pressure pain thresholds in healthy humans, using multiple raters. Clin J Pain. 2007; 23:760–766. PMID: 18075402.

13. Dagtekin O, König E, Gerbershagen HJ, Marcus H, Sabatowski R, Petzke F. Measuring pressure pain thresholds. Comparison of an electromechanically controlled algometer with established methods. Schmerz. 2007; 21:439–444. PMID: 17497183.

14. Kinser AM, Sands WA, Stone MH. Reliability and validity of a pressure algometer. J Strength Cond Res. 2009; 23:312–314. PMID: 19130648.

15. Simons DG, Travell JG. Myofascial pain and dys function: the trigger point mannual. 1999. 2nd ed. Baltimore: Williams & Wilkins;p. 19–44.

16. Lee JH, Lee JH, Shin HS, Yoon CH, Oh MK, Kwon SH. Usefulness of electronic pressure algometer in evaluation of pressure pain threshold in normal Korean adults. J Korean Acad Rehabil Med. 2008; 32:698–702.

17. Kwon YE, Lee SJ, Yoon CS, Lee JH. Pressure pain threshold measurement using a pressure algometer in myofascial pain syndromes. J Korean Pain Soc. 2001; 14:32–36.

18. Reeves JL, Jaeger B, Graff-Radford SB. Reliability of the pressure algometer as a measure of myofascial trigger point sensitivity. Pain. 1986; 24:313–321. PMID: 3960573.

19. Delaney GA, Mckee AC. Inter- and intra-rater reliability of the pressure threshold meter in measurement of myofascial trigger point sensitivity. Am J Phys Med Rehabil. 1993; 72:136–139. PMID: 8512674.

20. Vatine JJ, Shapira SC, Magora F, Adler D, Magora A. Electronic pressure algometry of deep pain in healthy volunteers. Arch Phys Med Rehabil. 1993; 74:526–530. PMID: 8489364.

21. Fischer AA. Pressure algometry over normal muscles. Standard value, validity and reproducibility of pressure threshold. Pain. 1987; 30:115–126. PMID: 3614975.