Comparison of muscle and joint pressure-pain thresholds in patients with complex regional pain syndrome and upper limb pain of other origin
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Comparison of muscle and joint pressure-pain thresholds in patients with complex regional pain syndrome and upper limb pain of other origin. / Mainka, Tina; Bischoff, Florian S; Baron, Ralf; Enax-Krumova, Elena K; Nicolas, Volkmar; Pennekamp, Werner; Treede, Rolf-Detlef; Vollert, Jan; Westermann, Andrea; Maier, Christoph.
In: PAIN, Vol. 155, No. 3, 03.2014, p. 591-7.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Comparison of muscle and joint pressure-pain thresholds in patients with complex regional pain syndrome and upper limb pain of other origin
AU - Mainka, Tina
AU - Bischoff, Florian S
AU - Baron, Ralf
AU - Enax-Krumova, Elena K
AU - Nicolas, Volkmar
AU - Pennekamp, Werner
AU - Treede, Rolf-Detlef
AU - Vollert, Jan
AU - Westermann, Andrea
AU - Maier, Christoph
N1 - Copyright © 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.
PY - 2014/3
Y1 - 2014/3
N2 - Pain localized in the deep tissues occurs frequently in complex regional pain syndrome (CRPS). In addition, hyperalgesia to blunt pressure over muscles is common in CRPS, but it often appears in limb pain of other origin as well. Considering that 3-phase bone scintigraphy (TPBS) reveals periarticular enhanced bone metabolism in CRPS, joint-associated hyperalgesia to blunt pressure might be a more specific finding than hyperalgesia over muscles. In 34 patients with upper limb pain (18 CRPS, 16 non-CRPS; diagnosed in accordance to the Budapest criteria) and in 18 healthy controls, pressure-pain thresholds (PPT) were assessed bilaterally over the thenar (PPTThenar), the metacarpophalangeal (PPTMCP), and the proximal interphalangeal (PPTPIP) joints using a pressure algometer (Somedic, Sweden). Beforehand, all patients had received TPBS for diagnostic purposes independently of the study. Region-of-interest (ROI) ratios (mineralization phase) for the MCP and PIP, excluding fracture sites, were correlated with the PPT. In CRPS, all ROI ratios were significantly increased and all PPT of the affected hand were decreased compared to non-CRPS (PPTThenar: 243±150kPa vs 358±197kPa, PPTMCP: 80±67kPa vs 159±93kPa, PPTPIP: 80±56kPa vs 184±110kPa; P<.01) and controls (PPTThenar: 478±106kPa, PPTMCP: 254±50kPa, PPTPIP: 275±76kPa; P<.01). A PPTThenar below 293kPa revealed 77% sensitivity but only 63% specificity, whereas a PPTPIP below 102kPa had 82% sensitivity and 94% specificity to identify CRPS. Only in CRPS were PPTMCP and PPTPIP correlated significantly inversely with the ROI ratio (MCP: r=-0.439, PIP: r=-0.447). PPTPIP shows higher specificity for CRPS type I than PPTThenar without loss of sensitivity. Therefore, measurement of joint PPT could be a noninvasive diagnostic tool reflecting increased bone metabolism assessed by TPBS as a sign of bone pathophysiology.
AB - Pain localized in the deep tissues occurs frequently in complex regional pain syndrome (CRPS). In addition, hyperalgesia to blunt pressure over muscles is common in CRPS, but it often appears in limb pain of other origin as well. Considering that 3-phase bone scintigraphy (TPBS) reveals periarticular enhanced bone metabolism in CRPS, joint-associated hyperalgesia to blunt pressure might be a more specific finding than hyperalgesia over muscles. In 34 patients with upper limb pain (18 CRPS, 16 non-CRPS; diagnosed in accordance to the Budapest criteria) and in 18 healthy controls, pressure-pain thresholds (PPT) were assessed bilaterally over the thenar (PPTThenar), the metacarpophalangeal (PPTMCP), and the proximal interphalangeal (PPTPIP) joints using a pressure algometer (Somedic, Sweden). Beforehand, all patients had received TPBS for diagnostic purposes independently of the study. Region-of-interest (ROI) ratios (mineralization phase) for the MCP and PIP, excluding fracture sites, were correlated with the PPT. In CRPS, all ROI ratios were significantly increased and all PPT of the affected hand were decreased compared to non-CRPS (PPTThenar: 243±150kPa vs 358±197kPa, PPTMCP: 80±67kPa vs 159±93kPa, PPTPIP: 80±56kPa vs 184±110kPa; P<.01) and controls (PPTThenar: 478±106kPa, PPTMCP: 254±50kPa, PPTPIP: 275±76kPa; P<.01). A PPTThenar below 293kPa revealed 77% sensitivity but only 63% specificity, whereas a PPTPIP below 102kPa had 82% sensitivity and 94% specificity to identify CRPS. Only in CRPS were PPTMCP and PPTPIP correlated significantly inversely with the ROI ratio (MCP: r=-0.439, PIP: r=-0.447). PPTPIP shows higher specificity for CRPS type I than PPTThenar without loss of sensitivity. Therefore, measurement of joint PPT could be a noninvasive diagnostic tool reflecting increased bone metabolism assessed by TPBS as a sign of bone pathophysiology.
KW - Adult
KW - Arthralgia
KW - Complex Regional Pain Syndromes
KW - Cross-Sectional Studies
KW - Female
KW - Hand
KW - Humans
KW - Male
KW - Middle Aged
KW - Myalgia
KW - Pain Measurement
KW - Pain Threshold
KW - Pressure
KW - Comparative Study
KW - Journal Article
KW - Research Support, Non-U.S. Gov't
U2 - 10.1016/j.pain.2013.12.014
DO - 10.1016/j.pain.2013.12.014
M3 - SCORING: Journal article
C2 - 24333949
VL - 155
SP - 591
EP - 597
JO - PAIN
JF - PAIN
SN - 0304-3959
IS - 3
ER -
