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Exploration of Quantitative Sensory Testing in Latent Trigger Points and Referred Pain Areas

Ambite-Quesada Silvia PT PhD; Arías-Buría, José L. PT, PhD; Courtney, Carol A. PT, PhD; Arendt-Nielsen, Lars PhD, Dr.Med.Sci.; Fernández-de-las-Peñas, César PT, PhD, Dr.Med.Sci.
The Clinical Journal of Pain: Post Acceptance: October 18, 2017
doi: 10.1097/AJP.0000000000000560
Original Article: PDF Only

Objective:

To investigate somato-sensory nerve fibre function by applying different quantitative sensory testing including thermal, mechanical and vibration thresholds over latent trigger points (TrP) and in its associated referred pain area.

Methods:

A total of 20 subjects with unilateral latent TrPs in the extensor carpi radialis brevis were included. Warmth detection threshold (WDT), cold detection threshold CDT) and heat/cold pain thresholds (HPT, CPT), mechanical detection (MDT) and pain (MPT) thresholds, vibration threshold (VT), and pressure pain thresholds (PPT) were blinded assessed over the TrP, in the referred pain area, and in the respective contra-lateral mirror areas. A multilevel mixed-model ANOVA with site (TrP, referred pain area) and side (real or contra-lateral) as within-subjects factors and gender as between-subjects factor was conducted.

Results:

No significant differences for thermal detection (WDT, CDT) or thermal pain thresholds (HPT, CPT) were found (all, P>0.141). The assessments over the TrP area showed lower PPT and MDT compared to the mirror contra-lateral TrP area (P<0.05). MDT were higher (P=0.001) but PPT (P<0.001) and MPT (P=0.032) were lower over the TrP area and contra-lateral mirror point compared to their respectively referred pain areas. Finally, VT was higher over the TrP area than in the referred pain area and over both mirror contra-lateral points.

Discussion:

Assessing sensory changes over latent myofascial TrPs reveal mechanical hyperesthesia, pressure pain hyperalgesia, and vibration hypoesthesia compared to a contra-lateral mirror area.

Contributors: All authors contributed to the study concept and design. SAQ and JLAB did the statistical analysis. SAQ and JLAB contributed to analysis and interpretation of data. CFdlP, CC and LAN contributed to draft the report. CFdlP and LAN obtained funding. CFdlP and CC provided administrative, technical, and material support. CFdlP, CC and LAN supervised the study. All authors revised the text for intellectual content and have read and approved the final version of the manuscript.

Conflict of interest statement: The authors have no conflicts of interest to declare.

Reprints: César Fernández de las Peñas, PT, PhD, Dr.Med.Sci., Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Madrid, SPAIN (e-mail: cesar.fernandez@urjc.es).

Received July 20, 2017

Accepted September 7, 2017

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.