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

Ambite-Quesada, Silvia, PT, PhD*,†; Arias-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: May 2018 - Volume 34 - Issue 5 - p 409–414
doi: 10.1097/AJP.0000000000000560
Original Articles

Objective: The objective of this study was to investigate somatosensory nerve fiber 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 patients 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 contralateral mirror areas. A multilevel mixed-model ANOVA with site (TrP, referred pain area) and side (real or contralateral) as within-patient factors and sex as between-patients factor was conducted.

Results: No significant differences for thermal detection (WDT, CDT) or thermal pain thresholds (HPT, CPT) were found (all, Ps>0.141). The assessments over the TrP area showed lower PPT and MDT compared with the mirror contralateral 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 contralateral mirror point compared with their respectively referred pain areas. Finally, VT was higher over the TrP area than in the referred pain area and over both mirror contralateral points.

Discussion: Assessing sensory changes over latent myofascial TrPs reveal mechanical hyperesthesia, pressure pain hyperalgesia, and vibration hypoesthesia compared with a contralateral mirror area.

*Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain

Department of Health Science and Technology, Center for Sensory-Motor Interaction (SMI), Faculty of Medicine, Aalborg University, Aalborg, Denmark

Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL

S.A.-Q. and J.L.A.-B.: performed the statistical analysis and also contributed to analysis and interpretation of data. C.F.-d.-l.-P., C.A.C., and L.A.-N.: contributed to draft the report and also supervised the study. C.F.-d.-l.P. and L.A.-N.: obtained funding. C.F.-d.l.-P. and C.A.C.: provided administrative, technical, and material support.

Partly supported by the David G. Simons Research Fund, Atlanta. The authors declare no conflict of interest.

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, Alcorcón, Madrid, Spain 28922 (e-mail:

Received July 20, 2017

Received in revised form August 30, 2017

Accepted September 7, 2017

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