Cuff Pressure Algometry

Chronic musculoskeletal pain is linked with sensitisation, initially in the peripheral structures and often later sensitisation of central mechanisms [1]. The degree of sensitisation can be estimated using standardised quantitative sensory testing (QST)[2]. The initial protocols for QST mainly focused on peripheral sensitisation in neuropathic pain, but modern QST protocols for musculoskeletal pain focus on three main aspects: widespread hyperalgesia, facilitation of pain in the central nervous system and the central nervous system’s ability to inhibit pain.

Cuff algometry provides standardised QST protocols focusing on bilateral pressure pain thresholds, temporal summation of pain (TSP) and conditioning pain modulation (CPM). Cuff algometry is an evidence-based research tool which has shown good to excellent within and between-day reliability in healthy subjects and patients with chronic musculoskeletal pain (ICC > 0.7) [3], [4], and it is used widely to study pain mechanisms in healthy subjects and chronic pain patients. Customisable protocols can be tailored to fit your specific protocol if the standardised protocols are not sufficient.

Widespread hyperalgesia facilitated TSP and impaired CPM have been studied in pain patients ranging from adolescents with patellofemoral pain [5] to patients with knee osteoarthritis [6] to patients with fibromyalgia [7] using cuff algometry.

Studies focusing on phenotyping of pain patients have shown that groups of patients with facilitated TSP and impaired CPM assessed by cuff algometry have more widespread pain in a general chronic pain patient population [8]. Further, the same methodology has been used to screen patients with knee osteoarthritis before total knee replacement. Patients with facilitated TSP and impaired CPM seem to be at a higher risk of developing chronic postoperative pain one year after surgery [6]. Further, widespread preoperative hyperalgesia measured by cuff algometry has been associated with the development of chronic postoperative pain following total knee replacement [6], and preoperative TSP has been associated with postoperative pain following total hip replacement [9].

References

• [1] T. Graven-Nielsen and L. Arendt-Nielsen, ‘Assessment of mechanisms in localized and widespread musculoskeletal pain’, Nat. Rev. Rheumatol., vol. 6, no. 10, Art. no. 10, Oct. 2010, doi: 10.1038/nrrheum.2010.107.
• [2] R. Rolke et al., ‘Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): Standardized protocol and reference values’, PAIN, vol. 123, no. 3, pp. 231–243, Aug. 2006, doi: 10.1016/j.pain.2006.01.041.
• [3] T. Graven-Nielsen, H. B. Vaegter, S. Finocchietti, G. Handberg, and L. Arendt-Nielsen, ‘Assessment of musculoskeletal pain sensitivity and temporal summation by cuff pressure algometry: a reliability study’, Pain, vol. 156, no. 11, pp. 2193–2202, Nov. 2015, doi: 10.1097/j.pain.0000000000000294.
• [4] Y. Imai, K. K. Petersen, C. D. Mørch, and L. Arendt Nielsen, ‘Comparing test–retest reliability and magnitude of conditioned pain modulation using different combinations of test and conditioning stimuli’, Somatosens. Mot. Res., vol. 33, no. 3–4, pp. 169–177, Oct. 2016, doi: 10.1080/08990220.2016.1229178.
• [5] M. S. Rathleff, K. K. Petersen, L. Arendt-Nielsen, K. Thorborg, and T. Graven-Nielsen, ‘Impaired Conditioned Pain Modulation in Young Female Adults with Long-Standing Patellofemoral Pain: A Single Blinded Cross-Sectional Study’, Pain Med., p. pnv017, Dec. 2015, doi: 10.1093/pm/pnv017.
• [6] K. K. Petersen, T. Graven-Nielsen, O. Simonsen, M. B. Laursen, and L. Arendt-Nielsen, ‘Preoperative pain mechanisms assessed by cuff algometry are associated with chronic postoperative pain relief after total knee replacement’, Pain, vol. 157, no. 7, pp. 1400–1406, Jul. 2016, doi: 10.1097/j.pain.0000000000000531.
• [7] A. Jespersen et al., ‘Computerized cuff pressure algometry: A new method to assess deep-tissue hypersensitivity in fibromyalgia’, Pain, vol. 131, no. 1, pp. 57–62, Sep. 2007, doi: 10.1016/j.pain.2006.12.012.
• [8] H. B. Vaegter and T. Graven-Nielsen, ‘Pain modulatory phenotypes differentiate subgroups with different clinical and experimental pain sensitivity’, Pain, vol. 157, no. 7, pp. 1480–1488, Jul. 2016, doi: 10.1097/j.pain.0000000000000543.
• [9] M. Izumi, K. K. Petersen, M. B. Laursen, L. Arendt-Nielsen, and T. Graven-Nielsen, ‘Facilitated temporal summation of pain correlates with clinical pain intensity after hip arthroplasty’, Pain, vol. 158, no. 2, pp. 323–332, Feb. 2017, doi: 10.1097/j.pain.0000000000000764.