Current Concept of Quantitative Sensory Testing and Pressure Pain Threshold in Neck/Shoulder and Low Back Pain

Abstract

In recent years, several published articles have shown that quantitative sensory testing (QST) and pressure pain threshold (PPT) are useful in the analysis of neck/shoulder and low back pain. A valid reference for normal PPT values might be helpful for the clinical diagnosis of abnormal tenderness or muscle pain. However, there have been no reliable references for PPT values of neck/shoulder and back pain because the data vary depending on the devices used, the measurement units, and the area examined. In this article, we review previously published PPT articles on neck/shoulder and low back pain, discuss the measurement properties of PPT, and summarize the current data on PPT values in patients with chronic pain and healthy volunteers. We also reveal previous issues related to PPT evaluation and discuss the future of PPT assessment for widespread use in general clinics. We outline QST and PPT measurements and what kinds of perceptions can be quantified with the PPT. Ninety-seven articles were selected in the present review, in which we focused on the normative values and abnormal values in volunteers/patients with neck/shoulder and low back pain. We conducted our search of articles using PubMed and Medline, a medical database. We used a combination of “Pressure pain threshold” and “Neck shoulder pain” or “Back pain” as search terms and searched articles from 1 January 2000 to 1 June 2022. From the data extracted, we revealed the PPT values in healthy control subjects and patients with neck/shoulder and low back pain. This database could serve as a benchmark for future research with pressure algometers for the wide use of PPT assessment in clinics.

Reference intervals and sources of variation of pressure pain threshold for quantitative sensory testing in a Japanese population

“…Lumbar PPTs ranged from 299 to 628 kPa in the back area in these healthy control subjects [5]. However, the sample size was statistically too small to use the range as a reference interval for the PPT [5]. In the present study, we determined the reference intervals and sources of variation of the PPT for quantitative sensory testing by enrolling a larger number of healthy individuals, as shown in Table 2, which exceeded the minimum sample size of 120 recommended for determining reference intervals in the eld of laboratory medicine [29].…”

“…The average values for all ages were as follows: PVM PPT-PVM, 539 kPa; PPT-MGM, 519 kPa; PPT-QC, 366 kPa; PPT-TA, 455 kPa; and PPT-TL, 368 kPa. We reviewed the previously published data in healthy control subjects measured by the instrument: The range of PPTs at the lumbar area was 299-628 kPa, that at the gluteal areas was 535.9-863.97 kPa, and that at the lower leg was 321.8-771.5 kPa [5,15,[23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38]. There were some differences between the articles depending on the volunteers' backgrounds.…”

“…Low back pain (LBP) is the most common musculoskeletal condition that evolves into chronic problems [8,9]. However, the reference intervals of QST for LBP and lower limb radiculopathy are not available [5].…”

“…In recent years, several published articles have shown that quantitative sensory testing (QST) is useful in the analysis of musculoskeletal pain disorders [1][2][3][4][5][6]. Based on the evidence from these studies, it is assumed that QST might be a useful tool in the analysis of the pathogenesis, classi cation, differential diagnosis, and prognosis of musculoskeletal pain [1][2][3][4][5][6].…”

“…QST uses psychophysical tests de ned as stimuli with predetermined physical properties based on speci c measurement protocols for the analysis of somatosensory aberrations. QST measures responses to sensory stimuli and can be used to assess somatosensory system function, the measurement of altered peripheral and/or central pain sensitivity, and descending pain modulation [4,5,7]. Low back pain (LBP) is the most common musculoskeletal condition that evolves into chronic problems [8,9].…”