Reliability of temporal summation, thermal and pressure pain thresholds in a healthy cohort and musculoskeletal trauma population

Abstract

Traumatic injuries affect approximately 978 million people worldwide with 56.2 million requiring inpatient care. Quantitative sensory testing (QST) can be useful in predicting outcome following trauma, however the reliability of multiple QST including temporal summation (TS), heat and cold pain thresholds (HPT, CPT) and pressure pain thresholds (PPT) is unknown. We assessed intra (between day) and inter-rater (within day) reliability of QST in asymptomatic participants (n = 21), and inter-rater (within day) reliability in participants presenting with acute musculoskeletal trauma (n = 25). Intra-class correlations with 95% confidence intervals (ICC 3,2), standard error of measurement (SEM) and Bland Altman Plots for limits of agreement were calculated. For asymptomatic participants, reliability was good to excellent for HPT (ICC range 0.76-0.95), moderate to good for PPT (ICC range 0.52-0.93), with one site rated poor (ICC 0.41), and poor to excellent for TS scores (ICC range 0.20-0.91). For musculoskeletal trauma participants reliability was good to excellent for HPT and PPT (ICC range 0.76-0.86), and moderate to good reliability for TS (ICC range 0.69-0.91). SEM for HPT for both sets of participants was~1˚C and an average of 7N for asymptomatic participants and less than 8N for acute musculoskeletal trauma participants for PPT. This study demonstrates moderate to excellent intra and inter-rater reliability for HPT and PPT in asymptomatic participants and good to excellent inter-rater reliability for acute musculoskeletal trauma participants, with TS showing more variability for both sets of participants. This study provides foundations for future work evaluating the sensory function over time following acute musculoskeletal trauma.

Conditioning to Enhance the Effects of Repetitive Transcranial Magnetic Stimulation on Experimental Pain in Healthy Volunteers

“…The average temperature over three trials was calculated for the determination of HPT. Given the nature of the study, we focused our thermal procedures on HPT, which is thought to have better intra- and inter-rater reliability and less variability over time relative to other QST measures, to avoid as much as possible confounding effects of time between visits ( 59 , 60 ). Moreover, since our SRPS procedure is based on heat, we thought that HTP was the most adequate outcome to assess intervention changes.…”

Reliability of quantitative sensory testing on myofascial trigger points in the upper trapezius muscle of individuals with chronic neck pain

“…Considering the reliability of the QST in other painful conditions, some studies have investigated orofacial pain 23 , knee osteoarthritis 24 , and musculoskeletal traumatic injury 25 . Our results found the ICC values similar to the ones in the aforementioned studies, indicating a pattern of error in the measurements performed with the QST, regardless of the population with pain studied.…”

“…Middlebrook et al 25 measured the inter-rater reliability of the QST in the assessment of individuals with traumatic musculoskeletal injury and found the ICC values ranging from 0.57 to 0.94. Our study identified less variation of ICC in the measurements of the thermal pain threshold; however, our sample consisted of patients with chronic pain (>3 months of pain).…”

Pain Perception in Contact Sport Athletes: A Scoping Review

“…More generally, the specificity of the observed differences in a given pain modality should be assessed using withinsubject designs including quantitative sensory testing across multiple pain modalities (e.g. [35,36]).…”

“…For example, future studies should investigate differences between sport expertise in nociceptive flexion reflex (R-III) which is considered as an index of spinal nociception [39]. Tests of central pain summation (e.g., [16,36,40]) or other pain modulation tests, such as heterotopic noxious counter-stimulation (conditioned pain modulation) [16], could be used to assess the efficacy of central pain regulatory mechanisms.…”