Validation of a Pressure Pain Threshold Scale in Patients Diagnosed With Myofascial Pain Syndrome and Fibromyalgia

June 15, 2016 updated by: Scott Cheatham, California State University, Dominguez Hills
To date, there are no valid and reliable pressure pain threshold scales for use in research or clinical practice. The existing manual palpation protocols and scales have limited support in the literature and our knowledge has not advanced since these scales were proposed in the 1990's. Therefore, the purpose of this investigation was to develop a valid and reliable PPTS in order to provide an objective means of assessing pressure pain thresholds and create a reliable method of communication among clinicians for individuals with a diagnoses characterized by MPS and FM. These conditions were chosen based on their high prevalence among chronic pain conditions and are also dependent upon the manual palpation examination for their diagnosis.

Study Overview

Status

Completed

Conditions

Detailed Description

The purpose of this investigation was to develop a valid and reliable PPTS in order to provide an objective means of assessing pressure pain threshold and to create a reliable method of communication among clinicians. Eighty-four participants (N=84) were enrolled in the study and assigned to three groups: FM (N=28), MPS (N=28), and control group (N=28). Participants were recruited from three sites. All participants were aged 18 to 65 years and met the inclusion criteria for 1 of the 3 groups. All participants were required to read, speak and write English as needed to complete forms and consent. The following criteria for each group was as follows:

  1. Control group: Individuals with no current or prior diagnosis consistent with MPS or FM. No current injuries or integumentary abnormalities at the designated palpation sites.
  2. MPS group: Individuals with a diagnosis of MPS that does not meet the American College of Rheumatology (ACR) diagnostic criteria for FM. No current injuries or integumentary abnormalities at the designated palpation sites.
  3. FM group: Individuals who met the criteria for a diagnosis of FM based upon the ACR diagnostic criteria. No current injuries or integumentary abnormalities at the designated palpation sites.

Prior to testing, participants filled out a screening questionnaire with questions that represent the exclusion criteria which were used to determine ineligibility for this study. Participants who met the inclusion criteria and consented to participate were enrolled in the study. A California State University Dominguez Hills approved consent was read and signed by all participants prior to beginning data collection. Following consent, participant filled out a questionnaire to provide demographic information which included age, height, weight, arm dominance.

Following completion of the paperwork, all participants underwent testing from the primary investigator which was conducted between the hours of 8 am and 2pm. Participants were instructed to refrain from taking any related medication (e.g. pain medication) prior to testing. All participants underwent the same testing procedures and were blinded from the examiner's scores and other participants enrolled in the study.

For the reliability portion of the study, a total of 20 participants (10 MPS/FM and 10 control group) underwent 2 days of testing. Each testing session lasted approximately 45 minutes. After the reliability portion was complete, all other recruited subjects underwent 1 day of testing which lasted approximately 45 minutes.

The testing process consisted of 2-parts which were based upon the American College of Rheumatology (ACR) diagnostic criteria for FM. The protocol required the examiner to apply pressure to 18 pre-determined and 2 control points up to 4kg/cm2 at a rate of 1kg per second for a total of 4 seconds at each point, one time.12, 13 For Part I, the examiner applied a gradually increasing pressure using the thumb and digital pressure sensor at each pre-determined tender point. For Part II, the examiner applied a gradual increasing pressure using the algometer to the pre-determined tender points. For both Part I and II, the participant recorded their level of discomfort at each tender point using the MTPS and VAS pain scales once the examiner reached 4kg/cm2 of pressure or once a maximum level of pressure was felt. Participants were able to stop testing at any time. The examiner simultaneously recorded the patient's response using the PPTS scale for each tender point.

Collected data was transferred to SPSS v.22 (IBM SPSS, Chicago, IL). Means, standard error of mean (SEM), 95% confidence intervals (95% CI), and ranges of the descriptive data from each group was calculated. Group differences were calculated using the independent t-test. Six clinical questions were measured in this investigation which required specific parametric and non-parametric (ordinal data) statistical calculations. The P-value was considered significant at the .05 level using a two-tailed test (α2 =.05) for all clinical questions.

Study Type

Observational

Enrollment (Actual)

84

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years to 65 years (Adult, Older Adult)

Accepts Healthy Volunteers

Yes

Genders Eligible for Study

All

Sampling Method

Non-Probability Sample

Study Population

3 groups of participants were recruited for this study:

  • Control group: Individuals with no current or prior diagnosis consistent with Myofascial Pain Syndrome (MPS) or Fibromyalgia (FM).
  • MPS group: Individuals with a diagnosis of MPS that does not meet the American College of Rheumatology (ACR) diagnostic criteria for FM.
  • FM group: Individuals who met the criteria for a diagnosis of FM based upon the ACR diagnostic criteria.

Description

Inclusion Criteria:

  • Control group: Individuals with no current or prior diagnosis consistent with Myofascial Pain Syndrome (MPS) or Fibromyalgia (FM).
  • MPS group: Individuals with a diagnosis of MPS that does not meet the American College of Rheumatology (ACR) diagnostic criteria for FM.
  • FM group: Individuals who met the criteria for a diagnosis of FM based upon the ACR diagnostic criteria.

Exclusion Criteria:

  • Current neurologic conditions (e.g. Multiple Sclerosis)
  • Current metabolic conditions (e.g. Diabetic Neuropathy)
  • Current systemic conditions (e.g. Rheumatoid Arthritis)
  • Any skin or connective tissue problems (e.g. Marfan Syndrome)
  • Current symptoms of numbness, tingling, burning, coldness, or pain in your back, hands, or feet.
  • Any prior surgeries that may affect their ability to participate in this study.
  • A pacemaker or electrical implant that may be affected by electronic equipment.
  • Currently taking medications that may alter a subject's sensation or affect their ability to participate in this study.
  • Current shingles or post-herpetic neuralgia.
  • Current open skin wounds on your neck, arms, back, or legs
  • Current injuries at the designated palpation sites.
  • Currently having other medical conditions or limited function that might affect participation.
  • The ability to tolerate testing duration and procedures.
  • The ability to understand and complete all consent forms and questionnaires.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Cohorts and Interventions

Group / Cohort
Fibromyalgia
Individuals who met the criteria for a diagnosis of FM based upon the ACR diagnostic criteria.
Myofascial Pain Syndrome
Individuals with a diagnosis of MPS that does not meet the American College of Rheumatology (ACR) diagnostic criteria for FM.
Control
Individuals with no current or prior diagnosis consistent with MPS or FM.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Pressure Pain Threshold Scale
Time Frame: Baseline
0-4 ordinal ranked scale (0-no pain to 4-intolerable pain)
Baseline

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Visual Analog Pain Scale
Time Frame: Baseline
Patient Related Outcome Measure for Pain
Baseline
Manual Tender Point Survey (MTPS)
Time Frame: Baseline
The MTPS is a version of the 11-point numeric pain rating scale for pain (ordinal scale)
Baseline

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

California State University, Dominguez Hills

Investigators

  • Principal Investigator: Scott W Cheatham, DPT, PhD, CSUDH

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

January 1, 2015

Primary Completion (Actual)

February 1, 2016

Study Completion (Actual)

February 1, 2016

Study Registration Dates

First Submitted

June 5, 2016

First Submitted That Met QC Criteria

June 15, 2016

First Posted (Estimate)

June 16, 2016

Study Record Updates

Last Update Posted (Estimate)

June 16, 2016

Last Update Submitted That Met QC Criteria

June 15, 2016

Last Verified

June 1, 2016

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • #15-116

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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