Knee extensor strength is associated with pressure pain thresholds in adults with fibromyalgia

W Michael Hooten, Casandra J Rosenberg, Jason S Eldrige, Wenchun Qu, W Michael Hooten, Casandra J Rosenberg, Jason S Eldrige, Wenchun Qu

Abstract

Objective: Individuals with fibromyalgia (FM) have lower muscle strength and lower pressure pain thresholds (PPT). The primary aim of this study was to determine the associations between muscle strength and PPT in adults with FM to test the hypothesis that greater measures of muscle strength would be associated with greater values of PPT. Secondary aims included determining the effects of pain severity and the peak uptake of oxygen (VO2) on the associations between muscle strength and PPT.

Methods: Knee extensor and flexor strength (N = 69) was measured in the dominant leg using a dynamometer, and PPT was assessed using an electronic algometer. Pain severity was determined using the Multidimensional Pain Inventory, and peak VO2 uptake was quantified using an electronically braked cycle ergometer.

Results: Univariable linear regression analysis demonstrated a significant association between PPT (dependent variable) and isometric knee extensor (P<.001), isokinetic (60°/s) knee extensor (P = .002), and isokinetic (60°/s) knee flexor strength (P = .043). In a multiple variable linear regression analysis adjusted for age, sex, pain severity, body mass index and peak VO2 uptake, a significant association was found between PPT and isometric knee extensor strength (P = .008). In a similar multiple variable analysis, a significant association was found between PPT and isokinetic knee extensor strength (P = .044).

Conclusion: Greater measures of isometric and isokinetic knee extensor strength were significantly associated with greater values of PPT in both univariable and multiple variable linear regression models.

Trial registration: ClinicalTrials.gov NCT01253395.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Knee Extensor Strength and Pressure…
Figure 1. Knee Extensor Strength and Pressure Pain Threshold.
This diagram demonstrates the associations between isometric knee extensor strength, isokinetic knee extensor strength and pressure pain threshold.

References

    1. Goes SM, Leite N, Shay BL, Homann D, Stefanello JM, et al. (2012) Functional capacity, muscle strength and falls in women with fibromyalgia. Clin Biomech (Bristol, Avon) 27: 578–583.
    1. Bachasson D, Guinot M, Wuyam B, Favre-Juvin A, Millet GY, et al... (2012) Neuromuscular fatigue and exercise capacity in fibromyalgia syndrome. Arthritis Care Res (Hoboken).
    1. Valkeinen H, Hakkinen A, Hannonen P, Hakkinen K, Alen M (2006) Acute heavy-resistance exercise-induced pain and neuromuscular fatigue in elderly women with fibromyalgia and in healthy controls: effects of strength training. Arthritis Rheum 54: 1334–1339.
    1. Harden RN, Revivo G, Song S, Nampiaparampil D, Golden G, et al. (2007) A critical analysis of the tender points in fibromyalgia. Pain Med 8: 147–156.
    1. Amris K, Jespersen A, Bliddal H (2010) Self-reported somatosensory symptoms of neuropathic pain in fibromyalgia and chronic widespread pain correlate with tender point count and pressure-pain thresholds. Pain 151: 664–669.
    1. Marques AP, Ferreira EA, Matsutani LA, Pereira CA, Assumpcao A (2005) Quantifying pain threshold and quality of life of fibromyalgia patients. Clin Rheumatol 24: 266–271.
    1. Kosek E, Ekholm J, Hansson P (1996) Sensory dysfunction in fibromyalgia patients with implications for pathogenic mechanisms. Pain 68: 375–383.
    1. Kosek E, Ekholm J, Hansson P (1996) Modulation of pressure pain thresholds during and following isometric contraction in patients with fibromyalgia and in healthy controls. Pain 64: 415–423.
    1. Kosek E, Hansson P (1997) Modulatory influence on somatosensory perception from vibration and heterotopic noxious conditioning stimulation (HNCS) in fibromyalgia patients and healthy subjects. Pain 70: 41–51.
    1. Staud R, Domingo M (2001) Evidence for abnormal pain processing in fibromyalgia syndrome. Pain Med 2: 208–215.
    1. Dinler M, Diracoglu D, Kasikcioglu E, Sayli O, Akin A, et al. (2009) Effect of aerobic exercise training on oxygen uptake and kinetics in patients with fibromyalgia. Rheumatol Int 30: 281–284.
    1. Redondo JR, Justo CM, Moraleda FV, Velayos YG, Puche JJ, et al. (2004) Long-term efficacy of therapy in patients with fibromyalgia: a physical exercise-based program and a cognitive-behavioral approach. Arthritis Rheum 51: 184–192.
    1. Miller TA, Allen GM, Gandevia SC (1996) Muscle force, perceived effort, and voluntary activation of the elbow flexors assessed with sensitive twitch interpolation in fibromyalgia. J Rheumatol 23: 1621–1627.
    1. Murthy G, Hargens AR, Lehman S, Rempel DM (2001) Ischemia causes muscle fatigue. J Orthop Res 19: 436–440.
    1. Hooten WM, Qu W, Townsend CO, Judd JW (2012) Effects of strength vs aerobic exercise on pain severity in adults with fibromyalgia: a randomized equivalence trial. Pain 153: 915–923.
    1. Carbonell-Baeza A, Aparicio VA, Sjostrom M, Ruiz JR, Delgado-Fernandez M (2011) Pain and functional capacity in female fibromyalgia patients. Pain Med 12: 1667–1675.
    1. Jacobsen S, Wildschiodtz G, Danneskiold-Samsoe B (1991) Isokinetic and isometric muscle strength combined with transcutaneous electrical muscle stimulation in primary fibromyalgia syndrome. J Rheumatol 18: 1390–1393.
    1. Maquet D, Croisier JL, Renard C, Crielaard JM (2002) Muscle performance in patients with fibromyalgia. Joint Bone Spine 69: 293–299.
    1. Norregaard J, Bulow PM, Danneskiold-Samsoe B (1994) Muscle strength, voluntary activation, twitch properties, and endurance in patients with fibromyalgia. J Neurol Neurosurg Psychiatry 57: 1106–1111.
    1. Gowans SE, deHueck A, Voss S, Silaj A, Abbey SE, et al. (2001) Effect of a randomized, controlled trial of exercise on mood and physical function in individuals with fibromyalgia. Arthritis Rheum 45: 519–529.
    1. Tomas-Carus P, Gusi N, Hakkinen A, Hakkinen K, Raimundo A, et al. (2009) Improvements of muscle strength predicted benefits in HRQOL and postural balance in women with fibromyalgia: an 8-month randomized controlled trial. Rheumatology (Oxford) 48: 1147–1151.
    1. Valkeinen H, Alen M, Hannonen P, Hakkinen A, Airaksinen O, et al. (2004) Changes in knee extension and flexor force, EMG and functional capacity during strength training in older females with fibromyalgia and healthy controls. Rheumatology (Oxford) 43: 225–228.
    1. Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, et al. (1990) The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum 33: 160–172.
    1. Cunningham JL, Rome JD, Kerkvliet JL, Townsend CO (2009) Reduction in medication costs for patients with chronic nonmalignant pain completing a pain rehabilitation program: a prospective analysis of admission, discharge, and 6-month follow-up medication costs. Pain Med 10: 787–796.
    1. Townsend CO, Kerkvliet JL, Bruce BK, Rome JD, Michael Hooten W, et al. (2008) A longitudinal study of the efficacy of a comprehensive pain rehabilitation program with opioid withdrawal: Comparison of treatment outcomes based on opioid use status at admission. Pain 140: 177–189.
    1. DuPen S, DuPen A (2000) Opioid conversion calculator. Poulsbo, WA: Cynergy Group.
    1. Cunningham JL, Rome JD, Kerkvliet JL, Townsend CO (2009) Reduction in medication costs for patients with chronic nonmalignant pain completing a pain rehabilitation program: a prospective analysis of admission, discharge, and 6-month follow-up medication costs. Pain medicine 10: 787–796.
    1. Hooten WM, Townsend CO, Decker PA (2007) Gender differences among patients with fibromyalgia undergoing multidisciplinary pain rehabilitation. Pain medicine 8: 624–632.
    1. Hooten WM, Townsend CO, Sletten CD, Bruce BK, Rome JD (2007) Treatment outcomes after multidisciplinary pain rehabilitation with analgesic medication withdrawal for patients with fibromyalgia. Pain medicine 8: 8–16.
    1. Liu F, Carlson L, Watson HK (2000) Quantitative abductor pollicis brevis strength testing: reliability and normative values. J Hand Surg Am 25: 752–759.
    1. Drouin JM, Valovich-mcLeod TC, Shultz SJ, Gansneder BM, Perrin DH (2004) Reliability and validity of the Biodex system 3 pro isokinetic dynamometer velocity, torque and position measurements. Eur J Appl Physiol 91: 22–29.
    1. Lund H, Sondergaard K, Zachariassen T, Christensen R, Bulow P, et al. (2005) Learning effect of isokinetic measurements in healthy subjects, and reliability and comparability of Biodex and Lido dynamometers. Clin Physiol Funct Imaging 25: 75–82.
    1. Short KR, Vittone JL, Bigelow ML, Proctor DN, Coenen-Schimke JM, et al. (2005) Changes in myosin heavy chain mRNA and protein expression in human skeletal muscle with age and endurance exercise training. Journal of applied physiology 99: 95–102.
    1. Kerns RD, Turk DC, Rudy TE (1985) The West Haven-Yale Multidimensional Pain Inventory (WHYMPI). Pain 23: 345–356.
    1. Bernstein IH, Jaremko ME, Hinkley BS (1995) On the utility of the West Haven-Yale Multidimensional Pain Inventory. Spine 20: 956–963.
    1. Rudy TE (1989) Multiaxial Assessment of Multidimensional Pain Inventory: Computer Program User’s Manual. Pittsburgh, PA: University of Pittsburgh.
    1. Darchuk KM, Townsend CO, Rome JD, Bruce BK, Hooten WM (2010) Longitudinal treatment outcomes for geriatric patients with chronic non-cancer pain at an interdisciplinary pain rehabilitation program. Pain Med 11: 1352–1364.
    1. Hooten WM, Mantilla CB, Sandroni P, Townsend CO (2010) Associations between heat pain perception and opioid dose among patients with chronic pain undergoing opioid tapering. Pain Med 11: 1587–1598.
    1. Hooten WM, Sandroni P, Mantilla CB, Townsend CO (2010) Associations between heat pain perception and pain severity among patients with chronic pain. Pain Med 11: 1554–1563.
    1. Jespersen A, Dreyer L, Kendall S, Graven-Nielsen T, Arendt-Nielsen L, et al. (2007) Computerized cuff pressure algometry: A new method to assess deep-tissue hypersensitivity in fibromyalgia. Pain 131: 57–62.
    1. Kadetoff D, Kosek E (2007) The effects of static muscular contraction on blood pressure, heart rate, pain ratings and pressure pain thresholds in healthy individuals and patients with fibromyalgia. Eur J Pain 11: 39–47.
    1. Kosek E, Lundberg L (2003) Segmental and plurisegmental modulation of pressure pain thresholds during static muscle contractions in healthy individuals. Eur J Pain 7: 251–258.
    1. Lannersten L, Kosek E (2010) Dysfunction of endogenous pain inhibition during exercise with painful muscles in patients with shoulder myalgia and fibromyalgia. Pain 151: 77–86.
    1. Staud R, Nagel S, Robinson ME, Price DD (2009) Enhanced central pain processing of fibromyalgia patients is maintained by muscle afferent input: a randomized, double-blind, placebo-controlled study. Pain 145: 96–104.
    1. Staud R, Robinson ME, Weyl EE, Price DD (2010) Pain variability in fibromyalgia is related to activity and rest: role of peripheral tissue impulse input. The journal of pain : official journal of the American Pain Society 11: 1376–1383.
    1. McIver KL, Evans C, Kraus RM, Ispas L, Sciotti VM, et al. (2006) NO-mediated alterations in skeletal muscle nutritive blood flow and lactate metabolism in fibromyalgia. Pain 120: 161–169.
    1. Park JH, Phothimat P, Oates CT, Hernanz-Schulman M, Olsen NJ (1998) Use of P-31 magnetic resonance spectroscopy to detect metabolic abnormalities in muscles of patients with fibromyalgia. Arthritis and rheumatism 41: 406–413.
    1. Sprott H, Rzanny R, Reichenbach JR, Kaiser WA, Hein G, et al. (2000) 31P magnetic resonance spectroscopy in fibromyalgic muscle. Rheumatology (Oxford) 39: 1121–1125.
    1. Tastekin N, Birtane M, Uzunca K (2007) Which of the three different tender points assessment methods is more useful for predicting the severity of fibromyalgia syndrome? Rheumatol Int 27: 447–451.
    1. Salli A, Yilmaz H, Ugurlu H (2012) The relationship between tender point count and disease severity in patients with primary fibromyalgia. Rheumatol Int 32: 105–107.
    1. Hodges PW, Mellor R, Crossley K, Bennell K (2009) Pain induced by injection of hypertonic saline into the infrapatellar fat pad and effect on coordination of the quadriceps muscles. Arthritis Rheum 61: 70–77.
    1. Rice DA, McNair PJ (2010) Quadriceps arthrogenic muscle inhibition: neural mechanisms and treatment perspectives. Semin Arthritis Rheum 40: 250–266.
    1. Schaible HG, Grubb BD (1993) Afferent and spinal mechanisms of joint pain. Pain 55: 5–54.
    1. Tucker K, Larsson AK, Oknelid S, Hodges P (2012) Similar alteration of motor unit recruitment strategies during the anticipation and experience of pain. Pain 153: 636–643.
    1. Da Costa D, Abrahamowicz M, Lowensteyn I, Bernatsky S, Dritsa M, et al. (2005) A randomized clinical trial of an individualized home-based exercise programme for women with fibromyalgia. Rheumatology (Oxford) 44: 1422–1427.
    1. Richards SC, Scott DL (2002) Prescribed exercise in people with fibromyalgia: parallel group randomised controlled trial. BMJ 325: 185.
    1. Almosnino S, Brandon SC, Sled EA (2012) Does choice of angular velocity affect pain level during isokinetic strength testing of knee osteoarthritis patients? Eur J Phys Rehabil Med 48: 569–575.
    1. Hinman RS, Crossley KM (2007) Patellofemoral joint osteoarthritis: an important subgroup of knee osteoarthritis. Rheumatology (Oxford) 46: 1057–1062.
    1. Watkins EA, Wollan PC, Melton LJ, 3rd, Yawn BP (2008) A population in pain: report from the Olmsted County health study. Pain medicine 9: 166–174.
    1. Borges O (1989) Isometric and isokinetic knee extension and flexor torque in men and women aged 20–70. Scand J Rehabil Med 21: 45–53.
    1. Fisher NM, Pendergast DR, Calkins EC (1990) Maximal isometric torque of knee extension as a function of muscle length in subjects of advancing age. Arch Phys Med Rehabil 71: 729–734.
    1. Gross MT, Credle JK, Hopkins LA, Kollins TM (1990) Validity of knee flexor and extension peak torque prediction models. Phys Ther 70: 3–10.
    1. Gross MT, McGrain P, Demilio N, Plyler L (1989) Relationship between multiple predictor variables and normal knee torque production. Phys Ther 69: 54–62.

Source: PubMed

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