María Palacios-Ceña1,2,3, Marco Barbero4, Deborah Falla5, Filippo Ghirlanda4, Lars Arend-Nielsen3, César Fernández-de-Las-Peñas1,2,3. 1. Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain. 2. Cátedra de Investigación y Docencia en Fisioterapia: Terapia Manual y Punción Seca, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain. 3. Department of Health Science and Technology, Center for Sensory-Motor Interaction (SMI), School of Medicine, Aalborg University, Aalborg, Denmark. 4. Department of Business Economics, Health and Social Care, Rehabilitation Research Laboratory 2rLab, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland. 5. Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom.
Abstract
OBJECTIVE: Earlier studies suggest that pain extent, extracted from the patients' pain drawings, can help clinicians to identify people with central sensitization or worse clinical features. Our aim was to investigate possible associations between perceived pain extent and clinical pain features, burden of headache, psychological outcomes, and pressure sensitivity in people with chronic tension-type headache (CTTH). METHODS: Ninety-nine people (27% men) with CTTH reported their pain on four different body charts representing the head and neck. Pain extent and frequency maps were obtained using customized software. Clinical features of headache, burden related to headache (Headache Disability Inventory [HDI]), anxiety and depression (Hospital Anxiety-Depression Scale [HADS]), and anxiety state/trait (State-Trait Anxiety Inventory [STAI]) levels were assessed. Pressure pain thresholds (PPT) were assessed over the temporalis muscle (trigeminal area), the cervical spine (extratrigeminal area), and the tibialis anterior muscle (distant pain-free area) to determine widespread pressure sensitivity. Associations between pain extent and all outcomes were analyzed. RESULTS: Pain extent showed significant positive associations with age (r = 0.221, P = 0.029) and burden of the headache (emotional: r = 0.213, P = 0.030; physical: r = 0.208, P = 0.039), but no other significant association was found. CONCLUSIONS: Pain extent weakly correlated with older age as well as with higher emotional and physical burden of the headache in CTTH. In this population, there was no relationship between pain extent and PPT, indicating that larger pain areas were not associated with signs of central sensitization. Pain drawings can complement other clinical pain features for better characterization of CTTH, but further studies are needed.
OBJECTIVE: Earlier studies suggest that pain extent, extracted from the patients' pain drawings, can help clinicians to identify people with central sensitization or worse clinical features. Our aim was to investigate possible associations between perceived pain extent and clinical pain features, burden of headache, psychological outcomes, and pressure sensitivity in people with chronic tension-type headache (CTTH). METHODS: Ninety-nine people (27% men) with CTTH reported their pain on four different body charts representing the head and neck. Pain extent and frequency maps were obtained using customized software. Clinical features of headache, burden related to headache (Headache Disability Inventory [HDI]), anxiety and depression (Hospital Anxiety-Depression Scale [HADS]), and anxiety state/trait (State-Trait Anxiety Inventory [STAI]) levels were assessed. Pressure pain thresholds (PPT) were assessed over the temporalis muscle (trigeminal area), the cervical spine (extratrigeminal area), and the tibialis anterior muscle (distant pain-free area) to determine widespread pressure sensitivity. Associations between pain extent and all outcomes were analyzed. RESULTS: Pain extent showed significant positive associations with age (r = 0.221, P = 0.029) and burden of the headache (emotional: r = 0.213, P = 0.030; physical: r = 0.208, P = 0.039), but no other significant association was found. CONCLUSIONS: Pain extent weakly correlated with older age as well as with higher emotional and physical burden of the headache in CTTH. In this population, there was no relationship between pain extent and PPT, indicating that larger pain areas were not associated with signs of central sensitization. Pain drawings can complement other clinical pain features for better characterization of CTTH, but further studies are needed.
Authors: Andrea M Aegerter; Manja Deforth; Venerina Johnston; Markus J Ernst; Thomas Volken; Hannu Luomajoki; Beatrice Brunner; Julia Dratva; Gisela Sjøgaard; Achim Elfering; Markus Melloh Journal: BMC Musculoskelet Disord Date: 2020-06-19 Impact factor: 2.362