Comparison of Techniques for Evaluation of Deep Pain Sensitivity in the Craniofacial Region

Aims: To determine whether a new palpometer and manual palpation can detect site-to-site differences in human craniofacial pain sensitivity in a similar pattern to that of an electronic pressure algometer and subsequently to compare between-session and within-session variability of palpometer and manual palpation. Methods: Sixteen volunteers participated. Experiment 1 was carried out in two sessions. In session 1, pressure pain thresholds (PPT) were determined with a pressure algometer at nine craniofacial sites. Manual palpation and the palpometer were then applied to all sites, and subjects scored perceived pressure/pain on a 0 to 100 numerical rating scale (NRS). Mean scores were compared using analysis of variance (ANOVA). Ten of the volunteers were recalled for a second session and the same protocol was carried out except for assessment of PPTs to establish between-session variability. In experiment 2, three craniofacial sites were examined using the palpometer and manual palpation. Both techniques were repeated 10 times at each site and coefficient of variation (CV) was compared to determine within-session variability. Results: There were no significant differences in NRS scores evoked by manual palpation or palpometer at any test site between repeated sessions. The CV varied between techniques, with lower within-session variability for the palpometer compared with manual palpation (P = .03). Conclusion: The palpometer and manual palpation could detect differences in craniofacial sensitivity in healthy subjects, with no significant differences between repeated sessions. All techniques showed the highest sensitivity at the retromandibular site and the lowest at the temporalis muscle site. The palpometer had lower within-session variability compared with manual palpation.

algometer; numerical rating scale; palpation; palpometer; temporomandibular disorders

1. Bendtsen L, Jensen R, Jensen NK, Olesen J. Muscle palpation with controlled finger pressure: New equipment for the study of tender myofascial tissues. Pain 1994;59:235–239.

2. Duinkerke AS, Luteijn F, Bouman TK, de Jong HP. Reproducibility of a palpation test for the stomatognathic system. Community Dent Oral Epidemiol 1986;14:80–85.

3. Fricton JR, Schiffman EL. The craniomandibular index: Validity. J Prosthet Dent 1987;58:222–228.

4. Levitt SR. Predictive value of the TMJ scale in detecting clinically significant symptoms of temporomandibular disorders. J Craniomandib Disord 1990;4:177–185.

5. Bendtsen L, Jensen R, Jensen NK, Olesen J. Pressure-controlled palpation: A new technique which increases the reliability of manual palpation. Cephalalgia 1995;15:205–210.

6. Dworkin SF, LeResche L. Research diagnostic criteria for temporomandibular disorders: Review, criteria, examinations and specifications, critique. J Craniomandib Disord 1992;6:301–355.

7. John MT, Zwijnenburg AJ. Interobserver variability in assessment of signs of TMD. Int J Prosthodont 2001;14:265–270.

8. Davey R, Bamford J, Emery P. The ACR classification criteria for headache disorders in SLE fail to classify certain prevalent headache types. Cephalalgia 2008;28:296–299.

9. Svensson P, Baad-Hansen L, Pigg M, et al. Guidelines and recommendations for assessment of somatosensory function in oro-facial pain conditions: A taskforce report. J Oral Rehabil 2011;38:366–394.

10. Fischer AA. Reliability of the pressure algometer as a measure of myofascial trigger point sensitivity. Pain 1987; 28:411–414.

11. Jensen K, Andersen HO, Olesen J, Lindblom U. Pressure-pain threshold in human temporal region. Evaluation of a new pressure algometer. Pain 1986;25:313–323.

12. Reeves JL, Jaeger B, Graff-Radford SB. Reliability of the pressure algometer as a measure of myofascial trigger point sensitivity. Pain 1986;24:313–321.

13. Polianskis R, Graven-Nielsen T, Arendt-Nielsen L. Computer-controlled pneumatic pressure algometry. A new technique for quantitative sensory testing. Eur J Pain 2001;5:267–277.

14. Bernhardt O, Schiffman EL, Look JO. Reliability and validity of a new fingertip-shaped pressure algometer for assessing pressure pain thresholds in the temporomandibular joint and masticatory muscles. J Orofac Pain 2007;21:29–38.

15. Futarmal S, Kothari M, Ayesh E, Baad-Hansen L, Svensson

P. New palpometer with implications for assessment of deep pain sensitivity. J Dent Res 2011;90:918–922.

16. Isselee H, De Laat A, Lesaffre E, Lysens R. Short-term reproducibility of pressure pain thresholds in masseter and temporalis muscles of symptom-free subjects. Eur J Oral Sci 1997;105:583–587.

17. Ohrbach R, Gale EN. Pressure pain thresholds in normal muscles: Reliability, measurement effects, and topographic differences. Pain 1989;37:257–263.

18. Visscher CM, Lobbezoo F, Naeije M. Comparison of algometry and palpation in the recognition of temporomandibular disorder pain complaints. J Orofac Pain 2004;18:214–219.

19. Vaughan B, McLaughlin P, Gosling C. Validity of an electronic pressure algometer. Int J Osteopath Med 2007; 10:24–28.

20. Svensson P, Graven-Nielsen T, Arendt-Nielsen L. Mechanical hyperesthesia of human facial skin induced by tonic painful stimulation of jaw muscles. Pain 1998;74:93–100.

21. Ayesh EE, Ernberg M, Svensson P. Effects of local anesthetics on somatosensory function in the temporomandibular joint area. Exp Brain Res 2007;180:715–725.

22. Lofgren M, Norrbrink. Pain relief in women with fibromyalgia: A cross-over study of superficial warmth stimulation and transcutaneous electrical nerve stimulation. J Rehabil Med 2009;41:557–562.

23. Ryan CG, Gray HG, Newton M, Granat MH. Pain biology education and exercise classes compared to pain biology education alone for individuals with chronic low back pain: A pilot randomised controlled trial. Man Ther 2010; 15:382–387.

24. Chaves TC, Nagamine HM, de Sousa LM, de Oliveira AS, Grossi DB. Intra- and interrater agreement of pressure pain threshold for masticatory structures in children reporting orofacial pain related to temporomandibular disorders and symptom-free children. J Orofac Pain 2007;21:133–142.

25. Chaves TC, Nagamine HM, de Sousa LM, de Oliveira AS, Grossi DB. Comparison between the reliability levels of manual palpation and pressure pain threshold in children who reported orofacial pain. Man Ther 2010;15:508–512.

26. Chesterton LS, Sim J, Wright CC, Foster NE. Interrater reliability of algometry in measuring pressure pain thresh- olds in healthy humans, using multiple raters. Clin J Pain 2007;23:760–766.

27. Goulet JP, Clark GT, Flack VF, Liu C. The reproducibility of muscle and joint tenderness detection methods and maximum mandibular movement measurement for the temporomandibular system. J Orofac Pain 1998;12:17–26.

28. Isselee H, De Laat A, Bogaerts K, Lysens R. Short-term reproducibility of pressure pain thresholds in masticatory muscles measured with a new algometer. J Orofac Pain 1998;12:203–209.

29. Schiffman EL, Ohrbach R, Truelove EL, et al. The research diagnostic criteria for temporomandibular disorders. V: Methods used to establish and validate revised axis I diagnostic algorithms. J Orofac Pain 2010;24:63–78.

30. List T, Helkimo M, Falk G. Reliability and validity of a pressure threshold meter in recording tenderness in the masseter muscle and anterior temporalis muscle. Cranio 1989;7:223–229.