title: Predicting the analgesic effect to oxycodone by ‘static’ and ‘dynamic’ quantitative sensory testing in healthy subjects Prediction of postoperative pain by preoperative pain response to heat stimulation in total knee arthroplasty Mental motor imagery and chronic pain: the foot laterality task. Medial tibial pain pressure threshold algometry in runners Interobserver reproducibility of the assessment of severity of complaints, grip strength, and pressure pain threshold in patients with lateral epicondylitis. The initial effects of a Mulligan's mobilization with movement technique on dorsiflexion and pain in subacute ankle sprains. Cold Hyperalgesia Associated With Poorer Prognosis in Lateral Epicondylalgia: A 1-Year Prognostic Study of Physical and Psychological Factors Can coadministration of oxycodone and morphine produce analgesic synergy in humans? An experimental cold pain study. Reproducibility of Electronic von Frey and von Frey Monofilaments Testing Test–retest and interobserver reliability of quantitative sensory testing according to the protocol of the German Research Network on Neuropathic Pain (DFNS): A multi-centre study Disc Stimulation and Patterns of Referred Pain Examination of Muscle Strength and Pressure Pain Thresholds in Knee Osteoarthritis: Test-Retest Reliability and Agreement Preoperative predictors of pain following total knee arthroplasty.
abstract: & NA ; The large inter‐individual variability in the magnitude of analgesia in response to opioids and the high prevalence of adverse events associated with their use underline the clinical importance of being able to predict who will or will not respond to opioid treatment . The present study used both static and dynamic quantitative sensory testing ( QST ) on 40 healthy volunteers in order to test whether this methodology can predict the analgesic effects of oral oxycodone , as compared to a placebo , on latency to onset , pain intensity , and tolerance to the cold pressor test ( CPT ) . Static QST consisted of measuring heat and cold pain thresholds . Dynamic QST included measurements of the magnitude of the diffuse noxious inhibitory control (DNIC)‐like effect and of temporal summation ( TS ) . Results showed that oxycodone , but not the placebo , significantly elevated the latency and tolerance to cold pain and significantly reduced pain intensity . The static QST results showed that heat pain thresholds predicted the magnitude of reduction in pain intensity in response to oxycodone treatment ( F(1,22 ) = 5.63 , p = 0.027 , R2 = 0.17 ) . The dynamic QST results showed that TS predicted the effect of oxycodone on the tolerance to CPT ( F(1,38 ) = 9.11 , p = 0.005 , R2 = 0.17 ) . These results suggest that both static and dynamic QST have the potential to be useful in the prediction of the response to opioid treatment Summary Pain responses to 2 types of preoperative heat stimuli were not independent clinical ly relevant predictors for postoperative pain after total knee arthroplasty . ABSTRACT It has been estimated that up to 54 % of the variance in postoperative pain experience may be predicted with preoperative pain responses to experimental stimuli , with suprathreshold heat pain as the most consistent test modality . This study aim ed to explore whether 2 heat test paradigms could predict postoperative pain  after total knee arthroplasty ( TKA ) . Patients scheduled for elective , unilateral , primary TKA under spinal anesthesia were consecutively included in this prospect i ve , observational study . Perioperative analgesia was st and ardized for all patients . Outcomes were postoperative pain during walk : from 6 to 24 hours ( primary ) , from postoperative day ( POD ) 1 to 7 ( secondary ) , and from POD 14 to 30 ( tertiary ) . Two preoperative tonic heat stimuli with 47 ° C were used ; short ( 5 seconds ) and long ( 7 minutes ) stimulation upon which patients rated their pain response on an electronic visual analog scale . Multivariate stepwise linear and logistic regressions analyses were carried out , including 8 potential preoperative explanatory variables ( among these anxiety , depression , preoperative pain , and pain catastrophizing ) to assess pain response to preoperative heat pain stimulation as an independent predictor for postoperative pain . A total of 100 patients were included , and 3 were later excluded . A weak correlation [ rho ( 95 % confidence interval ) ; P value ] was observed between pain from POD 1 to 7 and pain response to short [ rho = 0.25(0.04 to 0.44 ) ; P = .02 ] and to long [ rho = 0.27 ( 0.07 to 0.46 ) ; P = .01 ] heat pain stimulation . However , these positive correlations were not supported by the linear and logistic regression analyses , in which only anxiety , preoperative pain , and pain catastrophizing were significant explanatory variables ( but with low R‐squares ; 0.05 to 0.08 ) . Pain responses to 2 types of preoperative heat stimuli were not independent clinical ly relevant predictors for postoperative pain after TKA Several lines of evidence suggest that mental motor imagery is subserved by the same cognitive operations and brain structures that underlie action . Additionally , motor imagery is informed by the anticipated sensory consequences of action , including pain . We reasoned that motor imagery could provide a useful measure of  chronic leg or foot pain . Forty subjects with leg pain ( 19 bilateral , 11 right , and 10 left leg pain ) , 42 subjects with chronic pain not involving the legs , and 38 controls were shown 12 different line drawings of the right or left foot and asked to indicate which foot was depicted . Previous work suggests that subjects perform this task by mentally rotating their foot to match the visually presented stimulus . All groups of subjects were slower and less accurate with stimuli that required a greater degree of mental rotation of their foot . Subjects with leg pain were both slower and less accurate than normal and pain control subjects in responding to drawings of a painful extremity . Furthermore , subjects with leg pain exhibited a significantly greater decrement in performance for stimuli that required larger amplitude mental rotations . These data suggest that motor imagery may provide important insights into the nature of the pain experience Purpose Pressure algometry ( PA ) may provide an objective and st and ardised tool in assessing palpation pain over the tibia . The purpose of this study was to analyse the intra-rater repeatability of PA and to determine whether tibial tenderness in healthy runners differ from runners with medial tibial stress syndrome ( MTSS ) . Methods Pressure algometry was performed on 20 asymptomatic runners ( 40 legs ) and 9 MTSS patients ( 14 symptomatic legs ) at st and ardised locations along the medial border of the tibia . Intra-rater reliability was assessed in 10 r and omly selected asymptomatic runners through repeated measurements 2 weeks later . Results Intra-rater reliability was moderate to excellent ( ICC 0.53–0.90 ) in asymptomatic runners . Pain pressure threshold ( PPT ) was significantly reduced at 2/9–5/9 of the distance from the medial malleolus to the medial tibial condyle ( p = 0.002–0.022 ) . There was evidence of a statistically significant association between both height and weight , and PPT from the 3/9 ( r = 0.416 , p = 0.008 ) to 7/9 ( r = 0.334 , p = 0.035 ) and 3/9 ( r = 0.448 , p = 0.004 ) to 6/9 ( r = 0.337 , p = 0.034 ) area , respectively . In both MTSS patients and healthy runners , there was evidence of lower PPT in females compared to males ( p = 0.0001–0.049 ) and a negative association between age and PPT ( p = 0.001–0.033 ) . MTSS patients had significantly lower PPT at the 3/9 site ( p = 0.048 ) compared to asymptomatic runners . Conclusion Pain pressure threshold algometry can be incorporated into MTSS clinical assessment to objective ly assess pain and monitor progress . The presence of reduced medial tibial PPT in asymptomatic runners suggests that clinicians may not need to await resolution of medial tibia tenderness before allowing return to sport in MTSS patients .Level of evidence III OBJECTIVE To evaluate the interobserver reproducibility of the assessment of severity of complaints , grip strength , and pressure pain threshold in patients with lateral epicondylitis in primary care . DESIGN Two physiotherapists assessed independently , and in r and omized order , the severity of complaints scored on an 11-point numeric rating scale , pain-free grip strength , maximum grip strength , and pressure pain threshold . SETTING Primary care center in the Netherl and s. PARTICIPANTS Fifty patients were assessed by both physiotherapists . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Intraclass correlation coefficients ( ICCs ) and 95 % confidence intervals ( CIs ) were calculated to assess interobserver reliability . The Bl and and Altman method was used to assess interobserver agreement , which included calculation of the mean difference between the observers ( d ) , the 95 % CI for d , the st and ard deviation of the differences , and the 95 % limits of agreement . Finally , the smallest detectable difference ( SDD ) was calculated . RESULTS The ICC for the severity of complaints was.90 . The ICCs for the pain-free grip strength and maximum grip strength were.97 and .98 , respectively . The pressure pain threshold showed a lower reliability ( ICC=.77 ) . The interobserver agreement for all outcome measures was good , but systematic differences in assessment between the physiotherapists were found for the maximum grip strength and pressure pain threshold . For pressure pain threshold , the SDD was clearly larger than the predefined acceptable difference of 10 % of the total range of measurement . CONCLUSIONS The interobserver reliability of severity of complaints and grip strength was excellent , whereas the pressure pain threshold showed unsatisfactory reliability . Grip strength and overall assessment of the severity of complaints are useful and reliable measures for the assessment of lateral epicondylitis . Pain-free grip strength , in particular , is relatively easy to perform and has been shown to be associated with other measures of functional disability in patients with lateral epicondylitis . We , therefore , recommend the use of pain-free grip strength in both research and clinical practice Physiotherapists frequently use manipulative therapy techniques to treat dysfunction and pain result ing from ankle sprain . This study investigated whether a Mulligan 's mobilization with movement ( MWM ) technique improves talocrural dorsiflexion , a major impairment following ankle sprain , and relieves pain in subacute population s. Fourteen subjects with subacute grade II lateral ankle sprains served as their own control in a repeated measures , double-blind r and omized controlled trial that measured the initial effects of the MWM treatment on weight bearing dorsiflexion and pressure and thermal pain threshold . The subacute ankle sprain group studied displayed deficits in dorsiflexion and local pressure pain threshold in the symptomatic ankle . Significant improvements in dorsiflexion occurred initially post-MWM ( F(2,26 ) = 7.82 , P = 0.002 ) , but no significant changes in pressure or thermal pain threshold were observed after the treatment condition . Results indicate that the MWM treatment for ankle dorsiflexion has a mechanical rather than hypoalgesic effect in subacute ankle sprains . The mechanism by which this occurs requires investigation if we are to better underst and the role of manipulative therapy in ankle sprain management Background : Predictors of outcome in lateral epicondylalgia , which is mainly characterized as a mechanical hyperalgesia , are largely limited to sociodemographic and symptomatic factors . Quantitative sensory testing is used to study altered pain processing in various chronic pain conditions and may be of prognostic relevance . Methods : The predictive capacity of early measures of physical and psychological impairment on pain and disability and mechanical hyperalgesia , were examined using data from 41 patients assigned to placebo in a prospect i ve r and omized controlled trial of unilateral lateral epicondylalgia .  Quantitative sensory testing ( pressure , cold pain thresholds ) , motor function ( pain-free grip ) , and psychological factors ( Tampa Scale of Kinesiophobia , Hospital Anxiety and Depression Scale ) were measured at baseline . The outcome measures were the Patient-rated Tennis Elbow Evaluation ( PRTEE ) scale and pressure pain threshold ( PPT ) measured by digital algometry at the affected elbow . Backward stepwise linear regression was used to predict PRTEE and PPT scores at 2 and 12 months . Results : Cold pain threshold was the only consistent predictor for both PRTEE ( P<0.034 ) and PPT ( P<0.048 ) . Initial PRTEE was the strongest single predictor of PRTEE at 2 months , whereas female sex was the strongest single predictor of PPT ( P<0.002 ) . At 1 year , final models explained 9 % to 52 % of the variability in pain and disability and mechanical hyperalgesia , respectively . Discussion : Early assessment of cold pain threshold could be a useful clinical tool to help identify patients at risk of poorer outcomes and might provide direction for future research into mechanism-based treatment approaches for these patients AIMS The coadministration of subantinociceptive doses of oxycodone with morphine has recently been shown to result in a synergistic antinociceptive effect in rats . The present study was aim ed to investigate the possibility that coadministration of morphine and oxycodone can produce a similar synergistic effect in humans exposed to an experimental model of cold pressor test ( CPT ) . METHODS The enriched enrollment design was used to exclude ' stoic ' and ' placebo responders ' in a single-blind fashion . ' Nonstoic ' , placebo ' nonresponder ' female volunteers ( n = 30 ) were r and omly assigned to receive 0.5 mg kg(-1 ) oral morphine sulphate , 0.5 mg kg(-1 ) oral oxycodone hydrochloride , and the combination of 0.25 mg kg(-1 ) morphine sulphate with 0.25 mg kg(-1 ) oxycodone hydrochloride , 1 week apart from each other , in a double-blind crossover design . Latency to pain onset ( threshold ) , pain intensity ( VAS ) , and pain tolerance ( time until removal of the h and from the water ) were measured six times over a 3-h period , subsequent to the administration of each medication , and were used to assess their antinociceptive effect . RESULTS The combination produced a significantly higher effect on latency to pain onset than that of morphine alone [ difference in mean postbaseline value 2.2 ; 95 % confidence interval ( CI ) 0.48 , 3.9 ; P = 0.01 ] but the effect was nonsignificantly smaller that that of oxycodone alone . Similarly , the effect of the combination on pain tolerance was significantly larger than that of morphine alone ( combination difference 8.4 ; 95 % CI 2.5 , 14.3 ; P = 0.007 ) , whereas oxycodone alone caused a nonsignificantly larger effect than that of the combination treatment . Comparisons of pain magnitude failed to show any significant differences between the three treatments . CONCLUSIONS These results indicate that at the doses tested , morphine and oxycodone do not produce synergistic antinociceptive effects in healthy humans exposed to the CPT Objectives : Von Frey monofilaments ( VFM ) and Electronic von Frey are used as quantitative sensory testing to explore mechanical hyperalgesia . The aim of the study was to determine VFM and Electronic von Frey reproducibility and the time required for testing undamaged areas in volunteers and surgical in-hospital patients . Methods : Prospect i ve study in 2 groups of individuals without neurological disorders and not receiving treatments that alter sensorial response . Group 1 was formed by 30 healthy volunteers and group 2 by 28 patients after knee arthroplasty who received unilateral femoral block as postoperative analgesia .  Testing was performed by 2 trained investigators in the forearm and abdominal wall and repeated 24 hours later . Pain threshold was determined as the VMF or the pressure rate applied with the Electronic von Frey referred to as unpleasant . The time used in each test was measured . Intraobserver and interobserver reproducibility were analyzed by means of Kappa and Lin coefficients . Results : Intraobserver and interobserver reproducibility for VFM was only fair or moderate in both groups ( Kappa<0.6 ) . Intraobserver reproducibility for Electronic von Frey  was good in Group 1 ( Lin 0.61 to 0.8 ) and almost perfect in Group 2 ( Lin>0.8 ) . No differences were found between the 2 tested areas . Time used was 6.03 and 3.16 minutes for VFM and Electronic von Frey , respectively . Discussion : Exploration of mechanical allodynia in postoperative patients requires rapid and reliable quantitative sensory testing . Electronic von Frey was more reliable and rapid than VFM in exploring mechanical pain thresholds in undamaged areas in volunteers and patients . Further studies are required to confirm whether these results can be extrapolated to areas affected by surgery & NA ; Quantitative sensory testing ( QST ) is an instrument to assess positive and negative sensory signs , helping to identify mechanisms underlying pathologic pain conditions . In this study , we evaluated the test – retest reliability ( TR‐R ) and the interobserver reliability ( IO‐R ) of QST in patients with sensory disturbances of different etiologies . In 4 centres , 60 patients ( 37 male and 23 female , 56.4 ± 1.9 years ) with lesions or diseases of the somatosensory system were included .  QST comprised 13 parameters including detection and pain thresholds for thermal and mechanical stimuli .  QST was performed in the clinical ly most affected test area and a less or unaffected control area in a morning and an afternoon session on 2 consecutive days by examiner pairs ( 4 QSTs/patient ) . For both , TR‐R and IO‐R , there were high correlations ( r = 0.80–0.93 ) at the affected test area , except for wind‐up ratio ( TR‐R : r = 0.67 ; IO‐R : r = 0.56 ) and paradoxical heat sensations ( TR‐R : r = 0.35 ; IO‐R : r = 0.44 ) . Mean IO‐R ( r = 0.83 , 31 % unexplained variance ) was slightly lower than TR‐R ( r = 0.86 , 26 % unexplained variance , P < .05 ) ; the difference in variance amounted to 5 % . There were no differences between study centres . In a subgroup with an unaffected control area ( n = 43 ) , reliabilities were significantly better in the test area ( TR‐R : r = 0.86 ; IO‐R : r = 0.83 ) than in the control area ( TR‐R : r = 0.79 ; IO‐R : r = 0.71 , each P < .01 ) , suggesting that disease‐related systematic variance enhances reliability of QST . We conclude that st and ardized QST performed by trained examiners is a valuable diagnostic instrument with good test – retest and interobserver reliability within 2 days . With st and ardized training , observer bias is much lower than r and om variance . Quantitative sensory testing performed by trained examiners is a valuable diagnostic instrument with good interobserver and test – retest reliability for use in patients with sensory disturbances of different etiologies to help identify mechanisms of neuropathic and non‐neuropathic pain Study Design . Prospect i ve , within-subjects , observational experimental design . Objectives . To determine the pattern of pain response to noxious stimulation of the intervertebral disc .  Summary of Background Data . Experimental studies have demonstrated that noxious stimulation of interspinous ligaments , facet joints , and paravertebral muscles causes referred pain into the extremity , with the distal extent of radiation dependent on the intensity of stimulation . Analogous studies have not been performed on the lumbar intervertebral disc . Methods . A total of 25 consecutive patients meeting inclusion criteria completed a  pain diagram  before undergoing the intradiscal electrothermal annuloplasty procedure .  The location , intensity , and familiarity of any pain provoked during disc heating were correlated with presenting symptoms and duration of heating . Results . During disc heating , 68 % of patients reported exact reproduction of their presenting pain , in both pain quality and location . None of the patients experienced unfamiliar pain during the procedure . The pattern of pain reproduction was consistent ; pain originated proximally and progressed distally as stimulus intensity increased . Conclusion . Noxious stimulation of the intervertebral disc may result in low back and referred extremity in patients presenting with these symptoms . The distal extent of pain produced depends on the intensity of stimulation . Disc stimulation may reproduce pain that extends to below the knee Background and Purpose : Knee osteoarthritis ( OA ) is associated with reduced muscle strength and pain sensitization . The purpose of this study was to determine intrarater reliability and agreement ( measurement error ) of isometric knee extensor and flexor muscle strength assessed using h and held dynamometry and of pressure pain thresholds ( PPT ; a measure of pain sensitization ) from the knee , the leg , and the forearm assessed using h and held algometry in knee OA . Methods : A total of 20 subjects with knee OA participated in 2 sessions separated by 1 week . The highest of 4 examinations and the mean of the 3 highest examinations of muscle strength and the first and the mean of 2 PPT examinations were applied in the statistical analyses . Intrarater reliability was assessed using a 2-way r and om-effects model , consistency-type intraclass correlation coefficient , whereas agreement was assessed using 95 % limits of agreement ( LOA ) as a percentage of the mean ( LOA% ) . Results : Intraclass correlation coefficients for muscle strength were between 0.78 and 0.91 when using the highest examination and were between 0.86 and 0.94 when using the mean of the 3 highest examinations . Intraclass correlation coefficients for PPT were between 0.53 and 0.87 when using the first examination and were between 0.84 and 0.91 when using the mean of 2 examinations . Agreement ( LOA% ) for muscle strength ranged from 38.3 % to 47.3 % when using the highest examination and from 40.4 % to 53.3 % when using the mean of the 3 highest examinations . Agreement for PPT ranged from 54.2 % to 80.6 % when using the first examination and from 50.6 % to 58.9 % when using the mean of 2 PPT examinations . Discussion : A tendency toward improved intraclass correlation coefficients and LOA% ( only for PPTs ) was found when using the mean of more than 1 examination for both muscle strength and PPTs . Intrarater reliability was high to very high , whereas the LOA/LOA% indicated relatively high measurement errors . Conclusions : Examination of muscle strength and PPTs in knee OA is reliable , but affected by the measurement error , which is important to consider when reporting the results of clinical trials and in clinical practice Total knee arthroplasty has provided dramatic improvements in function and pain for the majority of patients with knee arthritis , yet a significant proportion of patients remain dissatisfied with their results . We performed a prospect i ve analysis of 215 patients undergoing TKA who underwent a comprehensive array of evaluations to discover whether any preoperative assessment could predict high pain scores and functional limitations postoperatively . Patients with severe pain with a simple knee range-of-motion test prior to TKA had a 10 times higher likelihood of moderate to severe pain at 6 months . A simple test of pain intensity with active flexion and extension preoperatively was a significant predictor of postoperative pain at 6 months after surgery . Strategies to address this particular patient group may improve satisfaction rates of TKA
target: The level of evidence for PMPs varied across different test procedures in different types of PJP .
  H and -held pressure algometry is the only test procedure that showed moderate positive evidence of intrarater reliability , agreement , and responsiveness , simultaneously , when it was investigated in patients with chronic knee osteoarthritis .
background: BACKGROUND Test procedures that were developed to assess somatosensory abnormalities should possess optimal psychometric properties ( PMPs ) to be used in clinical practice .
  The aim of this systematic review was to evaluate the literature to assess the level of evidence for PMPs of test procedures investigated in individuals with peripheral joint pain ( PJP ) .