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Pharmacodynamic understanding of the different local anesthetic concentrations allows adapting their use to diverse clinical/surgical procedures, such as intraoperative and/or postoperative analgesia. A crossover study was performed, where 6 calves (5 male and 1 female), weighing 120 ± 28 Kg, were subjected to combined sciatic and femoral nerve block using three ropivacaine concentrations. The treatments were: R0.75, using 0.75% ropivacaine; R0.2, 0.2% ropivacaine; and R0.12%, 0.12% ropivacaine. All treatments were performed with ultrasound and neurostimulation assistance, and a volume of 0.1 mL/kg of the respective local anesthetic solution was administered in each block point. The sites of mechanical nociceptive threshold (MNT) evaluation were based on the calf pelvic limb dermatomes. The proportion between desensitized areas, MNT elevation time and level of ataxia were registered. Elevation of MNT occurred in 100% of the tested areas in the R0.75 and R0.2 treatments, and in 82% of the R0.12 treatment. Mean MNT elevation times were 9.5 ± 0.7 h for R0.75, 6 ± 0.8 for R.02, and 2.4 ± 2.3 for R0.12, differing significantly between all treatments. No difference was observed between MNT elevation time and ataxia duration time, in each treatment. It is concluded that the duration of sensory-motor effects is dose-dependent, but there was not possible to detect block selectivity as the concentrations was reduced. More desensitized areas and extension were obtained with the use of higher concentrations.

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INTRODUCTION: Diagnosis of Achilles insertional tendinopathies (AIT) is based on pain by tendon palpation. However, there is no consensus or standard with regard to the amount of force to be used during the evaluation. Algometry is a method of measuring the pressure applied in a specific region and can be a method for determining diagnosis values. GOAL: To determine a cutoff value for pain threshold (PT) in the assessment of AIT. DESIGN: This is a prospective case-control study of diagnostic accuracy, to develop a diagnostic criterion. METHODS: Forty asymptomatic individuals and forty patients with AIT, matched by age and sex, were evaluated and submitted to algometry for PT and for visual analog scale (VAS) levels with 3 kgf at the insertion of the calcaneal tendon by two different evaluators. Inter-observer reproducibility was assessed through the interclass correlation coefficient (ICC). Sensitivity and specificity calculations of PT and of VAS were calculated and plotted on a receiver operating characteristic curve. RESULTS: The lowest ICC found was 0.788. With regard to the diagnosis through PT , the 4.08-kgf value showed the best relation between sensitivity and specificity (92.5% and 92.5%, respectively). Algometry values lower than 4.08 were considered positive for disease. For the diagnosis of AIT through VAS with 3 kgf, the value of 2.98 was estabilished (sensitivity of 92.5% and specificity of 97.5%). CONCLUSION: Algometry was shown to be a simple and reliable method for diagnosing AIT. Values of PT less than 4.08 kgf were found to be predictors of the disease.

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BACKGROUND: Pain assessment is a key measure that accompanies treatments in a wide range of clinical settings. A low-cost valid and reliable pressure algometer would allow objective assessment of pressure pain to assist a variety of health professionals. However, the pressure algometer is often expensive, which limits its daily use in both clinical and research settings. OBJECTIVES: This study aimed to assess the instrumental validity, and the intra- and inter-rater reliability of an inexpensive digital adapted pressure algometer. METHODS: A single rater applied 60 random compressions on a force platform. The pressure pain thresholds of 20 volunteers were collected twice (3 days apart) by two raters. The main outcome measurements were as follows: the maximal peak force (in kPa) and the pressure pain threshold (adapted pressure algometer vs. force platform). Cronbach's α test was used to assess internal consistency. The standard error of measurement provided estimates of measurement error, and the measurement bias was estimated with the Bland-Altman method, with lower and upper limits of agreement. RESULTS: No differences were observed when comparing the compression results (P = 0.51). The validity and internal intra-rater consistencies ranged from 0.84 to 0.99, and the standard error of measurement from 0.005 to 0.04 kPa. Very strong (r = 0.73-0.74) to near-perfect (r = 0.99) correlations were found, with a low risk of bias for all measurements. The results demonstrated the validity and intra-rater reliability of the digitally adapted pressure algometer. Inter-rater reliability results were moderate (r = 0.55-0.60; Cronbach's α = 0.71-0.75). CONCLUSION: The adapted pressure algometer provide valid and reliable measurements of pressure pain threshold. The results support more widespread use of the pressure pain threshold method among clinicians.

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BACKGROUND: With the hypothesis that equine dorsal lamellar tissue can be desensitized by anesthesia injection into distal interphalangeal joint (DIPJ), the objective was to assess the mechanical nociceptive threshold of hoof dorsal lamellae following intra-articular (IA) administration of lidocaine into this joint. METHODS: The DIPJ of the forelimbs of six adult healthy horses were injected with either 5 mL of lidocaine, or 5 mL of lactated Ringer's solution. Treatments were randomly distributed, with each forelimb undergoing a single treatment. The hooves were evaluated pre- and post-injection at pre-selected times over 4 h, using a pressure algometry model. Mechanical nociceptive thresholds (MNTs) were recorded for the sole (dorsal, palmarolateral, and palmaromedial regions), coronary band (medial, lateral, and dorsal regions), heel bulbs (medial and lateral), and dorsal lamellar region (2 cm and 4 cm distal to the coronary band). The MNT means were compared over time using the Friedman test and between treatments using the Wilcoxon signed-rank test, with values of P < 0.05 considered statistically significant. RESULTS: There were no differences between treatments for any region of the hoof during the evaluation period. However, MNT values indicating analgesia were recorded in the dorsal lamellar region in 50% of hooves following adminstration of lidocaine into the DIPJ. CONCLUSION: The administration of 5 mL of lidocaine into the DIPJ does not significantly increase the mechanical nociceptive threshold of the equine hoof.

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A dor passa ser um fator importante quando se estuda a população idosa, pois apresenta um grande impacto nas atividades diárias, aumentando as comorbidades e a mortalidade, transformando-se em um sério problema de saúde pública. OBJETIVOS: Avaliar a confiabilidade das medidas intraexaminador e interexaminador de um algômetro digital em mensurar o limiar da dor no quadril de idosos institucionalizados e frágeis. MATERIAIS E MÉTODOS: A amostra foi de forma intencional de acordo com a capacidade cognitiva dos idosos para responderem às avaliações; dois examinadores realizaram a algometria na região do quadril em 17 idosos residentes de uma instituição de longa permanência. RESULTADOS: Os coeficientes de correlação intraclasse (CCI) demonstraram alta confiabilidade do instrumento intra-examinador - iguais a 0,877 e muito alta interexaminador - iguais a 0,973. CONCLUSÃO: Há confiabilidade no algômetro digital em mensurar o limiar de dor no quadril em idosos de uma instituição de longa permanência.

Pain becomes an important factor when studying the elderly population, as it has a great impact on daily activities, increasing comorbidities and mortality, becoming a serious public health problem. OBJECTIVES: To evaluate the reliability of the intra-examiner and inter-examiner measurements of a digital algometer in measuring the hip pain threshold of institutionalized and fragile elderly people. MATERIALS AND METHODS: The sample was intentionally in accordance with the elderly's cognitive ability to respond to assessments; two examiners performed algometry in the hip region on 17 elderly residents of a long-term institution. RESULTS: The intraclass correlation coefficients (ICC) high reliability of the intraexaminer instrument - equal to 0.877 and very high interexaminer - equal to 0.973. CONCLUSION: There is reliability in the digital algometer in measuring the hip pain threshold in the elderly in a long-term institution.

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BACKGROUND: According to the American Physical Therapy Association, there is strong evidence to show that vertebral mobilization and manipulation procedures can be used to improve spinal and hip mobility and reduce pain and incapacity in low back pain patients that fit the clinical prediction rule. OBJECTIVES: To evaluate the immediate effects of high-velocity low-amplitude (HVLA) manipulation on pain and postural control parameters in individuals with nonspecific low back pain. METHODS: This study used a participant-blinded and assessor-blinded randomized controlled clinical trial involving a single session, in which 24 participants were randomly distributed into control (simulated manipulation) and intervention (HVLA lumbar manipulation) groups. The primary (pain: subjective pain intensity and pressure pain threshold) and secondary outcomes (postural control: ellipse area, center of pressure [COP] excursion, COP RMS velocity, and differences between the COP and center of projected gravity) were evaluated before and after the session using a numerical pain scale, algometer, and a force platform. For all outcomes, multiple mixed 2 (group) × 2 (time) ANOVAs were performed. RESULTS: For the subjective pain intensity, only time was significant as a main effect, where pre-intervention presented a greater value then post-intervention (F [1.44] = 4.377; p = 0.042; r = 0.30). For the pressure pain threshold no significant effect was found. For the postural control parameters, as a main effect, only the ellipse area was significantly greater in the control group (F [1.44] = 6.760; p = 0.013; effect size = 0.36). CONCLUSIONS: There was a reduction in subjective pain intensity, evaluated using a numerical scale, in both the intervention and control groups immediately after the intervention, suggesting that the spinal manipulation had a similar effect to the placebo procedure. No effect of HVLA lumbar manipulation was identified for postural control variables in either the intervention or control groups. TRIAL REGISTRATION: The study was registered at ClinicalTrials.gov under the number NCT02312778, registered at 14 September 2014.

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INTRODUCTION: Older adults experience significant chronic pain after hip fracture, resulting in decreased physical functioning. However, pain investigation in this population is mostly limited to self-reported pain intensity. Detailed pain assessment may identify intervention targets other than pain relief. The aim of this study is to investigate multiple dimensions of pain experience (intensity, sensory, affective, evaluative and miscellaneous dimensions) and to correlate them to lower limb functionality and limitations in daily living activities. METHODS: We conducted a cross-sectional study of 50 older adults (77.1 ± 8.1 years old) who underwent hip fracture surgery in the past 4 months. We used the Numeric Rating Scale (NRS), the McGill Pain Questionnaire (MPQ) and an algometer to assess pain intensity, pain quality and pressure pain threshold, respectively. Lower limb functionality and limitation in basic (activities of daily living (ADL)) and instrumental activities of daily living (IADL) were assessed using the Short Physical Performance Battery (SPPB) and the Brazilian OARS Multidimensional Functional Assessment Questionnaire. RESULTS: Participants described pain as brief, momentary and transient, especially during weight-bearing activities. Although the pain intensity measured by the NRS was reported as moderate to severe (7.5 ± 1.6 points), it was not correlated with physical functioning. However, we observed a moderate negative correlation between pressure pain threshold, ADL and IADL disability (r = -0.41, p < 0.01). Among pain qualities, the sensory category was moderately negatively correlated to SPPB (r = -0.41, p < 0.01), and the evaluative category was moderately correlated to ADL and IADL disability (r = 0.43, p < 0.01). CONCLUSION: Pain can be present 4 months after hip fracture surgery, particularly during weight-bearing activities, and it is associated with poor lower limb functionality, as well as ADL and IADL disability. Older adults may benefit from pain assessments that go beyond pain intensity measurements after hip fracture, as this helps clinicians optimise pain management and overall functional recovery.

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Objective: To compare the levels of non-specific physical symptoms and pressure pain threshold (PPT) found in patients with masticatory myofascial pain with those found in patients with temporomandibular arthralgia alone. Methods: The study followed an observational and cross-sectional protocol. A total of 64 female patients were evaluated for the presence of painful TMD, non-specific physical symptom levels, and PPT. Results: The group of patients with masticatory myofascial pain presented a lower mean for PPT as well as a higher mean for standardized T-Scores for non-specific physical symptom levels. Conclusion: Statistically significant differences were found in non-specific physical symptom levels and PPT between patients with an exclusive diagnosis of masticatory myofascial pain and patients with a diagnosis, also exclusive, of temporomandibular arthralgia.

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OBJECTIVE: To investigate the correlation between the numerical rating scale, visual analogue scale, and pressure threshold by algometry in women with chronic pelvic pain. STUDY DESIGN: This was a cross-sectional study. We included 47 patients with chronic pelvic pain. All subjects underwent a pain assessment that used three different methods and were divided according to the cause of pain (endometriosis versus non-endometriosis). Moreover, we assessed the agreement between the scales (visual, analogue and algometry) using the intraclass correlation coefficient (ICC). RESULTS: The ICC for the numeric rating scale and the visual analogue scale regarding pain (0.992), dysmenorrhea (1.00) and dyspareunia (0.996) were strong. The agreement between the scales was excellent (p ≤0.01). The correlation between algometry and the scales showed a moderate and inverse association, and this correlation was statistically significant: as the scores on the numeric rating scale and the visual analogue scale regarding dyspareunia increased, the algometry thresholds decreased. CONCLUSIONS: The assessment of women with chronic pelvic pain should combine pressure algometry and the numeric rating scale or the visual analogue scale, because of their inverse correlations and satisfactory reliability and sensitivity, to make pain assessment less subjective and more accurate.

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ABSTRACT BACKGROUND AND OBJECTIVES: Muscle pain is one of the causes of the leave of absence in physical activities, as well as limiting factor in sports performance. The objective of this study was to evaluate the early and late response to the pain perception threshold after acupuncture in a single application, in subjects submitted to repetitive strain. METHODS: Clinical-experimental quantitative trial, with control group and blind, with 47 healthy women, aged between 18 and 55 years (36.3±10.6), divided deterministically by sequential alternation to the groups: acupuncture (GACP n=16), Sham (Gsham n=16) and control (CGRT n=15). The repetitive strain was performed in the Reformer equipment of the Pilates method, before and after the intervention, with 0,25x40mm needles. The GACP received the needling at point ST36 (Zusanli). The Gsham received superficial needling out of the acupuncture point, and the CGRT only performed the exercise. All patients had the needles for 20 minutes, except for the CGRT who remained only at rest. A digital pressure algometer was used at point BL57 (Chengshan). The algometry was conducted before the intervention and the exercise, immediately after, and after 24 hours. RESULTS: The GACP showed a significant increase in the pain perception threshold when compared to Gsham (p =0.021) and to CGRT (p<0.001) and after 24 hours, with CGRT (p=0.006). The results were coherent with the acupuncture theoretical foundations, suggesting the release of opioid analgesics and applicability in the recovery of post-exercise sore muscles. CONCLUSION: A single acupuncture intervention was able to increase the Pain Perception Threshold immediately and after 24 hours.

RESUMO JUSTIFICATIVA E OBJETIVOS: A dor muscular é uma das causas de afastamento de práticas de atividades físicas e fator limitante no desempenho desportivo. O objetivo deste estudo foi avaliar a resposta imediata e tardia do limiar de percepção dolorosa após estímulo de acupuntura em uma única aplicação, em sujeitos submetidos a esforço repetitivo. MÉTODOS: Ensaio clínico-experimental, quantitativo, com grupo controle e encoberto, 47 mulheres sadias, com idades entre 18 e 55 anos (36,3±10,6), separadas por alocação determinista por alternância sequencial em grupos: acupuntura (GACP n=16), Sham (Gsham n=16) e controle (GCRT n=15). Realizou-se o esforço repetitivo no equipamento Reformer do método Pilates, antes e após a intervenção com agulhas 0,25x40mm. O GACP recebeu agulhamento no ponto E36 (Zusanli). O Gsham agulhamento superficial, fora do ponto de estímulo de acupuntura e o GCRT só realizou o exercício. Todos permaneceram 20 min com agulhas e o GCRT só em repouso. Utilizou-se um algômetro de pressão digital no ponto B57 (Chengshan). A algometria foi realizada antes da intervenção e do exercício, imediatamente após, e após 24 horas. RESULTADOS: O GACP teve aumento significativo do limiar de percepção dolorosa no momento imediato, quando comparado ao Gsham (p=0,021) e ao GCRT (p<0,001), e após 24 horas com o GCRT (p=0,006). Houve coerência dos resultados com as bases teóricas do estímulo da acupuntura, sugerindo liberação de opioides analgésicos e aplicabilidade em recuperação de dores musculares pós-exercícios. CONCLUSÃO: Uma única intervenção de acupuntura foi capaz de aumentar o limiar de percepção dolorosa de imediato e após 24 horas.

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The aim of the study will be to compare different types of analgesic electrical currents in relation to the pressure pain threshold and sensory comfort in healthy individuals. A total of 100 individuals will be randomly assigned to four groups: transcutaneous electrical nerve stimulation, interferential current, Aussie current or placebo. The electrical stimulation will be administered with a strong level for 30 min and to the placebo group, the electrodes will be positioned while the equipment will remain switched off. The pressure pain threshold and sensory comfort will be measured with an algometer and the visual analogue scale, respectively. The level of significance will be p < 0.05. STUDY REGISTRATION: NCT01950728 (clinical trials).

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Several factors may influence pressure pain threshold (PPT), including physical fitness. However, only a few authors have studied this relationship. The aim of this study was to investigate the relationships between muscle strength, functional capacity (ability to perform physical work and activities of daily living) and PPT in elderly women. This observational cross-sectional study involved 75 healthy women aged between 60 and 75 years. Volunteers underwent an evaluation consisting of anthropometry, functional capacity, muscle strength and PPT assessment by algometry in the following muscles: biceps brachii, flexor carpi ulnaris, flexor carpi radialis, vastus medialis, vastus lateralis and gluteus maximus. Mean age of the 75 volunteers was 66.8 ± 4.6 years old. No significant correlations were found between handgrip or elbow flexion strength and PPT in the upper limb muscles evaluated. The same was observed regarding functional capacity, lower limbs strength and PPT in lower limb muscles. Functional capacity and muscle strength did not correlate with PPT in healthy elderly women.

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BACKGROUND: The lumbar back and hip muscles are important for a normal functioning of the human spine and they are considered to be of etiological significance in chronic nonspecific low back pain (nCLBP). Inactivity and a lower level of physical activity in patients with nCLBP may change muscle characteristics and may be associated with pain and disability. Pressure algometry has been found to be non-invasive, efficient and reliable in the exploration of physio-pathological mechanisms involved in muscle pain syndromes. The subjective characteristic of the pressure pain thresholds (PPTs) cannot be avoided once it is the very objective of the measurement, i.e. the minimum pain perceptible by the person, is a subjective factor. Most studies have revealed gender differences between PPTs, with females showing lower thresholds. OBJECTIVE: to determine whether demographic variables and PPTs, are related pain intensity and a disability in patients with nCLBP. METHODS: One hundred and twenty-four patients with nCLBP were included in the study. The Visual Analogue Scale (VAS) and the Roland-Morris Questionnaire for Low Back Pain (RM) were used to evaluate the intensity of pain and degree of disability. The PPT was performed from L1 up to S2 dermatomes, at the muscles over the Gluteus medius, minimus and maximus, including a point located at the level of the piriformis, at the Quadratus lumborum, at the Iliopsoas and points of reference located at the level of the L1 up to L5 ligaments. The pain intensity was assessed by visual analogue scale (VAS) and the lumbar function by Roland Morris questionnaire (RM). Multiple linear regression models were used for both the VAS and the RM. RESULTS: No significant differences were found between the PPTs measured at either left or right limb. The mean VAS value was 7.3 (± 1.5) and the RM score was 14.2 (± 5.3). The PPT-values showed significant negative correlations to the VAS and the RM. The highest correlation between the mean VAS and PPT-values were found at the level of the Gluteus medius (r= -0.34, p< 0.001), which was the only measurement correlated to the intensity of pain (r2 = 0.11, p< 0.001). The RM was correlated to the BMI, the level of education and the PPT values at the level of the Iliopsoas muscle and the L4-L5 supraspinous ligament. CONCLUSIONS: This study showed that most PPT values are correlated to the VAS and the RM. Nevertheless, the variability explained by PPT values and demographic characteristics was low for pain intensity and function.

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OBJECTIVES: To assess the cardiac autonomic control at rest and during the deep breathing test (DBT) and its association with pain in women with fibromyalgia syndrome (FMS). METHODS: The study included 20 women with FMS and 20 healthy women (control group, CG). The pain was quantified by assessing the pressure pain threshold (PPT), VAS of pain, and the pain component of the SF-36 questionnaire. The RR intervals were recorded in the supine position and during the DBT. The heart rate variability (VHR) was measured by methods in the time and frequency domain. RESULTS: The group with FMS had abnormal cardiac autonomic modulation at rest and during DBT, compared to CG (P < 0.05). Positive correlations were found between PPT and the E/I ratio (r = 0.70), ΔFC (r = 0.66) and power spectrum density (DEP, r = 0.56) indices of DBT, as well as between pain component of the SF-36 and the E/I ratio (r = 0.49), ΔFC (r = 0.45) and DEP (r = 0.50) indices of DBT. Significant correlations were observed between the FIQ questionnaire and the LF/HF ratio index in the supine position and the E/I ratio (r = -0.63), ΔFC (r = -0.54), and DEP (r = -0.51) indices of DBT. CONCLUSIONS: The results of VHR indices during the supine position and the DBT women with FMS suggest impairment of neurocardiac integrity associated with pain and the impact of FMS on the quality of life.

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OBJECTIVE: To compare the effects of 5% lidocaine patches and placebo patches on pain intensity and electromyographic (EMG) activity of an active myofascial trigger point (MTrP) of the upper trapezius muscle. MATERIALS AND METHODS: Thirty-six patients with a MTrP in the upper trapezius muscle were randomly divided into two groups: 20 patients received lidocaine patches (lidocaine group) and 16 patients received placebo patches (placebo group). They used the patches for 12 h each day, for 2 weeks. The patch was applied to the skin over the upper trapezius MTrP. Spontaneous pain, pressure pain thresholds, pain provoked by a 4-kg pressure applied to the MTrP and trapezius EMG activity were measured before and after treatment. RESULTS: Baseline spontaneous pain values were similar in both groups and significantly lower in the lidocaine group than the placebo group after treatment. The baseline pressure pain threshold was significantly lower in the lidocaine group, but after treatment it was significantly higher in this group. Baseline and final values of the pain provoked by a 4-kg pressure showed no significant difference between the groups. Baseline EMG activity at rest and during swallowing of saliva was significantly higher in the lidocaine group, but no significant difference was observed after treatment. Baseline EMG activity during maximum voluntary clenching was similar in both groups, but significantly higher in the lidocaine group after treatment. CONCLUSIONS: These clinical and EMG results support the use of 5% lidocaine patches for treating patients with MTrP of the upper trapezius muscle.

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