Pressure pain thresholds in children before and after surgery: a prospective study

Line Kjeldgaard Pedersen 1 , 2 , Polina Martinkevich 2 , Ole Rahbek 1 , 2 , Lone Nikolajsen 3  and Bjarne Møller-Madsen 1 , 2
  • 1 Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark
  • 2 Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark
  • 3 Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus N, Denmark
Line Kjeldgaard Pedersen
  • Corresponding author
  • Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark
  • Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark, www.dpor.dk
  • Email
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Polina Martinkevich
  • Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark, www.dpor.dk
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Ole Rahbek
  • Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark
  • Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark, www.dpor.dk
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Lone Nikolajsen
  • Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus N, Denmark
  • Search for other articles:
  • degruyter.comGoogle Scholar
and Bjarne Møller-Madsen
  • Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark
  • Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark, www.dpor.dk
  • Search for other articles:
  • degruyter.comGoogle Scholar

Abstract

Background and aims

This prospective study aimed to assess pressure pain thresholds (PPTs) by pressure algometry and the correlation to postoperative pain in children undergoing orthopaedic surgery. We hypothesized, that the PPTs would decline immediately after elective orthopaedic surgery and return to baseline values at follow-up.

Methods

Thirty children aged 6–16 years were included. PPTs and intensity of pain (Numerical Rating Scale, NRS) were assessed 3–6 weeks before surgery (baseline), 1–2 h before surgery (Day 0), the first postoperative day (Day 1) and 6–12 weeks after surgery (Follow-up).

Results

A significant difference of PPTs between the four assessments was seen using the Friedman test for detecting differences across multiple tests and Wilcoxon signed-rank test with a Bonferroni adjustment. The changes in PPTs between baseline (PPTcrus = 248 kPa, PPTthenar = 195 kPa) and day 1 (PPTcrus = 146 kPa, PPTthenar = 161 kPa) showed a decline of PPTs as hypothesized (Zcrus = 2.373, p = 0.018; Zthenar = 0.55, p = 0.581). More surprisingly, a significant decrease in PPTs between baseline and day 0, just before surgery (PPTcrus = 171 kPa, PPTthenar = 179 kPa), was also measured (Zcrus = 2.475, p = 0.013; Zthenar = 2.414, p = 0.016). PPTs were positively correlated to higher age, weight and height; but not to NRS or opioid equivalent use.

Conclusions

Children undergoing orthopaedic surgery demonstrate significant changes in PPTs over time. The PPTs decrease significantly between baseline and day 0, further decreases the first day postoperatively and returns to baseline values at follow-up. This suggests that other factors than surgery modulate the threshold for pain.

Implications

Awareness of pressure pain thresholds may help identify children with affected pain perception and hence improve future pain management in children undergoing orthopaedic surgery. Factors as for example anticipatory anxiety, psychological habitus, expected pain, catastrophizing, distraction, physical activity, patient education and preoperative pain medication might play a role in the perception of pain and need further investigation.

  • [1]

    Nikolajsen L, Kristensen A, Pedersen L, Rahbek O, Jensen T, Møller-Madsen B. Intra- and interrater agreement of pressure pain thresholds in children with orthopedic disorders. J Child Orthop 2011;5:173–8.

    • Crossref
    • PubMed
    • Export Citation
  • [2]

    Chaves T, Nagamine H, Sousa L, Oliveira A, Grossi D. Comparison between the reliability levels of manual palpation and pressure pain threshold in children who reported orofacial pain. Manual Therapy 2010;15:508–12.

    • Crossref
    • PubMed
    • Export Citation
  • [3]

    Chesterton L, Sim J, Wright C, Foster N. Interrater reliability of algometry in measuring pressure pain thresholds in healthy humans, using multiple raters. Clin J Pain 2007;23:760–6.

    • Crossref
    • PubMed
    • Export Citation
  • [4]

    Cathcart S, Pritchard D. Reliability of pain threshold measurement in young adults. J Headache Pain 2006;7:21–6.

    • Crossref
    • PubMed
    • Export Citation
  • [5]

    Meeus M, Roussel N, Truijen S, Nijs J. Reduced pressure pain thresholds in response to exercise in chronic fatigue syndrome but not in chronic low back pain: an experimental study. J Rehabil Med 2010;42:884–90.

    • Crossref
    • PubMed
    • Export Citation
  • [6]

    Chaves T, Nagamine H, Sousa Ld, Oliveira Ad, Grossi D. 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;21:133–42.

    • PubMed
    • Export Citation
  • [7]

    Hashkes P, Friedland O, Jaber L, Cohen H, Wolach B, Uziel Y. Decreased pain threshold in children with growing pains. J Rheumatol 2004;31:610–3.

    • PubMed
    • Export Citation
  • [8]

    Hsu Y, Somma J, Hung Y, Tsai P, Yang C, Chen C. Predicting postoperative pain by preoperative pressure pain assessment. Anesthesiology 2005;103:613–8.

    • Crossref
    • PubMed
    • Export Citation
  • [9]

    Uziel Y, Chapnick G, Jaber L, Nemet D, Hashkes P. Five-year outcome of children with “growing pains”: correlations with pain threshold. J Pediatr 2010;156:838–40.

    • Crossref
    • PubMed
    • Export Citation
  • [10]

    Hogeweg J, Kuis W, Oostendorp R, Helders P. The influence of site of stimulation, age, and gender on pain threshold in healthy children. Phys Ther 1996;76:1331–9.

    • Crossref
    • PubMed
    • Export Citation
  • [11]

    Tesarz J, Eich W, Treede R, Gerhardt A. Altered pressure pain thresholds and increased wind-up in adult patients with chronic back pain with a history of childhood maltreatment: a quantitative sensory testing study. Pain 2016;157:1799–809.

    • Crossref
    • PubMed
    • Export Citation
  • [12]

    Riquelme I, Hatem S, Montoya P. Abnormal pressure pain, touch sensitivity, proprioception, and manual dexterity in children with autism spectrum disorders. Neural Plasticity 2016;2016:1–9.

  • [13]

    Soee A, Skov L, Kreiner S, Tornoe B, Thomsen L. Pain sensititvity and pericranial tenderness in children with tension-type headache: a controlled study. J Pain Res 2013;6:425–34.

  • [14]

    King C, Mano K, Barnett K, Pfeiffer M, Ting T, Kashikar-Zuck S. Pressure pain threshold and anxiety in adolescent females with and without juvenile fibromyalgia. A pilot study. Clin J Pain 2017;33:620–6.

    • Crossref
    • PubMed
    • Export Citation
  • [15]

    Scheper M, Pacey V, Rombaut L, Adams R, Tofts L, Calders P, Nicholson L, Engelbert R. Generalized hyperalgesia in children and adults diagnosed with hypermobility syndrome and ehlers-danlos syndrome hypermobility type: a discriminative analysis. Arthritis Care Res 2017;69:421–9.

    • Crossref
    • Export Citation
  • [16]

    Riquelme I, Montoya P. Developmental changes in somatosensory processing in cerebral palsy and healthy individuals. Clin Neurophysiol 2010;121:1314–20.

    • Crossref
    • PubMed
    • Export Citation
  • [17]

    Nielsen P, Nørgaard L, Rasmussen L, Kehlet H. Prediction of post-operative pain by an electrical pain stimulus. Acta Anaesthesiol Scand 2007;51:582–6.

    • Crossref
    • PubMed
    • Export Citation
  • [18]

    Palermo T, Drotar D. Prediction of children’s postoperative pain: the role of presurgical expectations and anticipatory emotions. J Pediatric Psychol 1996;21:683–98.

    • Crossref
    • Export Citation
  • [19]

    Goubert L, Vervoort T, Cano A, Crombez G. Catastrophizing about their childrens’s pain is related to higher parent-child congruency in pain ratings: an experimental investigation. European J Pain 2009;13:196–201.

    • Crossref
    • Export Citation
  • [20]

    Hermans L, Oosterwijck JV, Goubert D, Goudman L, Crombez G, Calders P, Meeus M. Inventory of personal factors influencing conditioned pain modulation in healthy people: a systematic literature review. Pain Practice 2016;16:758–69.

    • Crossref
    • Export Citation
Purchase article
Get instant unlimited access to the article.
$42.00
Log in
Already have access? Please log in.


or
Log in with your institution

Journal + Issues

Search