Search Results (36)

Objectives: Maxillary nerve block via the greater palatine canal (GPC) offers the potential for profound regional anesthesia of the maxilla but remains underutilized due to anatomical variability and technical complexity. The aim of this study was to explore the clinical feasibility, accuracy, and anesthetic effectiveness of a computer-guided approach by using CBCT-based surgical guides to access the pterygopalatine fossa via the GPC. Methods: Thirty-one patients underwent the procedure with patient-specific guides designed from cone-beam computerized tomography (CBCT) and intraoral scans. A 27G needle was directed through the guide to deliver 1.8 mL of 2% lidocaine with epinephrine 1:80.000. Pulpal anesthesia was assessed via electric pulp testing (EPT), and soft tissue anesthesia via pressure algometry at predefined oral and facial sites. Success was defined as absence of EPT response at maximum output and pressure pain threshold ≥ 700 g. To assess variations in anesthetic efficacy among multiple related groups, Cochran’s Q test and McNemar’s test were employed. Results: Successful needle placement was achieved in 30 out of 31 patients (96.7%) using the computer-guided approach, with a mean of 1.45 insertion attempts per case. Complete palatal soft tissue anesthesia was achieved in all subjects across the tested sites (100%). Pulpal anesthesia was most effective in posterior teeth, with success rates of 96.7% for first molars and 93.3% for first premolars, while the central incisor showed a reduced success rate of 50%. Transient visual disturbances occurred in three patients (10%), with no other adverse effects reported. Conclusions: These findings support the use of computer-guided GPC block as a method for achieving maxillary nerve anesthesia. Although anesthetic spread to anterior and buccal regions was limited, the technique demonstrated consistent effectiveness in the posterior maxilla, highlighting its potential utility in complex dental and surgical interventions requiring deep and long-lasting regional anesthesia. Full article

Background: Latent myofascial trigger points (MTrPs) are clinically relevant because they lower local pressure pain thresholds (PPTs), can perturb motor control, and may sustain shoulder symptoms even when overt pain is absent. However, even if previous studies assessed stiffness and mechanosensitivity differences between MTrPs and asymptomatic regions, objective patient-level cut-offs and diagnostic-accuracy metrics to distinguish latent MTrPs from adjacent asymptomatic tissue are lacking. Objective: To quantify the diagnostic accuracy of pressure algometry (PPT) and shear-wave elastography (SWE) for distinguishing latent MTrPs from adjacent asymptomatic tissue. Methods: A single-center cross-sectional study was conducted including 76 volunteers with ≥1 latent infraspinatus MTrP (assessed by following the current Delphi consensus criteria). The most sensitive latent MTrP and a control site 2 cm cranial was measured on the dominant side infraspinatus muscle in each participant. PPT and SWE were acquired with a standardized protocol (long-axis imaging, anisotropy control, minimal probe pressure; three captures per site; 1 cm rectangular ROI; operator blinded to site type). ROC analyses estimated areas under the curve (AUCs), Youden-optimal cut-offs, sensitivity, specificity, and likelihood ratios (LR+/−). Results: Latent MTrPs showed lower PPTs than controls (p < 0.001) and higher stiffness (shear modulus: p = 0.009; shear-wave speed: p = 0.022). PPT yielded AUC = 0.704 with an optimal cut-off of 47.5 N (sensitivity 0.75; specificity 0.592; LR+ 1.84; LR− 0.42), outperforming SWE metrics (shear modulus AUC 0.611; cut-off 23.6 kPa; sensitivity 0.632; specificity 0.605; LR+ 1.60; LR− 0.61; shear-wave speed AUC 0.601; cut-off 2.55 m/s; sensitivity 0.592; specificity 0.632; LR+ 1.61; LR− 0.65). Conclusions: In the infraspinatus, PPT provides moderate discrimination between latent MTrPs and adjacent asymptomatic tissue, whereas resting SWE—despite small mean differences—exhibited lower accuracy. These findings support mechanosensitivity as a primary measurable signal and position SWE as an adjunct. External validation across devices and operators, and multivariable models integrating sensory, imaging, and clinical features, are warranted. Full article

Myofascial pain syndrome (MPS) is caused by trigger points (TrPs): hypersensitive spots in taut muscle bands that impair function and cause pain. Dry needling (DN) is a common treatment in humans, but evidence in horses is limited. This prospective, controlled study evaluated the effectiveness of DN in reducing TrP-related pain in the brachiocephalic muscle of horses. Of the 98 horses enrolled, 66 were allocated to a treatment group receiving weekly DN sessions for three weeks, while 32 were assigned to a control group with no intervention. Pain and function were assessed using pressure algometry, a numerical rating scale (NRS), a functional total test score (FTTS), and behavioral indicators including jump sign (JS), equine pain face (EPF), and local twitch responses (LTRs). Assessments were performed at baseline and at 0, 4, 24, and 72 h post-intervention. Results indicate a significant increase in pressure pain thresholds (p < 0.001), especially after the second and third sessions. Both NRS and FTTS improved significantly over time (p < 0.001), and LTRs progressively decreased. EPF and JS showed minimal variation. These results support the use of DN to reduce local muscle pain and improve function in horses with TrPs. Further robust studies are warranted to refine protocols and investigate long-term effects. Full article

Background/Objectives: Temporomandibular disorders are a heterogeneous group of degenerative musculoskeletal conditions that present a series of symptoms such as pain, dysfunction of the masticatory muscles and/or temporomandibular joints, structural abnormalities, and limitation or alteration of mandibular movements. The objective of this study was to evaluate the efficacy of photobiomodulation therapy with low-power laser in patients refractory to treatment with botulinum toxin type A. Methods: A multicenter prospective experimental pilot study was proposed, in which 10 patients between 33 and 68 (50 ± 11.2) years old participated, assigned to a laser group (940 nm diode laser) who had previously been treated with a minimum of three doses of botulinum toxin type A without obtaining positive results. The patients underwent four photobiomodulation sessions over 4 weeks (registered at ClinicalTrials NCT06915064). Painful symptoms were evaluated using a visual analog scale at different locations, the pressure pain threshold using algometry, and the maximum vertical mandibular movement determined using digital calipers. The results were recorded four weeks after the end of treatment. Adverse effects were also evaluated. Results: Pain in the masticatory muscles was reduced in 70% of patients with statistically significant values (p = 0.002); a total of 60% of patients showed a considerable reduction in joint noise with outstanding statistical significance (p = 0.015). The majority of participants reported a reduction in the intensity of headaches after treatment. However, it only produced a slight improvement in maximum mouth opening and lateral excursions. Algometric values in the masticatory muscles showed improvement only in the left-sided irradiated muscles. Conclusions: Photobiomodulation therapy is a non-invasive treatment option for temporomandibular disorders that generates positive effects in cases refractory to treatment with botulinum toxin type A. Full article

Myofascial trigger points (MTrPs) are localized, hypersensitive areas in muscles that can cause pain and reduced performance. This study aimed to compare the prevalence and location of MTrPs in show-jumping and dressage horses. A secondary objective was to evaluate the potential of thermography, pressure algometry, and facial expression scoring in characterizing MTrPs in horses. Fourteen horses (seven dressage, seven show-jumping) were examined. Muscle palpation was used to identify MTrPs. Thermography was used to compare the skin surface temperature of MTrPs with adjacent control areas. Additionally, facial expressions were recorded during palpation and scored by three blinded observers using the Horse Grimace Scale (HGS). MTrPs were found in all horses. Both groups showed a high prevalence (>60%) of MTrPs in the back. Dressage horses had a higher prevalence of MTPrs in the neck (17%) and a lower prevalence in the rump (17%) than show-jumping horses (3% and 30%, respectively). Temperatures at MTrP sites were significantly higher than at control points (p < 0.01). Facial expression scores were also significantly higher during MTrP palpation compared to control (16 [0–24] vs. 6 [0–19], p = 0.004). These findings open a perspective for better recognition and treatment of myofascial pain in athletic horses. Full article

Background: Previous research has examined the acute effects of high-intensity exercise on muscle contractility, revealing potential interference in reaching peak contraction. This study aims to evaluate the impact of a standardized kettlebell swing protocol on low back musculature contractility, measured by tensiomyography (TMG), and pain sensitivity, measured by pressure algometry. Methods: Forty participants were randomly assigned to one of three groups: control, kettlebell swing, and kettlebell isometric hold. Pre-intervention TMG and pressure pain threshold (PPT) measurements were taken, followed by the intervention and post-intervention measurements. Results: Participants averaged 23.85 years (SD ± 2.73), 162.39 lbs (SD ± 28.69), and 174.29 cm (SD ± 12.45). Baseline ANOVAs showed no significant differences between groups for pre-intervention DM or PPT measurements, nor for demographics (p > 0.05). Although no significant within-group differences in TMG measurements were observed, the kettlebell swing group showed small mean differences in muscle displacement and contraction time for the gluteus maximus with effect sizes ranging from 0.09 to 0.49. Conclusions: The study suggests posterior chain muscles, such as the gluteus maximus, are involved in kettlebell swings. Also, despite the lack of significant TMG differences within groups, the kettlebell swing group exhibited small changes in muscle characteristics, enhancing the understanding of exercise-induced hypoalgesia and posterior chain involvement in resistance exercises. Full article

Background/Objectives: Cesarean section (C-section) scars are commonly linked to reduced tissue elasticity and increased pain due to adhesion formation. Addressing these concerns is essential to improving patient comfort and functional outcomes. This study aimed to assess the immediate effects of vacuum therapy on skin elasticity and pain sensitivity in C-section scar tissue. Methods: Thirty-one women with C-section scars older than six months and less than two years participated in an open clinical trial. The skin elasticity was assessed using the Adheremeter, and the pain sensitivity was measured through the Pressure Pain Threshold (PPT) using algometry. The intervention consisted of a 15 min vacuum therapy session using the AeroFlow^® device that targeted the scar and surrounding areas. Results: The vacuum therapy intervention resulted in significant improvements in the skin elasticity at multiple assessment points, particularly in regions with fascial restrictions (p < 0.05). Concurrently, the PPT values decreased, indicating a reduction in pain sensitivity around the scar area (p < 0.05). These findings suggest that vacuum therapy may enhance tissue flexibility and alleviate pain in adherent C-section scars. Conclusions: This study demonstrated the potential of vacuum therapy as an effective intervention to improve skin elasticity and reduce pain sensitivity in C-section scars. The Adheremeter-based assessment provided valuable insights into the biomechanical properties of scar tissue and supported its use in scar management protocols. This approach offers a promising, non-invasive strategy for personalized scar treatment, ultimately aiming to enhance patient outcomes and quality of life. Full article

Background: Myofascial trigger points (MTrPs) are hyperirritable spots in skeletal muscle associated with pain and dysfunction, often impacting individuals’ quality of life. Various interventions, such as dry needling and manual therapy, have shown limited effects in addressing these conditions. This study aimed to assess the effectiveness of a functional neurology intervention in reducing pain and improving muscle function in patients with MTrPs in the upper trapezius muscle. We hypothesized that a single session of functional neurology intervention would significantly increase the pressure pain threshold (PPT) and improve peripheral vascular response in individuals with myofascial trigger points compared to a control group. Methods: A randomized controlled trial (RCT) was conducted with 63 participants randomly assigned to an experimental (receiving functional neurology treatment) or control group. Pre- and post-treatment assessments were conducted, and both intra- and inter-group comparisons were performed using algometry to measure the PPT and infrared thermography to analyze peripheral vascular response. Data were analyzed using dependent and independent t-tests with statistical significance set at p < 0.05. Results: The experimental group demonstrated a significant 46.4% increase in PPT, while the control group showed negligible changes. Thermographic analysis indicated improved peripheral blood flow in the experimental group, reflected by increased skin temperatures and reduced thermal anomalies. No significant differences were observed between the groups at baseline. Conclusions: A single session of functional neurology intervention significantly reduced pain and improved muscle function in patients with MTrPs. These findings suggest that functional neurology offers a promising non-invasive alternative to traditional treatments, with potential implications for more rapid and sustained therapeutic outcomes. Full article

Background: Algometry is a validated and reliable measurement tool, but there are still no reliable data for the different algometers used by different raters in the same participant. Objective: The aim of this study was to determine the intra-reliability of pressure pain thresholds (PPTs) measured using a digital algometer with and without a digital screen by different raters at the same time in a pain-free population. Methods: Participants were healthy adults. PPTs were assessed using two different algometers: a digital algometer with a digital screen for a feedback of the pressure curve rate (SpTech Digital Algometer); and a digital algometer without a screen (Wagner Instruments FDX-25, Greenwich, CT, USA). Four PPT points were used: upper trapezius, lumbar spine, extensor carpi ulnaris, and tibialis anterior. The Copenhagen Psychosocial Questionnaire II was used to assess burnout, stress, sleeping problems, depressive symptoms, somatic stress, and cognitive stress. The intraclass coefficients (ICCs) for intra-rater reliability was calculated using a two-way mixed effects model, single measurement type, and absolute agreement definition. Results: A total of 47 healthy participants with a mean age of 30.51 (11.35) years were included. The upper trapezius and extensor carpi ulnaris had the lowest PPT values, and the tibialis anterior had the highest PPT value. Females had the lowest PPT values when compared with males with p < 0.05 in the upper trapezius and extensor carpi ulnaris regions. The intra-rater reliability ranged from good to excellent reliability, with the ICC values of rater 1 being higher when compared with rater 2. The PPT in tibialis anterior had the highest mean ICC scores. Conclusions: The intra-rater reliability of PPTs measured by different digital algometers ranged from good to excellent reliability. The rater with more experience demonstrated higher reliability. Full article

This study aimed to assess the immediate effects of transcutaneous spinal direct current stimulation (tsDCS) on pain outcomes, measured using the visual analog scale (VAS) and pressure pain thresholds in a cohort of 55 participants experiencing chronic pain using a controlled, randomized trial with 55 participants allocated into 2 groups: 2 mA and 0.5 mA of tsDCS for 20 min. Anodal stimulation was applied on the 12th thoracic vertebra, with the cathode positioned on the 7th cervical vertebra. Pain outcomes were assessed before and post intervention using the VAS and pressure algometry. Between- and within-group differences, along with chi-square tests, were used to determine the differences and responsiveness. Significance was established at p < 0.05. Findings showed significant temporal effects for both VAS (p < 0.001) and pressure algometry (p = 0.04). However, no between-group differences were noted for the time × group factor for VAS (p = 0.46) and pressure algometry (p = 0.78). No significant between-group differences were observed for the responsiveness analysis. The results indicate that a single 20-min session of 2 and 0.5 mA tsDCS improves pain scores for both intensities equally. However, there were no statistically significant between-group differences in pain perception or pressure pain threshold. Full article

Background/Objectives: Cesarean section (C-section) scars can lead to chronic pain due to changes in tissue properties. Combining elastography and algometry can assess these scars comprehensively by identifying areas of increased rigidity and quantifying pain sensitivity. This study aims to evaluate the efficacy of using elastography and algometry together to assess cesarean scar tissue, correlating tissue stiffness with pain thresholds for targeted pain management. Methods: Thirty-one non-pregnant women who had undergone a C-section between six months and two years prior participated. Elastography measured tissue stiffness, while algometry provided quantitative measures of pain sensitivity on and around the scar. The correlation between tissue stiffness and pain thresholds was analyzed. Results: Elastography identified areas of increased rigidity within the scar tissue, which corresponded with lower pain thresholds measured by algometry, indicating higher pain sensitivity. A significant correlation was found between increased tissue stiffness and reduced pain thresholds (p < 0.05). Conclusions: Combining elastography and algometry offers a powerful diagnostic tool for evaluating C-section scars. This approach identifies areas that may benefit from targeted pain management interventions, enhancing understanding and treatment of pain associated with cesarean scars. Incorporating these techniques into clinical practice could improve patient outcomes and quality of life. Full article

Background and Objectives: In this study, we aimed to evaluate pain intensity in patients after pilonidal disease surgeries of varying extent using pressure algometry and the visual analog scale and to explore potential correlations between these methods. Materials and Methods: A total of 78 adult patients with symptomatic pilonidal cysts were enrolled in this study. The patients were divided into two groups based on the type of surgery assigned to each patient at the pre-hospital consultation: pit-picking surgery (n = 39) and radical excision (n = 39). The pain levels at the surgical site were assessed and compared using the visual analog scale (VAS) and pressure algometry the morning before surgery and the day after the operation. Results: There was no statistically significant difference (p > 0.05) in VAS measurement results between surgical groups when comparing pain intensity experienced by patients before, during, and after surgery. Notably, specific pressure algometry variables (pressure pain tolerance left 2.05 ± 1.46 compared to 1.42 ± 0.73 kg/cm², p = 0.02; maximum pressure pain tolerance left 2.91 ± 1.33 compared to 2.32 ± 1.14 kg/cm², p = 0.04; maximum pressure pain tolerance center 2.51 ± 1.07 compared to 1.91 ± 0.91 kg/cm², p = 0.01; interval of pressure pain tolerance center 0.98 ± 0.62 compared to 0.59 ± 0.39 kg/cm², p = 0.00) on the first postoperative day were significantly lower in the “pit-picking” group compared to the excision group. Furthermore, no statistically significant correlation was found between VAS and pressure algometry measurements either before surgery or on the first postoperative day. Conclusions: In the early postoperative period following pilonidal disease surgery of varying extents, pain measured with the VAS does not differ. In contrast, the pressure algometry method showed greater pain in the minimally invasive surgery cohort on the first postoperative day. However, further larger studies are needed to compare these pain assessment methods in reporting pain intensity experienced during patient movement. Full article

Background and Objectives: To evaluate the effectiveness of an integral HAMMAM experience, a 4-week therapeutic program that combined hydrotherapy and Swedish massage, applied in a multisensorial immersive environment, on pain, well-being and quality of life (QoL) in women with endometriosis-related chronic pelvic pain that is unresponsive to conventional treatment. Materials and Methods: This randomized controlled trial included 44 women with endometriosis. They were randomly allocated to either the ‘HAMMAM’ group (n = 21) or to a control group (n = 23). The primary outcome, pain intensity, was evaluated using numeric rating scales (NRSs). The secondary outcomes were pain interference, pain-related catastrophic thoughts, pressure pain thresholds (PPTs), subjective well-being, functional capacity and QoL, which were evaluated using the brief pain inventory (BPI), the pain catastrophizing scale (PCS), algometry, the subjective well-being scale-20 (EBS-20), the Patient-Reported Outcomes Measurement Information System-29 (PROMIS-29) and the Endometriosis Health Profile-30 Questionnaire (EHP-30), respectively. The primary and secondary outcomes were measured at the baseline and after the intervention. The statistical (between-group analyses of covariance) and clinical effects were analyzed by the intention to treat. Results: The adherence rate was 100.0% and the mean (± standard deviation) satisfaction was 9.71 ± 0.46 out of 10. No remarkable health problems were reported during the trial. The ‘HAMMAM’ intervention improved dysmenorrhea and dyspareunia after the intervention with large and moderate effect sizes, respectively. Improvements in pain interference during sleep and PPTs in the pelvic region were also observed in women allocated to the ‘HAMMAM’ group. No effects were observed in catastrophizing thoughts, well-being nor QoL, except for the sleep subscale. Conclusions: A 4-week program of an integral ‘HAMMAM’ experience combining hydrotherapy and massage in a multisensorial immersive environment is a feasible and effective intervention to alleviate pain during menstruation and sexual intercourse as well as pain interference with sleep in women with endometriosis. Full article

Backgrounds: We aim to evaluate changes in pressure pain sensitivity before and after cardiac surgery using topographical sensitivity maps utilizing a pressure algometer. Methods: Pressure pain thresholds over 17 thoracic points and 4 distant pain-free points were assessed in 70 patients (women: 29, age: 67.5 years), before and at 1, 3, and 7 postoperative days. Thoracic topographical pressure pain sensitivity maps were calculated at all follow-ups. Postoperative pain was recorded at each follow-up on a numerical pain rate scale. Results: Postoperative pain intensity decreased from 6.4 (SD 1.0) on the first postoperative day to 5.5 (SD 1.9) on the third and to 4.5 (SD 1.7) on the seventh day (p < 0.001). The mixed-model ANOVA revealed that the lowest pressure pain thresholds were observed one day after surgery, increased slightly during follow-up, and were lower at the xiphoid process. Significant negative correlations between postoperative pain intensity and pressure pain thresholds were observed at each time point in thoracic measures (all, p < 0.01), but not with pressure pain thresholds from distant pain-free areas. Conclusions: Postoperative pain after cardiac surgery can be objectively quantified using algometry. Pressure pain hyperalgesia was associated with the intensity of postoperative pain. Full article

Background and Objectives: Chronic non-specific low back pain (CNLBP) persists beyond 12 weeks. Manual therapy recommended for CNLBP demonstrates short-term efficacy. Pain Neuroscience Education (PNE) teaches patients to modify pain perception through explanations, metaphors, and examples, targeting brain re-education. Motivational Interviewing (MI) enhances motivation for behavioral change, steering patients away from ambivalence and uncertainty. These approaches collectively address the multifaceted nature of CNLBP for effective management. The aim of this study was to investigate a manual therapy intervention combined with PNE with MI on pain, pressure pain threshold (PPT), disability, kinesiophobia, catastrophizing, and low back functional ability in individuals experiencing CNLBP. Materials and Methods: Sixty adults with CNLBP were randomly divided into three equal groups (each n = 20). The first group received manual therapy and PNE with integrated MI (combined therapy group), the second group underwent only manual therapy (manual therapy group), and the third group followed a general exercise program at home (control group). Pain in the last 24 h was assessed using the Numeric Pain Rating Scale (NPRS), functional ability with the Roland–Morris Disability Questionnaire (RMDQ), PPT in the lumbar region through pressure algometry, kinesiophobia with the Tampa Scale for Kinesiophobia (TSK), catastrophizing with the Pain Catastrophizing Scale (PCS), and performance using the Back Performance Scale (BPS) at baseline, in the fourth week, and six months post-intervention. Results: Statistically significant differences between the intervention groups and the control group were found in both the fourth-week measurement and the six-month follow-up, as evident in the NPRS and RMDQ scores, as well as in the total values of tested PPTs (p < 0.05). Differences were also observed between the two intervention groups, with a statistically greater improvement in the combined therapy group at both time points (fourth week and six-month follow-up) (p < 0.05). Regarding the TSK and PCS scores in the fourth week, statistically significant differences were observed between the two intervention groups compared to the control group, as well as between the two intervention groups (p < 0.05). However, in the six-month follow-up, statistically significant differences were found only between the combined therapy group and the other two groups, with the combined therapy group showing significant improvements (p < 0.05). In relation to BPS, both intervention groups exhibited statistically significant differences compared to the control group in the fourth week, without any significant differences between the two intervention groups. However, in the six-month follow-up, significant differences were noted between the combined therapy group and the other two groups (p < 0.05), with combined therapy demonstrating greater improvement. Conclusions: The addition of PNE with integrated MI enhanced the positive effects of a manual therapy intervention in all outcome measures. The combination of manual therapy plus PNE with integrated MI appeared to provide greater improvements compared to the isolated application of manual therapy, and these improvements also lasted longer. These short- and long-term positive effects are likely attributed to the combination of PNE with integrated MI, which contributed to increasing the effectiveness of the treatment. Further studies are required to investigate the optimum dosage of manual therapy and PNE with integrated MI in individuals with CNLBP. Full article