Clinical Rheumatology

, Volume 8, Issue 4, pp 467–474

Measurement of pain threshold in patients with rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, and healthy controls

  • E. M. Gerecz-Simon
  • E. R. Tunks
  • J. -A. Heale
  • W. F. Kean
  • W. W. Buchanan


Pain threshold was measured using a pressure algometer in 126 subjects, of whom 54 were females and 72 males. These subjects included 18 males and 18 females with rheumatoid arthritis, 18 males and 18 females with osteoarthritis, 18 males with ankylosing spondylitis, and 18 male and 18 female healthy control volunteers. Six points were studied on each side of the body: 2 cm above the eyebrow on the forehead, lateral aspect of the arm at the insertion of the deltoid muscle, midpoint of the ulna, hypothenar eminence in the palm, midpoint of the quadriceps muscle, and midpoint of the anteromedial aspect of the tibia. None of these points corresponded to the “trigger” points in fibromyalgia. The pain threshold was statistically significantly higher in patients with ankylosing spondylitis than in patients with osteoarthritis, and these in turn were statistically higher than in the normal subjects. Patients with rheumatoid arthritis had significantly lower pain thresholds than the normal subjects. No laterality in pain threshold was identified, but females had in general a lower pain threshold.

Key words

Pain Threshold Pressure Algometer Rheumatoid Arthritis Ankylosing Spondylitis Osteoarthritis 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Chapman, C., Casey, K., Bubner, R., Foley, K., Gracely, R., Reading, A. Pain measurement: an overview. Pain 1985, 22, 1–31.PubMedGoogle Scholar
  2. 2.
    Beecher, W.H. The measurement of pain. Pharmacol Rev 1957, 9, 59–209.PubMedGoogle Scholar
  3. 3.
    Orloff, S. Pain tolerance threshold and pain perception threshold: Clinical and experimental studies. Clin Rheum Dis 1979, 5, 755–773.Google Scholar
  4. 4.
    Bird, H.A., Dixon, J.S. The measurement of pain. Bailliere's Clin Rheumatol 1987, 1, 71–89.Google Scholar
  5. 5.
    Keele, K.D., Pain sensitivity tests: the pressure algometer. Lancet 1954, ii, 636–639.Google Scholar
  6. 6.
    Mersky, H., Spear, F.G. The reliability of the pressure algometer. Br J Soc Clin Psychol 1964, 3, 130–136.Google Scholar
  7. 7.
    McCarty, D.J., Gatter, R.A., Phelps, P. A dolorimeter for quantification of articular tenderness. Arthritis Rheum 1965, 8, 551–559.Google Scholar
  8. 8.
    Huskisson, E.C., Hart, D.F. Pain threshold and arthritis. Br Med J 1972, 4, 193–196.PubMedGoogle Scholar
  9. 9.
    Wolff, B.B. Methods of testing pain mechanisms in normal man. In: Textbook of Pain. Editors: Wall, P.D., Melzak, R., New York. Churchill-Livingston, 1984, 186–194.Google Scholar
  10. 10.
    Reeves, J.L., Jaeger, B., Graff-Radford, S.B. Reliability of the pressure algometer as measure of myofascial trigger point sensitivity. Pain, 1986, 24, 313–321.PubMedGoogle Scholar
  11. 11.
    Fischer, A.A. Pressure algometry over normal muscles. Standard values, validity and reproducibility of pressure threshold. Pain 1987, 30, 115–126.PubMedGoogle Scholar
  12. 12.
    Buchanan, H.M., Midgley, J.A. Evaluation of pain threshold using a simple pressure algometer. Clin Rheumatol 1987, 6, 4, 510–517.PubMedGoogle Scholar
  13. 13.
    Tunks, E., Crook, J., Norman, G., and Kalaher, S. Trigger points and tenderness in fibromyalgia. Pain, 1988, 34, 11–19.PubMedGoogle Scholar
  14. 14.
    Ropes, M.W., Bennett, G.A., Cobb, S., Jacox, R., Jessar, R.A. 1958 Revision of diagnostic criteria for rheumatoid arthritis. Arthritis Rheum 1959, 2, 16–20.PubMedGoogle Scholar
  15. 15.
    Altman, R., Asch, E., Bloch, D., Bole, G., Borenstein, D., Brandt, K., Christy, W., Cooke, T.D., Greenwald, R., Hochberg, M., Howell, D., Kooman, W., Longley, S. III, Mankin, H., McShane, D.J., Medsger, T.Jr., Meenan, R., Mikkelsen, W., Moskowitz, R., Murphy, W., Rothschild, B., Segal, M., Sokoloff, L., Wolfe, F. Development of criteria for the classicication and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Arthritis Rheum 1986, 29, 1039–1049.PubMedGoogle Scholar
  16. 16.
    Kelgren, J.H. Diagnostic criteria for population studies. Bull Rheum Dis 1962, 13, 291–292.PubMedGoogle Scholar
  17. 17.
    Keele, K.D. Pain complaint threshold in relation to pain of cardiac infarction. Br Med J 1968, 1, 670–673.PubMedGoogle Scholar
  18. 18.
    O'Driscoll, S.L., Jayson, M.I. Pain threshold analysis in patients with osteoarthritis of the hip. Br Med J 1974, IV, 714–716.Google Scholar
  19. 19.
    Wolff, B.B., Jarvik, M.E. Relationship between superficial and deep somatic thresholds of pain with a note on handedness. Am J Psychol 1964, 77, 589–599.PubMedGoogle Scholar
  20. 20.
    McGrath, P.A. et al. Non-pain and pain sensations evoked by tooth-pulp stimulation. Pain 1983, 15, 377–388.PubMedGoogle Scholar
  21. 21.
    Chapman, W.P., Jones, C.M. Variations in cutaneous and visceral pain sensitivity in normal subjects. J Clin Invest 1944, 23, 81–91.Google Scholar
  22. 22.
    Blitz, B., Dianerstein, A.J. Effects of different types of instructions on pain parameters. J Abnorm Psychol 1968, 73, 276–280.PubMedGoogle Scholar
  23. 23.
    Huskisson, E.C. The treatment of chronic pain. Editor: Hart, F.D. Medical and Technical Publishing Co. 1973, 15–16.Google Scholar
  24. 24.
    Neri, M., Agarzain, E. Aging and right-left assymetry in experimental pain measurement. Pain 1984, 19, 43–48.PubMedGoogle Scholar

Copyright information

© Springer-Verlag 1989

Authors and Affiliations

  • E. M. Gerecz-Simon
    • 1
  • E. R. Tunks
    • 1
  • J. -A. Heale
    • 1
  • W. F. Kean
    • 1
  • W. W. Buchanan
    • 1
  1. 1.Department of Rheumatology-McMaster University Medical Centre and Laboratories for Inorganic MedicineMcMaster UniversityHamiltonCanada

Personalised recommendations