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Intra- and interrater agreement of pressure pain thresholds in children with orthopedic disorders

  • Original Clinical Article
  • Published:
Journal of Children's Orthopaedics

Abstract

Purpose

Pressure algometry is widely used to obtain measures of mechanical pain sensitivity in adults, both in experimental and clinical pain conditions. Only very few studies describe the use of pressure algometry in children. The purpose of this study was to produce reference values of pressure pain thresholds and to determine the intra- and interrater agreement, in order to introduce pressure algometry as a standardized method for the assessment of pain thresholds in children with orthopedic disorders.

Methods

Pressure pain thresholds were determined at the leg and at the thenar in 50 children aged 4–12 years. All were scheduled for physical examination at the outpatient Orthopedic Clinic at Aarhus University Hospital, Denmark, because of various orthopedic disorders such as clubfoot and Baker’s cyst. Pressure pain thresholds were determined by two different raters: 20 children were examined twice by rater 1 (intrarater agreement), and another 20 children were examined by both rater 1 and rater 2 (interrater agreement). An additional ten children were examined once by rater 1 to increase the number of children used to determine the reference values.

Results

The pressure pain threshold was 183.1 kPa (mean, SD: 90.7) at the leg and 179.1 kPa (mean, SD: 97.4 kPa) at the thenar (n = 50). Pressure pain thresholds were similar in boys (n = 27) and girls (n = 23). Also, pressure pain thresholds were not affected by age. Bland–Altman plots showed excellent intrarater agreement and satisfactory interrater agreement.

Conclusion

Pressure algometry has excellent intrarater agreement and satisfactory interrater agreement. Pressure algometry was well-tolerated even by very young children. The method deserves more widespread use both in clinical and experimental settings.

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References

  1. Rolke R, Baron R, Maier C, Tolle TR, Treede RD, Beyer A, Binder A, Birbaumer N, Birklein F, Botefur IC, Braune S, Flor H, Huge V, Klug R, Landwehrmeyer GB, Magerl W, Maihofner C, Rolko C, Schaub C, Scherens A, Sprenger T, Valet M, Wasserka B (2006) Quantitative sensory testing in the German research network on neuropathic pain (DFNS): standardized protocol and reference values. Pain 123:231–243

    Article  CAS  Google Scholar 

  2. Arendt-Nielsen L, Nie H, Laursen MB, Laursen BS, Madeleine P, Simonsen OH, Graven-Nielsen T (2010) Sensitization in patients with painful knee osteoarthritis. Pain 149:573–581

    Article  Google Scholar 

  3. Kosek E, Ekholm J, Hansson P (1996) Sensory dysfunction in fibromyalgia patients with implications for pathogenic mechanisms. Pain 68:375–383

    Article  CAS  Google Scholar 

  4. Baad-Hansen L, Leijon G, Svensson P, List T (2008) Comparison of clinical findings and psychosocial factors in patients with atypical odontalgia and temporomandibular disorders. J Orofac Pain 22:7–14

    Google Scholar 

  5. Kasch H, Qerama E, Kongsted A, Bach FW, Bendix T, Jensen TS (2008) Deep muscle pain, tender points and recovery in acute whiplash patients: a 1-year follow-up study. Pain 140:65–73

    Article  Google Scholar 

  6. Hashkes PJ, Friedland O, Jaber L, Cohen HA, Wolach B, Uziel Y (2004) Decreased pain threshold in children with growing pains. J Rheumatol 31:610–613

    Google Scholar 

  7. Uziel Y, Chapnick G, Jaber L, Nemet D, Hashkes PJ (2010) Five-year outcome of children with “growing pains”: correlations with pain threshold. J Pediatr 156:838–840

    Article  Google Scholar 

  8. Fernandez-Mayoralas DM, Fernandez-de-las-Penas C, Ortega-Santiago R, Ambite-Quesada S, Jimenez-Garcia R, Fernandez-Jaen A (2010) Generalized mechanical nerve pain hypersensitivity in children with episodic tension-type headache. Pediatrics 126:187–194

    Article  Google Scholar 

  9. Hogeweg JA, Kuis W, Oostendorp RA, Helders PJ (1996) The influence of site of stimulation, age, and gender on pain threshold in healthy children. Phys Ther 76:1331–1339

    CAS  Google Scholar 

  10. Chaves TC, Nagamine HM, de Sousa LM, de Oliveira AS, Grossi DB (2007) 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 21:133–142

    Google Scholar 

  11. Chaves TC, Nagamine HM, de Sousa LM, de Oliveira AS, Grossi DB (2010) Comparison between the reliability levels of manual palpation and pressure pain threshold in children who reported orofacial pain. Manual therapy 15:508–512

    Article  Google Scholar 

  12. Ohrbach R, Gale EN (1989) Pressure pain thresholds, clinical assessment, and differential diagnosis: reliability and validity in patients with myogenic pain. Pain 39:157–169

    Article  CAS  Google Scholar 

  13. Chung SC, Kim JH, Kim HS (1993) Reliability and validity of the pressure pain thresholds (PPT) in the TMJ capsules by electronic algometer. Cranio 11:171–176

    CAS  Google Scholar 

  14. Antonaci F, Sand T, Lucas GA (1998) Pressure algometry in healthy subjects: inter-examiner variability. Scand J Rehabil Med 30:3–8

    Article  CAS  Google Scholar 

  15. Chesterton LS, Sim J, Wright CC, Foster NE, Chesterton LS, Barlas P, Foster NE, Baxter GD, Wright CC (2007) Interrater reliability of algometry in measuring pressure pain thresholds in healthy humans, using multiple raters. Clin J Pain 23:760–766

    Article  Google Scholar 

  16. Meeus M, Roussel NA, Truijen S et al (2010) Reduced pressure pain threshold in response to exercise in chronic fatigue syndrome but not in chronic low back pain: An experimental study. J Rehabil Med 42:884–890

    Article  Google Scholar 

  17. Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1:307–310

    Article  CAS  Google Scholar 

  18. Persson AL, Brogardh C, Sjolund BH (2004) Tender or not tender: test–retest repeatability of pressure pain thresholds in the trapezius and deltoid muscles of healthy women. J Rehabil Med 36:17–27

    Article  Google Scholar 

  19. Kallai I, Barke A, Voss U (2004) The effects of experimenter characteristics on pain reports in women and men. Pain 112:142–147

    Article  Google Scholar 

  20. Aslaksen PM, Myrbakk IN, Hoifodt RS, Flaten MA (2007) The effect of experimenter gender on autonomic and subjective responses to pain stimuli. Pain 129:260–268

    Article  Google Scholar 

  21. Lautenbacher S, Kunz M, Strate P, Nielsen J, Arendt-Nielsen L (2005) Age effects on pain thresholds, temporal summation and spatial summation of heat and pressure pain. Pain 115:410–418

    Article  Google Scholar 

  22. Chesterton LS, Barlas P, Foster NE, Baxter GD, Wright CC (2003) Gender differences in pressure pain threshold in healthy humans. Pain 101:259–266

    Article  Google Scholar 

  23. Goubert L, Vervoort T, Cano A, Crombez G (2009) Catastrophizing about their children`s pain is related to higher parent–child congruency in pain ratings: an experimental investigation. Eur J Pain 13:196–201

    Article  CAS  Google Scholar 

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Acknowledgments

This work was supported in part by a grant from Agustinus Fonden.

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Authors and Affiliations

  1. Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark

    Lone Nikolajsen & Anders D. Kristensen

  2. Danish Pain Research Center, Aarhus University Hospital, Norrebrogade 44, Building 1A, 8000, Aarhus C, Denmark

    Lone Nikolajsen, Anders D. Kristensen & Troels S. Jensen

  3. Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark

    Line K. Pedersen, Ole Rahbek & Bjarne Møller-Madsen

  4. Orthopedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark

    Line K. Pedersen, Ole Rahbek & Bjarne Møller-Madsen

Authors
  1. Lone Nikolajsen
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  2. Anders D. Kristensen
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  3. Line K. Pedersen
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  4. Ole Rahbek
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  5. Troels S. Jensen
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  6. Bjarne Møller-Madsen
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Correspondence to Lone Nikolajsen.

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Nikolajsen, L., Kristensen, A.D., Pedersen, L.K. et al. Intra- and interrater agreement of pressure pain thresholds in children with orthopedic disorders. J Child Orthop 5, 173–178 (2011). https://doi.org/10.1007/s11832-011-0336-4

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  • DOI: https://doi.org/10.1007/s11832-011-0336-4

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