Vibration and rotation during biaxial pressure algometry is related with decreased and increased pain sensations

Abstract

Objective: During palpation, the pressure intensity and direction include minor deviations suggesting that standardized variations of the pressure intensity during pressure algometry may optimize the stimulus efficacy. This study examined the perceived pain outcome and reliability of a biaxial (bidirectional) algometer exerting rotational and vibratory stimulation on top of the basic pressure. Methods: In 24 healthy subjects, pressure pain thresholds (PPTs) were recorded with a linear pressure gradient (30kPa/s) applied by a 1-cm2 probe bilaterally on the tibialis anterior muscle via biaxial and handheld algometers. During constant pressure stimulation (5 seconds, 75%, 100%, 125% PPT), rotational (45°, 90°, and 180°), linear vibrational (15, 25, and 50Hz), and radial vibrational stimulations (5, 15, and 25Hz) were applied randomly via regular and fanning rounded probes (1cm2). Subjects rated perceived pain on a 10-cm visual analogue scale on two occasions separated by 1 week period. Results: Repeated measures analysis of variance revealed enhanced effect of rotation angle (P<0.001), probe (P<0.001), and radial vibration frequency (P<0.02), and suppressing effect of axial vibration frequency (P<0.03) on pain perception, relative to basic pressure alone. PPT reliability of biaxial and handheld algometers showed averaged intraclass correlation coefficient of 0.94 and 0.945, and coefficient of variations of 15.4 and 13.5%, respectively. Conclusions: PPT assessment and multidirectional stimulations can be exerted reliably via biaxial algometer. Linear vibrational stimulation effect on pressure pain perception verified the inhibitory interaction between simultaneous pressure stimulation of low-threshold mechanoreceptors and nociceptors, while radial vibration and rotational stimulation showed facilitatory effects.