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Modulation of pressure pain thresholds during & following isometric contraction in patients with fibromyalgia (FM) & in healthy controls

  [ 12 votes ]   [ Discuss This Article ] • March 15, 1996

This study aimed at evaluating the influence of submaximal
isometric contraction on pressure pain thresholds (PPTs) in 14
fibromyalgia (FM) patients and 14 healthy volunteers, before
and after skin hypoesthesia. PPTs were determined with
pressure algometry over m. quadriceps femoris before, during
and following an isometric contraction. Maximum voluntary
contraction (MVC) was assessed using a computerized
dynamometer. A contraction of 22% MVC on average was held
until exhaustion (max. 5 min) and PPTs were assessed every 30
sec. A local anesthetic cream and a control cream were
applied following a double-blind design and PPTs were
reassessed. In healthy volunteers PPTs increased during
contraction (P < 0.001), then decreased after the end of
contraction (P < 0.001) but remained above precontraction
values during the 5 min of post-contraction assessments (P <
0.001). In FM patients PPTs decreased in the middle of the
contraction period (P < 0.05) and remained below
precontraction levels during the rest of the contraction
period (P < 0.05) and during the 5 min of post-contraction
assessment (immediately post-contraction NS; 2.5 min
post-contraction P < 0.01; 5 min post-contraction P < 0.05).
The normalized PPTs were significantly lower in patients than
in controls during contraction (start P < 0.01; middle P <
0.001; end P < 0.001) and at all times during post-contraction
assessments (P < 0.001). Anesthetic cream raised PPTs at rest
in controls (P < 0.01) but not in FM patients, and did not
influence contraction or post-contraction PPTs in either
group. Therefore, the increased pressure pain sensibility in
FM patients is more pronounced deep to the skin. The observed
decrease of PPTs during isometric contraction in FM patients
could be due to sensitization of mechanonociceptors caused by
muscle ischemia and/or dysfunction in pain modulation during
muscle contraction.

Kosek E, Ekholm J, Hansson P

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