Background & Aims

Accurate evaluation of pericranial sensitivity is crucial for mitigating diagnostic errors and enhancing the interpretation of treatment effectiveness. The primary aim of this ongoing study is to compare the relative and absolute reliability between the following techniques employed in assessing pericranial sensitivity in healthy participants and tension-type headache (TTH) patients: manual palpation, palpation with the aid of a mechanical device (device-guided palpation) and pressure pain threshold (PPT).

Methods

Fifty healthy participants and 35 TTH patients are being evaluated in two sessions by a single examiner within an interval of one week. The primary outcome is the pericranial mechanical sensitivity assessed by means of manual palpation and the calculation of the total tenderness score (TTS); palpation with 0.5, 1, 2, and 4 kg loads (Palpeter); and PPT. The assessment sites are the frontal, temporal, masseter, and trapezius muscles and also the posterior region of the neck on both sides. The order of techniques and sites was randomized for each person. Intraclass correlation coefficient (ICC) and its 95% confidence interval (CI), standard error of measurement (SEM), the smallest detectable change (SDC), and correlation coefficients are being computed.

Results

So far only the healthy participants and 10 TTH patients completed the data collection and were analyzed. For the healthy participants, the TTS presented acceptable values of relative reliability considering the ICC 95% CI from 0.41 to 0.76. Moreover, the SEM and SDC were moderate considering the maximum TTS value. Overall, the device-guided palpation and the PPT presented good to excellent relative reliability considering the ICC 95% CIs from 0.66 to 0.94. In the TTH group, although all palpation methods presented good to excellent relative reliability values, the ICC 95% CIs were large, ranging from 0.06 to 0.97 for all methods. Further, the SEM and SDC values were higher for the TTH patients.

Conclusions

TTS seems an appropriate technique to be used in the clinical practice and in research investigations. Moreover, the device-guided palpation may be regarded as a reference standard owing to its exceptional reliability.

References

Costa YM, Ariji Y, Ferreira D, Bonjardim LR, Conti PCR, Ariji E, et al. Muscle hardness and masticatory myofascial pain: Assessment and clinical relevance. J Oral Rehabil 2018;45:640-646.
Castien RF, van der Wouden JC, De Hertogh W. Pressure pain thresholds over the cranio-cervical region in headache: a systematic review and meta-analysis. J Headache Pain 2018;19:9.
Kothari SF, Kothari M, Zambra RF, Baad-Hansen L, Svensson P. Standardization of muscle palpation- methodological considerations. Clin J Pain 2014;30:174-182.
de Vet HC, Terwee CB, Knol DL, Bouter LM. When to use agreement versus reliability measures. J Clin Epidemiol 2006;59:1033-1039.
Costa YM, de Araujo-Junior ENS, Fiedler LS, de Souza PRJ, Silva L, FerreiraD, et al. Reproducibility of quantitative sensory testing applied to musculoskeletal orofacial region: Site and sex differences. Eur J Pain 2019;23:81-90.

Presenting Author

Soraya Salmanzadeh Ardestani

Poster Authors

Soraya Ardestani

MSc

University of Campinas/Piracicaba Dental School

Lead Author

Leonardo Rigoldi Bonjardim

Bauru School of Dentistry, University of São Paulo

Lead Author

Fernando Exposto

Section of Orofacial Pain and Jaw Function, Aarhus University

Lead Author

Peter Svensson

DDS

Department of Dentistry and Oral Health, Aarhus University

Lead Author

Rigmor Højland Jensen

DDS

University of Copenhagen/Department of Clinical Medicine

Lead Author

Yuri Martins Costa

DDS, PhD

Department of Biosciences Piracicaba Dental School University of Campinas Piracicaba, São Paulo, Brazil

Lead Author

Topics

  • Specific Pain Conditions/Pain in Specific Populations: Orofacial Pain