Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 142 No. 3940 (2012)

The diagnostic value of measuring pressure pain perception in patients with diabetes mellitus

  • Tobias Wienemann
  • Ernst Adolf Chantelau
DOI
https://doi.org/10.4414/smw.2012.13682
Cite this as:
Swiss Med Wkly. 2012;142:w13682
Published
23.09.2012

Abstract

QUESTION UNDER STUDY: Repetitive skin trauma and reduced pressure pain sensation are necessary components of plantar ulcer risk in patients with diabetic neuropathy. The diagnostic value of measuring pressure nociception to detect ulcer risk is, however, unknown. Instead, measuring the vibration perception threshold (VPT) by 64 Hz graduated Rydel-Seiffer tuning fork has become standard clinical practice to screen for neuropathy and ulcer proneness. We therefore set up a diagnostic case-control study to compare the VPT, the cutaneous pressure pain perception threshold (CPPPT) and the deep pressure pain perception threshold (DPPPT) at the foot sole in diabetic patients with and without past or present painless plantar ulcer.

METHODS: A total of 68 patients were studied, 34 with active or previous plantar ulcer. VPT was measured by Rydel-Seiffer tuning fork at the 1st metatarsal head (≤4/8 grade indicating clinical neuropathy). CPPPT was measured at a toe skinfold by calibrated monofilaments. DPPPT was measured by Algometer II® over musculus hallucis longus and over a metatarsophalangeal joint.

RESULTS: The sensitivity and specificity to identify patients with present or past foot ulcer were as follows: 0.82 and 0.88 (VPT cut-off 1/8); 0.97 and 0.62(VPT cut-off 4/8); 0.93 and 0.77 (CPPPT cut-off 513 mN); 0.76 and 0.58 (DPPPT muscle, cut-off 545 kPa); 0.82 and 0.79 (DPPPT joint, cut-off 760 kPa).

CONCLUSION: Pressure algometry was not superior to measuring VPT for distinguishing between patients with and without painless plantar ulcers; VPT ≤1/8 was more efficient than ≤4/8 grade in identifying ulcer patients.

References

  1. Ziegler D, Mayer P, Wiefels K, Gries FA. Assessment of small and large fiber function in long-term type1 (insulin-dependent) diabetic patients with and without painful neuropathy. Pain. 1988;34:1–10.
  2. Krumova E K, Geber C, Westermann A, Maier C. Neuropathic pain: is quantitative sensory testing helpful? Curr Diab Rep. 2012;4:393–402.
  3. Liniger C, Albeanu A, Bloise D, Assal JP. The tuning fork revisited. Diabetic Med. 1990;7:859–64.
  4. Abbott CA, Vileikyte L, Williamson S, Carrington AL, Boulton AJ. Multicenter study of the incidence of and predictive risk factors for diabetic neuropathic foot ulceration. Diabetes Care. 1998;17:1071–6.
  5. Pham H, Armstrong DG, Harvey C, Harkless LB, Giurini JM, Veves A. Screening techniques to identify people at high risk for foot ulceration: a prospective multicenter trial. Diabetes Care. 2000;23:606–11.
  6. Young MJ, Veves A, Breddy JL, Boulton AJM. The prediction of diabetic neuropathic foot ulceration using vibration perception thresholds. Diabetes Care. 1994;17:557–60.
  7. Kanji KN, Anglin RES, Hunt DL, Panju A. Does this patient with diabetes have large-fiber peripheral neuropathy? JAMA. 2010;303:1526–32.
  8. Chantelau E, Abholz HH. Was ist gesichert in der Therapie des Typ-2 Diabetikers? Ein aktueller Überblick in vier Teilen. Teil I: Die Erkrankung. (Article in German). Z Allg Med. 2001;77:403–8.
  9. Rolke R, Magerl W, Andrews Campbell K, Schalber C, Caspari S, Birklein F, et al. Quantitative sensory testing: a comprehensive protocol for clinical trials. Eur J Pain. 2006;10:77–88.
  10. Jensen TS, Baron R, Haanpää M, Kalso E, Loeser JD, Rice ASC, et al. A new definition of neuropathic pain. Pain. 2011;152:2204–5.
  11. Wagner FW. Supplement: algorithms of foot care. In: Levin ME, O’Neal LW (eds.). The diabetic foot. 3rd Edition. St.Louis, Mosby,1983: p 291–302.
  12. Thye-Ronn P, Sindrup SH, Arendt-Nielsen L, Brennum J, Hother-Nielsen O, Beck-Nielsen H. Effect of short-term hyperglycemia per se on nociceptive and non-nociceptive thresholds. Pain. 1994;56:43–9.
  13. Damci T, Osar Z, Beyhan S, Ilkova H, Ozyazar M, Gorpe U, et al. Does instantaneous blood glucose affect vibration perception threshold measurement using biothesiometer? Diabetes Res Clin Pract. 1999;46:19–22.
  14. Rolke R, Baron R, Maier C, Tölle TR, Treede RD, Beyer A, et al. Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): Standardized protocol and reference values. Pain. 2006;123:231–43.
  15. Lambert GA, Mallos G, Zagami AS. Von Frey’s hairs – a review of their technology and use – a novel automated von Frey device for improved testing for hyperalgesia. J Neurosci Methods. 2009;177:420–6.
  16. Rolke R, Campbell KA, Magerl W, Treede RD. Deep pain thresholds in the distal limbs of healthy human subjects. Eur J Pain. 2005; 9:39–48.
  17. Geber C, Klein T, Azad S, Birklein F, Gierthmühlen J, Huge V, et al. Test-retest and interobserver reliability of quantitative sensory testing according to the protocol of the German Research Network on Neuropathic Pain (DFNS):A multi-centre study. Pain. 2011;152:548–56.
  18. Polianskis R, Graven-Nielsen T, Arendt-Nielsen L. Computer-controlled pneumatic pressure algometry- a new technique for quantitative sensory testing. Eur J Pain. 2001;5:267–77.
  19. Graven-Nielsen T, Mense S, Arendt-Nielsen L. Painful and non-painful pressure sensations from human skeletal muscle. Exp Brain Res. 2004;159;273–83.
  20. Schliessbach J, van der Klift E, Siegenthaler A, Arendt-Nielsen L, Curatolo M, Streitberger K. Does acupuncture needling induce analgesic effects comparable to diffuse noxious inhibitory controls? Evidence Based Complementary and Alternative Medicine. 2012; Article ID785613. doi:10.1155/2012/785613
  21. Le Quesne PM, Fowler CJ. A study of pain threshold in diabetics with neuropathic foot lesions. J Neurol Neurosurg Psychiatr. 1986;49:1191–4.
  22. Chantelau E, Wienemann T, Richter A. Pressure pain thresholds at the diabetic Charcot foot: an exploratory study. J Musculoskelet Neuronal Interact. 2012;12:95–101.
  23. Ylinen J. Pressure algometry. Austral J Physiother. 2007;53:207.
  24. Williams G, Gill JS, Aber V, Mather HM. Variability in vibration perception threshold among sites: a potential source of error in biothesiometry. Br Med J. 1988;296:233–5.