Pressure Pain Threshold Protocols With Pressure Algometer in Patients With Low Back Pain: A Systematic Review With Meta-Analysis

Objective: The pressure pain threshold is commonly employed to assess pain in various conditions. Despite its widespread use, the measurement of pressure pain thresholds is not consistently described across studies. Therefore, this review aimed to systematically examine the evidence regarding the assessment of pressure pain thresholds in patients with low back pain, including the protocols and body sites employed.

Methods: Six databases were systematically screened from their earliest records to May 2023 to identify studies utilizing pressure pain thresholds. Eligibility screening was conducted for the identified studies, and the included studies underwent appraisal using the appropriate tool corresponding to their study design.

Results: Upon categorizing based on the type of pain, we included 5 studies involving acute low back pain and 43 studies with chronic pain. The meta-analysis was conducted to compare subjects with and without pain, revealing no significant difference for the paraspinal region (SMD = -4.19, 95%CI = -11.7 to 3.32, z = -1.09, p = .27), piriformis (SMD = -1.24, 95%CI = -4.25 to 1.76, z = -0.81, p = .42) and quadratus lumborum musculature (SMD = -0.37, 95%CI = -1.35 to 0.60, z = -0.75, p = .45).

Conclusion: The paraspinal and gluteal musculature are the most frequently evaluated. Concerning the protocols for assessment, no consensus was identified. However, studies that assessed chronic low back pain typically adhered to a similar approach regarding the number of measures and a constant increase in pressure.