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JANUARY 31, 2024

Can Pressure Pain Thresholds Help Identify Effective Fibromyalgia Treatments?

Recently published data found that transcutaneous electrical nerve stimulation (TENS) can improve fibromyalgia patients’ pressure pain thresholds (PPT) even when they do not report an improvement in self-reported pain scores, indicating that PPT may be used to identify effective pain treatments for these patients. 

“Pressure pain thresholds may be used as a tool to track changes to TENS intervention over time,” study investigator Giovanni Berardi, DBT, PhD, a postdoctoral


Recently published data found that transcutaneous electrical nerve stimulation (TENS) can improve fibromyalgia patients’ pressure pain thresholds (PPT) even when they do not report an improvement in self-reported pain scores, indicating that PPT may be used to identify effective pain treatments for these patients. 

“Pressure pain thresholds may be used as a tool to track changes to TENS intervention over time,” study investigator Giovanni Berardi, DBT, PhD, a postdoctoral scholar at the Roy J. and Lucille A. Carver College of Medicine, in Iowa City, Iowa, told Pain Medicine News.

TENS helps relieve pain in people with fibromyalgia, reflected by post-treatment improvement in patients’ self-reported pain scores, according to researchers.

The phase 2, randomized, double-blind, placebo-controlled Fibromyalgia Activity Study with TENS included 228 female patients with fibromyalgia treated at the University of Iowa and Vanderbilt University Medical Center (J Pain 2023:S1526-5900[23]00653-3. doi:10.1016/j.jpain.2023.12.009). Participants were split into three groups: those receiving active TENS (n=76), placebo TENS (n=68) and no TENS (n=94). Each participant received their intervention for four weeks, and their resting pain, movement-evoked pain (MEP), PPT and conditioned pain modulation (CPM) were evaluated before and after treatment.

Although there were no significant changes in PPT or CPM after four weeks of treatment in any of the three groups, patients who reported clinically relevant improvements in MEP (≥30% decrease) demonstrated an increase in PPT that was statistically significant compared with those who did not report a clinically relevant improvement in MEP. The researchers reported that there was no clinically significant reduction in CPM recorded when comparing MEP responders and nonresponders.

“As clinicians start to utilize different assessments, pressure pain thresholds may be an (effective) novel way to measure patients’ response to fibromyalgia treatment, while CPM is not,” Berardi said.

The researchers concluded that although these measures may not relate to self-reported pain symptoms, PPT and CPM may provide insight to underlying mechanisms contributing to pain. 

—Myles Starr

Berardi reported no relevant financial disclosures.