title: Effects of adipose thickness and muscle hardness on pressure pain sensitivity.
abstract: OBJECTIVE
  Pressure algometry is used for assessment of pain sensitivity. In this study the relation between tissue characteristics and pressure pain thresholds was investigated.
  
  
  METHODS
  Three-dimensional finite-element computer-models were developed to simulate the tissue stress and strain distribution during pressure stimulation on muscles with different hardness (I, II, III, IV (hardest)) and subcutaneous adipose tissue thickness (normal and thicker). The computer model was validated based on data recorded by computer-controlled pressure-induced muscle pain in 8 and 16 partecipants, respectively.
  
  
  RESULTS
  The experimental pressure-indentation curve fitted the outcome of the FE model (R>0.73). Stress and strain were extracted from the models at a known painful pressure stimulation level. PPT and PPTO were not significantly different in subjects with normal and thick adipose tissue in accordance with the simulation model where the strain in muscle tissue was comparable in the two conditions. The strain in adipose tissue was larger in subjects with thick adipose tissue compared with normal adipose thickness. In relaxed muscle (hardness I) the principal strain peaked at 0.12 in the adipose tissue, was reduced to 0.07 in the muscle tissue and 0.05 in the harder muscle. Significantly higher PPT and PPTO were recorded in harder compared with softer muscles (P<0.02).
  
  
  CONCLUSIONS
  The pressure pain sensitivity of the deep layer is related to the amount of muscle strain, which is affected by the muscle hardness and the thickness of adipose tissue. This is clinically relevant as these two factors are not taken into consideration when pressure pain assessments are performed in clinical routine.
authors.affiliation: Laboratory for Musculoskeletal Pain and Motor Control, Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7D-3, Aalborg, Denmark.
authors.forename: Sara
authors.initials: S
authors.lastname: Finocchietti
authors.forename: Carsten Dahl
authors.initials: CD
authors.lastname: Mørch
authors.forename: Lars
authors.initials: L
authors.lastname: Arendt-Nielsen
authors.forename: Thomas
authors.initials: T
authors.lastname: Graven-Nielsen
mesh_terms: D000273:Adipose Tissue / Q000503:physiopathology*; D000328:Adult; D000818:Animals; D003198:Computer Simulation; D055119:Elastic Modulus; D005260:Female; D006244:Hardness; D006801:Humans; D006930:Hyperalgesia / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008954:Models, Biological; D018482:Muscle, Skeletal / Q000503:physiopathology*; D010146:Pain / Q000150:complications / Q000503:physiopathology*; D011312:Pressure; D014110:Touch