Article
Comparison of pain characteristics reveals distinct differences between pain sensitivity of various deep fasciae
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Authors
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Aditya Vadgaonkar
- Medizinische Fakultät Mannheim der Universität Heidelberg, Orthopädisch-Unfallchirurgisches Zentrum, Universitätsmedizin Mannheim, Mannheim, Germany
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Emanuela Thalacker
- Medizinische Fakultät Mannheim der Universität Heidelberg, Neurophysiologie, Mannheim, Germany
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Sascha Gravius
- Medizinische Fakultät Mannheim der Universität Heidelberg, Orthopädisch-Unfallchirurgisches Zentrum, Universitätsmedizin Mannheim, Mannheim, Germany
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Andreas Schilder
- Medizinische Fakultät Mannheim der Universität Heidelberg, Orthopädisch-Unfallchirurgisches Zentrum, Universitätsmedizin Mannheim, Mannheim, Germany
| Published: | October 23, 2023 |
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Outline
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Objectives: The possible role of deep fasciae in the perception of pain has been confirmed by various studies. Existing histological research recognizes the presence of sensory nerves in fascia and thereby its contribution in conditions of chronic pain. In particular, deep fascial pain is expected to result from a combination of increased nerve density, sensitization of the nerves and chronic nociceptive stimulation, whether physical or chemical. The variation of in the density of nociceptive innervation of various fasciae is known but the differences in the characteristics of the pain evoked in these fasciae on stimulation has not been studied. This study aimed to investigate the differences in the intensity and the duration of pain on its induction with injection of hypertonic saline.
Methods: In separate sessions, 16 healthy subjects received ultrasound guided bolus injections of isotonic (0.9%) and hypertonic (5.8%) into the thoracolumbal, temporal, trapezius fasciae and iliotibial tract. Subjects were then asked to rate the intensity of pain (Numeric Rating Scale, NRS 0 to 100) over a period of 20 minutes. Peak pain was defined as the highest intensity of evoked pain. Significant differences in intensity and duration of the pain experienced were determined by one-way repeated-measures ANOVA.
Results and conclusion: The range of peak pain intensity for the study sample was between 12 and 95 on the NRS. The peak intensity of pain was highest for the temporalis fascia (59.94 ± 17.04) followed by the iliotibial tract (45.25 ± 13.34), thoracolumbal fascia (39.75 ± 17.75) and trapezius fascia (30.31 ± 12.45), p<0.001. Analysis of the duration of the persistence of pain revealed no statistically significant difference.
Deep fasciae are profusely innervated tissues containing nociceptors contributing to perception of pain in chronic conditions. However, neither are all deep fasciae equally sensitive to pain stimuli nor do they experience pain for the same duration after equal stimulation. Our results suggest that differences in the perceived intensity of pain on chemical or physical irritation of various fascia, such as during surgery or in myofascial pain syndrome may partially be due to their different characteristics.
