From the Guidelines
To increase the pressure pain threshold in patients, a multimodal approach combining physical interventions, psychological techniques, and appropriate medications is recommended, with a focus on graded exercise therapy, manual therapy techniques, and cognitive behavioral therapy, as supported by the most recent and highest quality study 1. The goal of treatment is to restore function and improve quality of life, and a holistic approach is essential in achieving this goal. According to the 2022 CDC clinical practice guideline for prescribing opioids for pain 1, noninvasive nonpharmacologic approaches, including physical therapy, weight loss for knee osteoarthritis, and behavioral therapies, can improve pain and function without risk for serious harms. Some key methods to increase the pressure pain threshold include:
- Graded exercise therapy, which can help promote desensitization to pressure stimuli
- Manual therapy techniques, such as myofascial release and joint mobilization, applied progressively to sensitive areas
- Cognitive behavioral therapy focused on pain neuroscience education, which can help patients understand pain mechanisms and develop adaptive coping strategies
- Relaxation techniques, including diaphragmatic breathing, progressive muscle relaxation, and mindfulness meditation, to reduce overall nervous system sensitization These approaches work by modulating central pain processing pathways, reducing inflammatory mediators, activating descending pain inhibitory systems, and addressing the neuroplastic changes that maintain heightened pain sensitivity. Regular reassessment using pressure algometry or similar tools will help track progress and guide treatment adjustments, as recommended by the 2017 HIVMA of IDSA clinical practice guideline for the management of chronic pain in patients living with HIV 1. It is essential to note that access and cost can be barriers for patients, particularly those with low incomes or inadequate insurance, and health insurers and health systems can improve pain management by increasing reimbursement for and access to noninvasive nonpharmacologic therapies with evidence for effectiveness 1.
From the Research
Methods to Increase Pressure Pain Threshold (PPT)
There are several methods that can be used to increase the pressure pain threshold (PPT) in patients, including:
- Bowen therapy: A study found that Bowen therapy had a significant increase in pressure pain thresholds at two out of ten body sites in healthy subjects 2
- Exercise and physical activity: Although not directly mentioned in the provided studies, exercise and physical activity can help increase PPT by reducing pain sensitivity and improving overall physical function
- Postural correction and body awareness: A study found that scapular position had a strong influence on PPT, suggesting that postural correction and body awareness may help increase PPT 3
- Pain management techniques: Techniques such as conditioned pain modulation (CPM) may help increase PPT by reducing pain sensitivity 4
Factors that Influence PPT
Several factors can influence PPT, including:
- Gender: Studies have found that gender can influence PPT, with women generally having lower PPT than men 3, 5
- Age: Age may also influence PPT, although the evidence is weak and conflicting 3
- Body mass index (BMI): BMI may not influence PPT, although the evidence is limited and conflicting 3
- Hormone levels and menstrual phase: Hormone levels and menstrual phase may influence PPT in women, although the evidence is limited and conflicting 6, 5
- Medications and medical conditions: Certain medications and medical conditions, such as fibromyalgia, can influence PPT 5, 4
Measurement and Reliability of PPT
PPT can be measured using a variety of techniques, including pressure algometry and electronic algometry. The reliability of PPT measurements can vary depending on the technique used and the population being studied. A study found that PPT measurements had excellent intra-rater reliability and moderate to good inter-rater reliability in patients with chronic shoulder pain 4. Another study found that the pressure algometer was an effective tool for determining the source of orofacial pain, but that additional factors should be considered when evaluating PPT, including body symmetry and posture, hormone levels, and the use of medications 6.