Painful and non-painful pressure sensations from human skeletal muscle

Thomas Graven-Nielsen, Siegfried Mense, Lars Arendt-Nielsen

Painful and non-painful pressure sensations from muscle are generally accepted to exist but the peripheral neural correlate has not been clarified. The aim of the present human study was to assess the non-painful and painful pressure sensitivity with (1) anaesthetised skin, and (2) anaesthetised skin combined with a block of large diameter muscle afferents. The skin was anaesthetised by a topically applied anaesthetic cream and later lidocaine was administrated subcutaneously. The pressure sensitivity was assessed quantitatively by computer-controlled pressure stimulation on the anterior tibial muscle. Thresholds to detection, pain and pain tolerance were assessed. In the first experiment, computer-controlled needle insertion depths evoking touch and pain sensations were used to assess the efficacy of cutaneous anaesthesia. Touch and pain sensations evoked during needle insertions were found to be superficial in intact skin but when anaesthetised, touch sensation was occasionally evoked at depths related to penetration of the fascia. With the skin completely anaesthetised to brush and von Frey hair pinprick stimulation, skin indentation with the strongest von Frey hair caused a sensation described as a deep touch sensation. Simultaneously, pressure detection and pain thresholds increased but it was still possible to elicit non-painful and painful pressure sensation in all subjects. In a second experiment, a differential nerve block of group I and II afferent fibres was obtained by full-leg ischaemia simultaneously with cutaneous anaesthesia. The efficacy of the tourniquet block was continuously assessed by a battery of somatosensory tests (heat, brush, vibration, electrical and movement detection) applied at the foot simultaneously with pressure stimulation on the anterior tibial muscle. After 20 min of ischaemia, group II afferent fibres mediating the sensations of movement detection, vibration and brush on the foot was blocked but the heat pain threshold was not affected. In this condition (anaesthetised skin and block of group I and II fibres from deep tissue) a pressure sensation was evoked in 70% of subjects although the pressure detection threshold was increased. The pressure pain sensitivity was decreased, which, however, might indicate a partial block of group III and IV muscle afferents. In a third experiment, the tactile sensations elicited by electrical stimulation of the tibialis anterior muscle and skin at the lower leg were significantly decreased after 20 min of ischaemia, validating the blocking effects of group I and II nerve fibres. The present data show a marginal contribution of cutaneous afferents to the pressure pain sensation that, however, is relatively more dependent on contributions from deep tissue group III and IV afferents. Moreover, a pressure sensation can be elicited from deep tissue probably mediated by group III and IV afferents involving low-threshold mechanoreceptors.