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Evidence derived from knee OA patients suggests that central sensitisation is an important contributor to chronic OA pain, and a direct link between the level of sensitisation in referred areas and clinical pain intensity experienced by OA patients has been shown [ 41].
Sörensen et al. [ 60] found that fibromyalgic patients experienced stronger pain and larger referred areas after intramuscular injection of hypertonic saline.Moreover, spatial summation effect during increase of the stimulation area was found only in patients with FM and not in healthy controls or in patients with chronic low-back pain [ 61].
Temporal stimulation was found to be more pronounced and to cause stronger pain and larger referred areas in FM patients compared to controls [ 60].The increased efficacy of temporal summation in FM has even so been reproduced with cutaneous heat stimulation [ 55] and with cold and heat taps [ 59].
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On the other hand, in the referred area, an extraordinary amount of human and Pleistocene mammal footprints are registered.
If the splint area assumes a value nearly equal to 260 cm2, the clinician can adjust the size of the referred area to determine the portion.
The minimum requirement to be considered for the study was at least of 1 year of clinical experience in the referred area.
Significant differences in referred pain areas between groups (P < 0.001) and muscles (P < 0.001) were found: the referred pain areas were larger in CTTH children (P < 0.001), and the referred pain area elicited by suboccipital TrPs was larger than the referred pain from the remaining TrPs (P < 0.001).
The referred pain areas were drawn on anatomical maps, digitalized, and also measured.
Table 2 details the size of the referred pain areas in all the examined muscles.
Further, larger referred pain areas are also considered manifestation of central sensitization mechanisms [39].
Additionally, TrP referred pain areas were larger in children with CTTH than in healthy children.
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