WHAT IS HYPERBARALGESIA? - MEDICINE - 2025

Called hiperbaralgesia to the pain caused by a tactile stimulus (pressure) in some region of the body, which should not cause pain under normal conditions. A frequent example is evident in the physical examination, especially in terms of palpation and abdominal percussion.

The palpation method is used by doctors to explore the abdominal area. Through this, the treating physician can determine cases of peritoneal irritation, areas of hyperesthesia and hyperbaralgesia, muscle rigidity, among other elements.

Hyperesthesia, hyperalgesia, and hyperbaralgesia

Although they are terms used by treating physicians in diagnosis to define the reaction to a stimulus, for the common denominator of people they can have the same connotation. However, there are substantial differences between them:

Hyperesthesia

It can be defined as an increase in tactile sensitivity that can cause pain. This is generally present in the different modalities of skin sensitivity: tactile and thermal sensation.

Hyperalgesia

It is the lowering of the perceptual threshold for painful stimuli that causes a facilitation in the production of pain.

That is, the threshold is considerably reduced and it becomes extremely easy to overcome it, producing pain with stimuli that would not normally produce it.

The causes of hyperalgesia can be due to lesions in the nociceptors or local lesions that provoke inflammatory responses.

Hyperbaralgesia

It can be defined as a type of hyperalgesia. It is evidenced by the application of pressure at points that under normal conditions should not hurt when applying pressure.

The decrease in the pain threshold is in this case due to pressure and can be due to multiple causes; most of these can be explained according to the location of the pain.

There is little documented information on hyperbaralgesia, since it is normally studied as hyperalgesia, although it is pain on palpation, percussion and / or compression.

The 6 main pathologies associated with hyperbaralgesia

The presence of hyperbaralgesia is generally present in severe pictures of abdominal distention, ischemia and irritation, thus being able to determine certain etiologies in the patient:

1- Acute pyelonephritis

On the abdominal physical examination, probable acute pyelonephritis can be diagnosed through a maneuver called renal fist percussion.

This maneuver consists of identifying pain with a light blow with the fist in the lateral lumbar region of the affected side.

When there is hyperbaralgesia - that is, if there is pyelonephritis - it is called positive fist percussion. If, on the other hand, there is no hyperbaralgesia, it is called negative fist percussion and means that the kidney is not obstructed.

2- Acute cholecystitis

In inflammation of the gallbladder and its ducts, hyperbaralgesia is located mainly at the cystic point, located at the junction of the right costal ridge with the outer edge of the rectus muscle.

It is basically one of the main criteria for the clinical diagnosis of acute cholecystitis.

3- Acute appendicitis

In acute appendicitis, the abdomen is irritated and painful on deep palpation, mainly at the appendicular point or McBurney's point.

The McBurney point is located at the junction of the middle third with the distal third, of an imaginary line that is drawn between the umbilical scar and the anterior superior iliac spine.

It is the point of greatest compression pain in acute appendicitis. If there is pain to compression and / or decompression of the McBurney point, it is called positive McBurney. On the contrary, if there is no pain it is called negative McBurney.

When there is any complication and the appendicitis evolves into peritonitis, the hyperbaralgesia extends to the entire abdomen.

4- Muscle contractures

In muscle contractures the simple movement is painful, radiating to the entire affected muscle.

However, with acupressure the pain increases considerably. This makes it possible to evaluate, by compressing the muscle, the area of ​​greatest contraction of its fibers.

5- Sacroiliitis

To diagnose sacroiliitis, acupressure of the sacroiliac point is carried out, which is located immediately below the posterior superior iliac spine and is explored by pressing with the thumb until the nail pales.

This point is evaluated with the patient lying on the abdomen and positioned transversely on the table or in the lateral decubitus position.

The sacroiliac point is the point of choice for puncture of the joint if necessary.

6- Intercostal neuritis

Intercostal neuritis is acute pain that results from compression of the intercostal nerves by the intercostal muscles and is generated after doing some physical effort.

According to its location, it is usually confused with some other thoracic pathology, acute myocardial infarction, pleural effusion, acute respiratory infections, among other conditions.

The main difference between neuritis and other pathologies is that neuritis is greatly exacerbated by acupressure of the intercostal space whose nerve is involved.

References

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2. Global year againts neuropathic pain. 2014-2015 International Association for the Study of Pain. Recovered from: s3.amazonaws.com
3. Alvarez. Medical Semiology Physiopathology, Semiotechnics and Propedeutics. Teaching based on the patient. Editorial Panamericana. Buenos Aires. Argentina. 2011. Pain. P. 59-71.
4. Cerecedo, V. (2003)._ Clinical history: didactic methodology. Panamerican Medical Ed. Catholic University of Chile.
5. Dagnino, (1994)._ Definitions and classifications of pain._ Bulletin of the medical school. Taken from publicationsmedicina.uc.cl