Abstract
Our aim was to quantify spatial differences in pressure and thermal pain sensitivity
maps between patients with unilateral lateral epicondylalgia (LE) and age- and sex-matched
controls. Pressure (PPT), cold (CPT), and heat (HPT) pain thresholds were assessed
over 12 points forming a 3 × 4 matrix (4 points in the superior part, 4 points in
the middle, and 4 points in the lower part around the lateral epicondyle) bilaterally
in 16 subjects with strictly unilateral LE and 16 age- and sex-matched controls in
a blinded design. Topographical pain sensitivity maps to pressure and thermal stimulation
over the elbow in patients with LE and healthy controls were calculated. A multilevel
3-way ANCOVA test was applied to detect differences in topographical maps between
groups. Subjects with LE showed bilateral lower PPT, higher CPT (pain at higher temperature)
and lower HPT (pain at lower temperature) at all the measurement points as compared
to controls (all, P < .01). PPT were lower at points over the extensor carpi radialis brevis (ECRB) muscle
as compared to points over the extensor digitorum communis muscle (P < .01) and over the extensor carpi ulnaris muscle (P < .001). CPT and HPT were not significantly different between points (P > .05). Topographical pressure and thermal pain sensitivity maps revealed bilateral
hyperalgesia in patients with strictly unilateral LE. LE patients exhibited heterogeneously
distributed pressure pain hyperalgesia while cold or heat maps were homogenous. The
most sensitive localizations for PPT assessment corresponded to the muscle belly of
the ECRB. Our results confirm the role of ECRB muscle in LE and argue for evidence
of peripheral and central sensitization mechanisms in patients with strictly unilateral
symptoms.
Perspective
Topographical pressure and thermal sensitivity maps revealed bilateral hyperalgesia
in patients with strictly unilateral lateral epicondylalgia (LE). LE patients exhibited
heterogeneously distributed pressure pain hyperalgesia while cold or heat pain maps
were homogenous. The most sensitive localizations for PPT assessment corresponded
to the muscle belly of the ECRB.
Key words
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References
- In vivo investigation of ECRB tendons with microdialysis technique: No signs of inflammation but high amounts of glutamate in tennis elbow.Acta Orthop Scand. 2000; 71: 475-479
- The relationship of anticipated pain and fear avoidance beliefs to outcome in patients with chronic low back pain who are not receiving workers’ compensation.Spine. 2005; 30: 1051-1057
- Pressure pain sensitivity and hardness along human normal and sensitized muscle.Somatosens Mot Res. 2006; 23: 97-109
- Sensory innervation of the Achilles tendon by group III and IV afferent fibers.Anat Embryol (Berl). 1985; 172: 145-156
- Quantitative and qualitative perceptual analysis of cold dysesthesia and hyperalgesia in fibromyalgia.Pain. 2002; 96: 177-187
- Pressure pain sensitivity maps of the neck-shoulder and the low back regions in males and females.BMC Musculoskeletal Disorders. 2010; 11: 234
Binderup AT, Arendt-Nielsen L, Madeleine P: Pressure pain threshold mapping: A new imaging modality of muscle sensitivity to pain. 2008 Annual Ieee Student Paper Conference 126-129, 2008
- The influence of gender and sex steroids on craniofacial nociception.Headache. 2007; 47: 319-324
- Gender differences in pressure pain threshold in healthy humans.Pain. 2003; 101: 259-266
- Inter-rater reliability of algometry in measuring pressure pain thresholds in healthy humans, using multiple raters.Clin J Pain. 2007; 23: 760-766
- A new integrative model of lateral epicondylalgia.Br J Sports Med. 2009; 43: 252-258
- Comparison of pain thresholds and pain tolerance levels between Middle Easterners and Swedes and between genders.J Oral Rehabil. 2009; 36: 271-278
- Cold and post-traumatic pain: Modelling of the peripheral nerve message.Biosystems. 1997; 43: 145-167
- Pressure pain sensitivity mapping in experimentally induced lateral epicondylalgia.Med Sci Sports Exerc. 2010; 42: 922-927
- Widespread mechanical pain hyper-sensitivity as sign of central sensitization in unilateral lateral epicondylalgia: A blinded, controlled study.Clin J Pain. 2009; 25: 555-561
- Exploration of the extent of somato-sensory impairment in patients with unilateral lateral epicondylalgia.J Pain. 2009; 10: 1179-1185
- Pressure pain sensitivity topographical maps reveal bilateral hyperalgesia of the hands in patients with unilateral carpal tunnel syndrome.Arthritis Care Res. 2010; 62: 1055-1064
- Bilateral widespread mechanical pain sensitivity in myofascial temporomandibular disorder: Evidence of impairment in central nociceptive processing.J Pain. 2009; 10: 1170-1178
- Application of pressure algometry in manual medicine.J Man Med. 1990; 5: 145-150
- Gender differences in pressure pain threshold in a repeated measures assessment.Psychol Health Med. 2007; 12: 567-579
- Topographical mapping and mechanical pain sensitivity of myofascial trigger points in the infraspinatus muscle.Eur J Pain. 2008; 12: 859-865
- Studying sex and gender differences in pain and analgesia: A consensus report.Pain. 2007; 132: S26-S45
- Modulation of central hypersensitivity by nociceptive input in chronic pain after whiplash injury.Pain Med. 2004; 5: 366-376
- Muscle trigger points and pressure pain hyperalgesia in the shoulder muscles in patients with unilateral shoulder impingement: A blinded, controlled study.Exp Brain Res. 2010; 202: 915-925
- Incidence and prevalence of upper-extremity musculoskeletal disorders. A systematic appraisal of the literature.BMC Musculoskelet Disords. 2006; 7: 7
- Comparative reliability and validity of chronic pain intensity measures.Pain. 1999; 83: 157-162
- Contralateral attenuation of pain after short-duration submaximal isometric exercise.J Pain. 2007; 8: 887-892
- Neurokinin 1-receptors and sensory neuropeptides in tendon insertions at the medial and lateral epicondyles of the humerus: Studies on tennis elbow and medial epicondylalgia.J Orthop Research. 2004; 22: 321-327
- Substance P and calcitonin gene related peptide expression at the extensor carpi radialis brevis muscle origin: Implications for the etiology of tennis elbow.J Orthop Res. 1999; 17: 554-559
- Wrist extensor muscle pathology in lateral epicondylitis.J Hand Surg Br. 1999; 24: 177-183
- Delayed onset muscle soreness in neck/shoulder muscles.Eur J Pain. 2005; 9: 653-660
- Relative sensitivity to alfentanil and reliability of current perception threshold vs. von Frey tactile stimulation and thermal sensory testing.J Peripher Nerv Syst. 2001; 6: 232-240
- Hypoalgesic and sympatho-excitatory effects of mobilization with movement for lateral epicondylalgia.Phys Ther 83. 2003; : 374-383
- Reproducibility indices applied to cervical pressure pain threshold measurements in healthy subjects.Clin J Pain. 2000; 20: 341-347
- Evidence for different mechanisms of primary and secondary hyperalgesia following heat injury to the glabrous skin.Brain. 1984; 107: 1179-1188
- Epidemiologic surveillance of upper-extremity musculoskeletal disorders in the working population.Arthritis Rheum. 2006; 55: 765-778
- Somato-visceral sensibility.in: Schmidt R. Fundamentals of Sensory Physiology. 3rd ed. Springer-Verlag, Berlin, Germany1985: 30-61
- Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points.Arch Phys Med Rehabil. 2008; 89: 16-23
Shepard DL: A two dimensional interpolation function for irregularly spaced data. Proceedings of the 23rd National Conference, Association of Computing Machinery, Washington, DC, 1968
- Identification of muscle afferents subserving sensation of deep pain in humans.J Neurophysiol. 1994; 72: 883-889
- Excitatory amino acid concentrations increase in the spinal cord dorsal horn after repeated intramuscular injection of acidic saline.Pain. 2005; 119: 142-149
- Experimental deep tissue pain in wrist extensors: A model of lateral epicondylalgia.Eur J Pain. 2003; 7: 277-288
- Sensory and motor effects of experimental muscle pain in patients with lateral epicondylalgia and controls with delayed onset muscle soreness.Pain. 2005; 114: 118-130
- The effect of selective blockade of myelinated afferent neurons on mechanical hyperalgesia in lateral epicondylalgia.The Pain Clinic. 1993; 6: 9-16
- Abnormal microvascular responses in lateral epicondylitis.Br J Rheumatol. 1994; 33: 1166-1168
- Are there gender differences in pain perception?.J Neurosci Nurs. 2006; 38: 172-176
- Characterisation of chronic lateral epicondylalgia using the McGill pain questionnaire, visual analogue scales, and quantitative sensory tests.The Pain Clinic. 2002; 13: 251-259
- Reflex sympathetic dystrophy: Changing concepts and taxonomy.Pain. 1995; 63: 127-133
- Sensory hypersensitivity occurs soon after whiplash injury and is associated with poor recovery.Pain. 2003; 104: 509-517
- Soft-tissue rheumatic disorders of the neck and upper limb: Prevalence and risk factors.Semin Arthritis Rheum. 2003; 33: 185-203
- Recent Concepts in the neyrophysiology of pain.Man Ther. 1999; 4: 196-202
- Hyperalgesia in tennis elbow patients.J Musculoskeletal Pain. 1994; 2: 83-97
Article info
Publication history
Published online: June 17, 2011
Accepted:
April 3,
2011
Received in revised form:
March 23,
2011
Received:
February 5,
2011
Footnotes
The present study has partially supported by a grant from the Danish Working Environment Authority (“Undersøgelse af manifestationer, årsagsmekanismer samt progression af smerter hos computerbrugere” project) Gigtforeningen, and Arbejdsmiljofondet.
Authors have no conflict of interest to declare for this manuscript.
Identification
Copyright
© 2011 American Pain Society. Published by Elsevier Inc. All rights reserved.
