Abstract
There is emerging evidence of altered pain signal processing as a likely underlying
mechanism in chronic lateral epicondylalgia (LE), yet this remains to be assessed.
Furthermore, it has been proposed that neurodynamic tests reflect nociceptive withdrawal
responses. Therefore, the objective was to improve our understanding of spinal cord
excitability as measured by nociceptive flexion reflex (NFR) threshold in chronic
LE with and without a positive neurodynamic test. NFR threshold, pain-free grip, and
pressure pain threshold were measured in 30 LE participants and 31 healthy controls.
Test of neural tissue involvement (using upper limb neural tension, radial bias) was
used to differentiate LE participants with or without a positive neurodynamic test.
There were significant differences in NFR threshold between the control and LE with
or without a positive neurodynamic test (F[2,54] = 5.68, P = .006), after adjusting for age, sex, pain rating at NFR threshold, and reflex size
(NFR interval peak z score). The mean differences (95% confidence interval) in NFR
threshold between the control and LE with or without a positive neurodynamic test
were 3.74 mA (.637, 6.84) and 3.38 mA (.0245, 6.74) respectively.
Perspective
The results suggest evidence of spinal cord hyperexcitability, particularly sensory
hypersensitivity, in LE with or without a positive neurodynamic test. Our data appear
to support the hypothesis that continued peripheral afferent stimulation results in
facilitation of nociceptive pathways in this patient population.
Key words
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Article info
Publication history
Published online: June 11, 2012
Accepted:
April 10,
2012
Received in revised form:
April 5,
2012
Received:
October 30,
2011
Footnotes
Supported in part by the Singapore Health Services Pty Ltd (Talent Development Fund) and The Australian Government's Department of Education, Employment and Workplace Relations (Prime Minister's Australia Asia Endeavour Award) (E.C.W.L.), as well as a fellowship from the National Health and Medical Research Council of Australia (M.S.).
The authors have no conflicts of interest to report.
Identification
Copyright
© 2012 American Pain Society. Published by Elsevier Inc. All rights reserved.
