The Association Between Conditioned Pain Modulation and Manipulation-induced Analgesia in People With Lateral Epicondylalgia

Ahmad Muhsen, Penny Moss, William Gibson, Bruce Walker, Angela Jacques, Stephan Schug, Anthony Wright, Ahmad Muhsen, Penny Moss, William Gibson, Bruce Walker, Angela Jacques, Stephan Schug, Anthony Wright

Abstract

Objectives: Conditioned pain modulation (CPM) and manipulation-induced analgesia (MIA) may activate similar neurophysiological mechanisms to mediate their analgesic effects. This study assessed the association between CPM and MIA responses in people with lateral epicondylalgia.

Materials and methods: Seventy participants with lateral epicondylalgia were assessed for CPM followed by MIA. A single assessor measured pressure pain thresholds (PPT) before, during, and after cold water immersion (10°C) of the asymptomatic hand and contralateral lateral glide (CLG) mobilization of the neck. For analyses, linear mixed models evaluated differences in CPM and MIA responses. Pearson partial correlations and regression analyses evaluated the association between CPM and MIA PPT.

Results: There was a significant increase (CPM and MIA, P<0.001) in PPT from baseline during the interventions (CPM mean: 195.84 kPa for elbow and 201.87 kPa for wrist, MIA mean: 123.01 kPa for elbow and 126.06 kPa for wrist) and after the interventions (CPM mean: 126.06 kPa for elbow, 114.24 kPa for wrist, MIA mean: 123.50 kPa for elbow and 122.16 kPa for wrist). There were also significant moderate and positive partial linear correlations (r: 0.40 to 0.54, P<0.001) between CPM and MIA measures, controlling for baseline measures. Regression analyses showed that CPM PPT was a significant predictor of MIA PPT (P<0.001) and the models explained between 73% and 85% of the variance in MIA PPT.

Discussion: This study showed that CPM and MIA responses were significantly correlated and that the CPM response was a significant predictor of MIA response.

Figures

FIGURE 1
FIGURE 1
Test session timeline. CLG indicates cervical lateral glide mobilization; CPM, conditioned pain modulation; CPT, cold pressor test; MIA, manipulation-induced analgesia; PFG, pain-free grip; PPT, pressure pain threshold; PRTEE, Patient-rated Tennis Elbow Evaluation; ULNDT-RN, upper limb neurodynamic test-radial nerve.
FIGURE 2
FIGURE 2
Consort diagram. Flow of participants during the recruitment process. CPM indicates conditioned pain modulation; MIA, manipulation-induced analgesia.
FIGURE 3
FIGURE 3
Differences in pressure pain threshold values between CPM and MIA over time (mean±SEM). CPM indicates conditioned pain modulation; MIA, manipulation-induced analgesia.

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Source: PubMed

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