Sensitization-associated and neuropathic-associated symptoms in patients with unilateral lateral elbow tendinopathy: an exploratory study

Ignacio Cancela-Cilleruelo; Jorge Rodríguez-Jiménez; César Fernández-de-Las-Peñas; Lars Arendt-Nielsen; José L Arias-Buría

doi:10.1080/09593985.2023.2264384

Sensitization-associated and neuropathic-associated symptoms in patients with unilateral lateral elbow tendinopathy: an exploratory study

Physiother Theory Pract. 2023 Oct 5:1-8. doi: 10.1080/09593985.2023.2264384. Online ahead of print.

Authors

Ignacio Cancela-Cilleruelo^{1

2}, Jorge Rodríguez-Jiménez², César Fernández-de-Las-Peñas^{2

3}, Lars Arendt-Nielsen^{3

4

5}, José L Arias-Buría²

Affiliations

¹ Escuela Internacional de Doctorado, Universidad Rey Juan Carlos, Móstoles, Spain.
² Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain.
³ Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark.
⁴ Department of Gastroenterology and Hepatology, Mech-Sense, Clinical Institute, Aalborg University Hospital, Aalborg, Denmark.
⁵ Steno Diabetes Center North Denmark, Clinical Institute, Aalborg University Hospital, Aalborg, Denmark.

PMID: 37795605
DOI: 10.1080/09593985.2023.2264384

Abstract

Objectives: We evaluate the presence of sensitization-associated symptoms and neuropathic pain features and identify if there is an association between these symptoms and pressure pain sensitivity, pain, and related-disability in lateral elbow tendinopathy.

Methods: Thirty-seven (43% women, age: 45.5 ± 9.5 years) patients with lateral elbow tendinopathy completed: demographic (i.e. age, height, and weight); clinical (i.e. pain history, pain intensity, and Disabilities of the Arm, Shoulder and Hand); and psychophysical (i.e. pressure pain thresholds at the elbow, cervical spine, hand, and leg) outcomes, and the Central Sensitization Inventory and Self-administered Leeds Assessment of Neuropathic Symptoms and Signs questionnaires. Step-wise multiple linear regression models were performed to identify predictors of sensitization- or neuropathic-associated symptoms.

Results: Six (16%) patients exhibited sensitization-associated symptoms (mean: 46.5, SD: 6.1), whereas 13 (35%) patients showed neuropathic-associated symptoms (mean: 13.5; SD: 1.4). Sensitization-associated symptoms were positively associated with neuropathic-associated symptoms (r = 0.538, P = .001) and negatively associated with pressure pain thresholds at the leg (r = -0.378, P = .021). Neuropathic-associated symptoms were positively associated with related-disability (r = 0.479, P = .003) and negatively associated with pressure pain threshold at the elbow (r = -0.394, P = .017). Stepwise regression analyses revealed that neuropathic-like symptoms explained 26.8% of the variance of sensitization symptoms (r²: 0.268), whereas pressure pain threshold at the elbow explained an additional 6.6% to neuropathic-like symptoms (r²: 0.334).

Conclusion: This explorative study identified sensitization- and neuropathic-associated symptoms in 16% and 35% of the people with lateral elbow tendinopathy. Sensitization- and neuropathic-associated symptoms were associated. Pressure pain sensitivity at the elbow (peripheral sensitization) was associated with neuropathic -associated symptoms.

Keywords: Lateral elbow tendinopathy; neuropathic; pressure pain threshold; sensitization.