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Clinical Journal of Pain:
doi: 10.1097/AJP.0000000000000078
Original Article: PDF Only

Cold Hyperalgesia Associated with Poorer Prognosis in Lateral Epicondylalgia: A One Year Prognostic Study of Physical and Psychological Factors.

Coombes, Brooke K. PhD; Bisset, Leanne PhD; Vicenzino, Bill PhD

Published Ahead-of-Print
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Background: Predictors of outcome in lateral epicondylalgia, which is mainly characterised as a mechanical hyperalgesia, are largely limited to socio-demographic and symptomatic factors. Quantitative sensory testing is used to study altered pain processing in various chronic pain conditions and may be of prognostic relevance.

Methods: The predictive capacity of early measures of physical and psychological impairment on pain and disability and mechanical hyperalgesia, were examined using data from 41 patients assigned to placebo in a prospective randomised controlled trial of unilateral lateral epicondylalgia. Quantitative sensory testing (pressure, cold pain thresholds), motor function (pain free grip) and psychological factors (Tampa scale of kinesiophobia, Hospital anxiety and depression scale) were measured at baseline. The outcome measures were the Patient Rated Tennis Elbow Evaluation (PRTEE) scale and pressure pain threshold (PPT) measured by digital algometry at the affected elbow. Backwards stepwise linear regression was used to predict PRTEE and PPT scores at two and twelve months.

Results: Cold pain threshold was the only consistent predictor for both PRTEE (P<0.034) and PPT (P<0.048). Initial PRTEE was the strongest single predictor of PRTEE at 2 months, while female sex was the strongest single predictor of PPT (P<0.002). At one year, final models explained 9 to 52% of the variability in pain and disability and mechanical hyperalgesia respectively.

Discussion: Early assessment of cold pain threshold could be a useful clinical tool to help identify patients at risk of poorer outcomes and might provide direction for future research into mechanism-based treatment approaches for these patients.

(C) 2014 by Lippincott Williams & Wilkins

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