Widespread Mechanical Pain Hypersensitivity as Sign of Central Sensitization in Unilateral Epicondylalgia

Fernández‐Carnero, Josué; Fernández‐de‐las‐Peñas, César; de-la-Llave-Rincón, Ana I; Ge, Hong You; Arendt-Nielsen, Lars

doi:10.1097/ajp.0b013e3181a68a040

Cited by 154 publications

(111 citation statements)

References 46 publications

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“…In fact, previous studies have also demonstrated that individuals with either CTS or LE also have lower PPT over the tibialis anterior muscle, supporting a central sensitization process in these pain conditions. 23,28 The results from the current study are clinically relevant, as they demonstrate that a musculoskeletal pain condition such as LE exhibits similar nerve sensitization as a neuropathic pain condition like CTS. A novel finding in the current study was that, generally, pressure nerve hypersensitivity was different between patients with CTS versus LE and was related to specific nerve trunks.…”

Section: Nerve Pressure Pain Hypersensitivity and Clinical Featuresmentioning

confidence: 82%

“…25 Generalized sensitization identified by lower PPT over the median, radial, and ulnar nerve trunks has been found in patients with whiplash 57,59 and unilateral migraine, 25 suggesting possible hyperexcitability of the central nervous system. 34 It has also been shown that patients with unilateral LE 23 and unilateral CTS 28 exhibited signs of central hyperexcitability as demonstrated by lower PPT over the median, ulnar, and radial nerve trunks bilaterally when compared to healthy controls.…”

Section: Participants P Atients Diagnosed With Cts Bymentioning

confidence: 99%

“…Although central sensitization mechanisms appear to be present in individuals with either LE 23 or CTS, 19,28 it is known that hyperexcitability of the central nervous system is a dynamic condition influenced by multiple factors, particularly activity of peripheral nociceptors. 36 In such a scenario, central sensitization may be influenced by peripheral nociceptive activity from specific nerve trunks (the median nerve for CTS and radial and ulnar nerves for LE).…”

Section: Peripheral Nerve Nociception and Central Sensitizationmentioning

confidence: 99%

“…[ research report ] of previous studies conducted on individuals with LE or CTS. 23,28 However, PPT assessment in other areas unrelated to specific nerve trunks would have been helpful to clarify if current findings are neural tissue specific or just indicative of general hypersensitivity throughout the arm. In fact, previous studies have also demonstrated that individuals with either CTS or LE also have lower PPT over the tibialis anterior muscle, supporting a central sensitization process in these pain conditions.…”

Section: Nerve Pressure Pain Hypersensitivity and Clinical Featuresmentioning

confidence: 99%

“…Additionally, it has been reported that the lower cervical spine (C5-C6 level) is sensitized in these conditions. 23,28 Therefore, the aim of our study was to investigate differences in pressure pain hypersensitivity over the 3 main nerve trunks of the arm and the cervical spine in women with unilateral LE or CTS. Our hypothesis was that women with LE would have greater hypersensitivity over the radial nerve and women with CTS would demonstrate greater hypersensitivity over the median nerve, without differences in neck sensitization between groups.…”

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confidence: 99%

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Specific Mechanical Pain Hypersensitivity Over Peripheral Nerve Trunks in Women With Either Unilateral Epicondylalgia or Carpal Tunnel Syndrome

Fernández‐de‐las‐Peñas

Ortega‐Santiago²,

Ambite-Quesada³

et al. 2010

J Orthop Sports Phys Ther

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Section: Nerve Pressure Pain Hypersensitivity and Clinical Featuresmentioning

confidence: 82%

Section: Participants P Atients Diagnosed With Cts Bymentioning

confidence: 99%

Section: Peripheral Nerve Nociception and Central Sensitizationmentioning

confidence: 99%

Section: Nerve Pressure Pain Hypersensitivity and Clinical Featuresmentioning

confidence: 99%

mentioning

confidence: 99%

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Specific Mechanical Pain Hypersensitivity Over Peripheral Nerve Trunks in Women With Either Unilateral Epicondylalgia or Carpal Tunnel Syndrome

Fernández‐de‐las‐Peñas

Ortega‐Santiago²,

Ambite-Quesada³

et al. 2010

J Orthop Sports Phys Ther

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Pressure pain sensitivity topographical maps reveal bilateral hyperalgesia of the hands in patients with unilateral carpal tunnel syndrome

Fernández‐de‐las‐Peñas¹,

Madeleine²,

Martínez-Pérez³

et al. 2010

Arthritis Care & Research

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Objective. To assess topographical pressure pain sensitivity maps of the hand in patients with unilateral carpal tunnel syndrome (CTS) as compared with healthy subjects. Methods. A total of 20 women with CTS (ages 32-52 years) and 20 healthy matched women (ages 32-51 years) were recruited. Pressure pain thresholds (PPTs) were measured bilaterally over 30 locations of the palm of each hand by an assessor blinded to the subjects' conditions. Results. Patients showed lower PPTs in both hands in all of the measurement points as compared with controls (P < 0.001 for all). PPTs were lower in those points over the proximal phalanx of the fingers and the thenar eminency as compared with those points located over the distal phalanx of the fingers (P < 0.001). CTS patients showed lower PPT levels in dermatomes C6, C7, and C8 when compared with healthy controls (P < 0.001 for all), but without differences between dermatomes (P ‫؍‬ 0.4). PPT was negatively correlated with both hand pain intensity and duration of symptoms (P < 0.001 for all). Conclusion. Our findings revealed bilateral generalized pressure pain hyperalgesia in unilateral CTS because lower PPT levels were found in all of the points. The pressure pain hyperalgesia was not uniformly distributed since PPTs were lower in points over the proximal phalanx of the fingers and the thenar eminency as compared with those points located over the distal phalanx of the fingers. The decrease in PPT levels was associated with the intensity and the duration of the pain symptoms, supporting a role of both peripheral and central sensitization mechanisms in this pain condition.

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Normalization of widespread hyperesthesia and facilitated spatial summation of deep‐tissue pain in knee osteoarthritis patients after knee replacement

Graven‐Nielsen

Wodehouse

Langford

et al. 2012

Arthritis & Rheumatism

302

319

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Objective. The modest association between radiographic joint damage and pain in osteoarthritis (OA) has led to the suggestion of facilitated central pain processing. This study evaluated the importance of ongoing tissue pathology in the maintenance of enhanced central pain processing.Methods. Pain assessment was performed on 48 patients with symptomatic knee OA and 21 sex-and age-matched pain-free healthy control subjects. Twenty of the OA patients subsequently underwent total knee replacement surgery and were reassessed. Pressurepain thresholds (PPTs) were recorded using a pressure algometer (both over and distant from the knee) and a double-chamber inflatable cuff mounted around the calf. Spatial summation was assessed by relating PPTs using the dual-and single-chamber cuff. Conditioned pain modulation (CPM) was assessed by recording the increase in PPT in response to experimental arm pain.Results. PPTs at the knee and at sites away from the knee were reduced in OA patients as compared with healthy pain-free control subjects (P < 0.0001). Cuff PPTs were decreased in OA patients as compared with the healthy controls (P < 0.05), who also exhibited a greater degree of spatial summation (P < 0.05). Whereas an elevation of PPTs was noted in the healthy controls in response to experimental arm pain (P < 0.0001), no such CPM was observed in the OA patients. Following joint replacement in the OA patients, there was a reduction in the widespread mechanical hyperesthesia, along with normalization of spatial summation ratios and restoration of CPM.Conclusion. The widespread hyperesthesia and enhanced spatial summation observed in OA patients imply sensitized central pain mechanisms together with the loss of CPM. Normalization of the results following joint replacement implies that these central pain processes are maintained by peripheral input.

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Widespread Mechanical Pain Hypersensitivity as Sign of Central Sensitization in Unilateral Epicondylalgia

Cited by 154 publications

References 46 publications

Specific Mechanical Pain Hypersensitivity Over Peripheral Nerve Trunks in Women With Either Unilateral Epicondylalgia or Carpal Tunnel Syndrome

Specific Mechanical Pain Hypersensitivity Over Peripheral Nerve Trunks in Women With Either Unilateral Epicondylalgia or Carpal Tunnel Syndrome

Pressure pain sensitivity topographical maps reveal bilateral hyperalgesia of the hands in patients with unilateral carpal tunnel syndrome

Normalization of widespread hyperesthesia and facilitated spatial summation of deep‐tissue pain in knee osteoarthritis patients after knee replacement

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