Hypoalgesia induced by elbow manipulation in lateral epicondylalgia does not exhibit tolerance

Paungmali, A., Vicenzino, B. and Smith, M. (2003) Hypoalgesia induced by elbow manipulation in lateral epicondylalgia does not exhibit tolerance. Journal of Pain, 4 8: 448-454. doi:10.1067/S1526-5900(03)00731-4

Author Paungmali, A.
Vicenzino, B.
Smith, M.
Title Hypoalgesia induced by elbow manipulation in lateral epicondylalgia does not exhibit tolerance
Journal name Journal of Pain   Check publisher's open access policy
ISSN 1526-5900
Publication date 2003-01-01
Year available 2003
Sub-type Article (original research)
DOI 10.1067/S1526-5900(03)00731-4
Open Access Status
Volume 4
Issue 8
Start page 448
End page 454
Total pages 7
Editor G. F. Gebhart
Place of publication UK
Publisher Churchill Livingstone
Language eng
Subject C1
321024 Rehabilitation and Therapy - Occupational and Physical
730114 Skeletal system and disorders (incl. arthritis)
Abstract Previous studies have demonstrated that the initial hypoalgesic effect of spinal manipulative therapy was not antagonized by naloxone and did not exhibit tolerance with repeated applications. The implication is that endogenous opioid mechanisms of pain relief are probably not at play in spinal manipulative therapy. The role of endogenous opioid peptides in manipulation of the peripheral joints has not been investigated. The aim of this study was to evaluate whether the initial hypoalgesic effect of a peripheral manipulative technique (mobilization-with-movement treatment for the elbow) demonstrated a tolerance to repeated applications (ie, reduction in magnitude of effect over repeated applications). Twenty-four participants with unilateral chronic lateral epicondylalgia participated in the study. A repeated measures study was conducted to examine the effect of repeated applications of the mobilization-with-movement treatment for the elbow on 6 separate treatment occasions at least 2 days apart. Pain-free grip strength and pressure pain threshold were chosen as the pain-related outcome measures. Changes in the percent maximum possible effect scores of measures of hypoalgesia were evaluated across the 6 treatment sessions by using linear trend analysis. The results showed no significant difference for the hypoalgesic effect of the treatment technique between sessions (P >.05). This peripheral manipulative therapy treatment technique appeared to have a similar effect profile to previously studied spinal manipulative therapy techniques, thereby contributing to the body of knowledge that indicates that manipulative therapy most likely induces a predominant non-opioid form of analgesia.
Keyword Clinical Neurology
Endogenous Opioid
Pain Threshold
Manipulative Therapy
Stimulation-produced Analgesia
Midbrain Periaqueductal Gray
Opioid Receptors
Columnar Organization
Emotional Expression
Q-Index Code C1
Institutional Status UQ

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Created: Wed, 15 Aug 2007, 05:17:19 EST