Assessment of Pressure Pain Threshold (PPT) and Conditioned Pain Modulation (CPM) After Effect in Patients With and Without Tennis Elbow (TE)

The Hashemite University

Status: Enrolling

Conditions: Conditioned Pain Modulation (CPM); Tennis Elbow; Health Adult Subjects; Pressure Pain Threshold (PPT); Lateral Elbow Tendinopathy (Tennis Elbow)

Treatments: Other: Physiological/measurement-validation study

Study type: Interventional

Funder types: Other

Identifiers

NCT07178288

32/1/2024/2025

Details and patient eligibility

About

This study at Hashemite University looks at how people with and without tennis elbow (AKA lateral elbow tendinopathy) feel pressure pain and how their bodies briefly "turn down" pain after a cold stimulus. Participants complete brief questionnaires (basic demographics without names, a tennis-elbow symptom form, and a physical-activity form) and then have their pressure-pain threshold (PPT) tested with a handheld device that slowly increases pressure on standard spots near the elbow and wrist; they say when it first becomes painful. To test the body's built-in anti-pain system (conditioned pain modulation, CPM), one hand is placed in ice water (the cold-pressor task) and PPT is measured again at set times (before, during, and after the cold stimulus) to see how much pain sensitivity changes and how long that change lasts. Both PPT reliability and CPM after effect are measured in this study. The study findings may help improve future assessment and treatment of musculoskeletal pain conditions.

Full description

This is a quasi-experimental reliability and time-course study using digital algometry for PPT and the cold-pressor task for CPM. Primary outcomes include PPT reliability (with intraclass correlation coefficient (ICC), standard error of measurement (SEM), and smallest detectable change (SDC) and the duration of CPM after-effects (time to return toward baseline). Testing is planned in the Physiotherapy Clinic at the Community Rehabilitation Center, with a minimum sample noted in the application. The protocol emphasizes standardized sites, repeated measures at predefined time points, and storage of coded data on university systems.

Enrollment: 38 estimated patients

Sex: All

Ages: 18 to 60 years old

Volunteers: Accepts Healthy Volunteers

Inclusion and exclusion criteria

TE Group

Inclusion Criteria:

Patients with Tennis Elbow confirmed at initial assessment by the Primary Investigator (PI)

Unilateral elbow pain > 6 weeks duration reproduced on at least two of the following tests:

• Palpation of the lateral epicondyle
• Isometric testing of the wrist extensors
• Middle finger extension test
• Passive stretch of wrist extensors
• Resisted hand gripping using a dynamometer
• Upper limb neurodynamic test-radial nerve bias (ULNDT-RN)

Exclusion Criteria:

• History of chronic pain conditions (e.g. fibromyalgia, irritable bowel
• syndrome, temporomandibular dysfunction, migraines)
• Neurological or sensory dysfunction (especially in the upper limbs)
• History of chronic musculoskeletal pain (e.g. arthritis, chronic low back
• pain)
• Contraindications to cold application (i.e. Reynaud's disease, diabetes)
• Current or long-term use of pain medication or anti-depressants

Healthy Group The asymptomatic group included adults (18-65 years) without pain (acute or chronic) at least 3 months before the experimental sessions.

Trial design

Primary purpose: Other

Allocation: N/A

Interventional model: Single Group Assignment

Masking: None (Open label)

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38 participants in 1 patient group

PPT_CPM Arm

Experimental group

Description:

Procedure After completing self reported questionnaires, participants will attend a single test session where they undergo a Pressure Pain Threshold (PPT) test-retest protocol followed by a Conditioned Pain Modulation (CPM) testing protocol, with a rest period of 10 minutes in between. The experimental protocols will be performed by the same investigator. All instructions will be standardized

Treatment:

Other: Physiological/measurement-validation study