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Abstract
Objective: The aim of this study was to evaluate the potential role of peripheral noradrenergic mechanisms in the hyperalgesia associated with lateral epicondylalgia.
Methods: Under double blind conditions, 20 patients with lateral epicondylalgia received either a regional block with guanethidine or a control block procedure, on two study days separated by a wash out period of at least 14 days. Prior to administration of the block and two hours post administration subjects were evaluated using a number of pain related measures. The measures included: evaluation of pressure pain thresholds, heat pain thresholds, cold pain thresholds, and neuro-dynamic testing.
Results: The study demonstrated improvements in pressure pain threshold [P = 0.01] and range of movement in the neurodynamic test [P = 0.0002] under both experimental conditions. There was, however, a selective improvement in cold pain thresholds under the guanethidine condition [P = 0.036].
Conclusion: The results are discussed in terms of potential mechanisms responsible for hyperalgesia in musculoskeletal pain states. The findings suggest that cold hyperalgesia associated with lateral epicondylalgia may be sympathetically maintained.