The association between conditioned pain modulation and manipulation induced analgesia in people with lateral epicondylalgia

Objectives: Conditioned Pain Modulation (CPM) and Manipulation Induced Analgesia (MIA) may activate similar neurophysiological mechanisms to mediate their analgesic effects. This study assessed the association between CPM and MIA responses in people with lateral epicondylalgia (LE). Methods: Seventy participants with LE were assessed for CPM followed by MIA. A single assessor measured pressure pain thresholds (PPT) before, during, and after cold water immersion (10°C) of the asymptomatic hand and contralateral lateral glide (CLG) mobilization of the neck. For analyses, linear mixed models evaluated differences in CPM and MIA responses. Pearson partial correlations and regression analyses evaluated the association between CPM and MIA PPT. Results: There was a significant increase (CPM and MIA p<0.001) in PPT from baseline during the interventions (CPM mean 195.84 kPa elbow and 201.87 kPa wrist. MIA mean 123.01 kPa elbow 126.06 kPa wrist) and post the interventions (CPM mean 126.06 kPa elbow, 114.24 kPa wrist, MIA mean 123.50 kPa elbow, 122.16 kPa wrist). There were also significant moderate and positive partial linear correlations (r: 0.40–0.54, p<0.001) between CPM and MIA measures, controlling for baseline measures. Regression analyses showed that CPM PPT was a significant predictor of MIA PPT (p