OBJECTIVE: Conditioned pain modulation (CPM) and manipulation induced analgesia (MIA) are two forms of endogenous analgesia. Many forms of analgesia can be influenced by the nature of the patient clinician interaction. The aim of this study was to evaluate the influence of an empathetic and supportive interaction on CPM and MIA in people with lateral epicondylalgia (LE). METHODS: In a double-blind, randomised, controlled trial, 68 participants with LE were assigned to two groups: the empathetic and neutral interaction groups. The interactions were carried out by a trained, professional role play actor, playing the part of a research assistant (RA). The RA actor spent 15 min prior to CPM and MIA assessment interacting with the participants in an empathetic or neutral manner. Immediately after the interaction, a blinded assessor measured pressure pain threshold (PPT) at the symptomatic elbow and ipsilateral wrist during CPM and MIA testing. Linear mixed models were used to evaluate differences in CPM and MIA responses between the interaction groups. RESULTS: There was a significant difference in CARE scores between the groups (p < 0.001), indicating that the intervention group experienced a more empathic interaction. Both groups showed a significant increase in PPT measures, indicative of a CPM and MIA analgesic response (p < 0.001), however the analgesic responses were greater in the group that had experienced a supportive, empathetic interaction (post CPM wrist p < 0.001; elbow p = 0.001), (post MIA wrist p <= 0.001; elbow p = 0.001). DISCUSSION: A single session of empathetic interaction positively influenced both CPM and MIA responses in people with LE.

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