Lateral Epicondylalgia as a Nociceptive/Nociplastic Pain Condition According to the International Association for the Study of Pain (IASP) Taxonomy: A Theoretical Hypothesis
6 affiliations
- 1Department of Psychology, Universidad Rey Juan Carlos, 28922 Madrid, Spain
- 2Department of Rehabilitation Sciences, School of Medicine, Tufts University, Boston, MA 02111, USA
- 3Department Physical Therapy, Occupational Therapy, Rehabilitation, and Physical Medicine, University Rey Juan Carlos, 28922 Madrid, Spain
- 4Center for Neuroplasticity and Pain (CNAP), Sensory-Motor Interaction Center (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, DK-9220 Aalborg, Denmark
- 5Department of Gastroenterology & Hepatology, Mech-Sense, Clinical Institute, Aalborg University Hospital, DK-9000 Aalborg, Denmark
- 6Steno Diabetes Center North Denmark, Clinical Institute, Aalborg University Hospital, DK-9000 Aalborg, Denmark
Abstract
Lateral epicondylalgia (LE) is a chronic musculoskeletal pain condition characterized by treatment effect heterogeneity. The identification of specific pain phenotypes may help in subgrouping LE patients based on their predominant pain mechanism, thereby supporting the development of more targeted treatments. In the current proposal, we present a conceptual application of the International Association for the Study of Pain (IASP) taxonomy to identify a predominant LE pain phenotype. The clinical presentation of LE is traditionally considered predominantly nociceptive, with the wrist extensor tendon as the main peripheral driver. Thus, the presence of trigger point (TrP)-associated referred pain has also been considered as a potential peripheral nociceptive drive. However, the treatment of peripheral drivers alone has shown limited short-term effects in LE, requiring research beyond possible peripheral inputs. Furthermore, evidence supports the presence of altered pain processing in some individuals with LE, suggestive of nociplastic pain features in a subgroup of patients. The potential presence of nociplastic features would imply the need to address maladaptive neuroplasticity associated with pain processing in these patients with LE. The current proposal hypothesizes that LE is a heterogeneous pain condition in which different pain phenotypes, e.g., nociceptive-alone, nociplastic, or mixed-type, can coexist in some patients with different relevance according to the duration, intensity, stage and severity of the disease. Recognizing the relative predominance of nociceptive and nociplastic phenotypes may guide more individualized treatment selection in individuals with LE. However, these hypotheses require prospective validation before they can be established as a clinical decision-making tool. Future studies should identify high-value care options for the treatment of people with LE, as current approaches only yield short-term effects.
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BibTeX
@article{cigaranmendez2026lateral,
title = {{Lateral Epicondylalgia as a Nociceptive/Nociplastic Pain Condition According to the International Association for the Study of Pain (IASP) Taxonomy: A Theoretical Hypothesis}},
author = {Margarita Cigarán-Mendez and Joshua Cleland and Jorge Rodríguez-Jiménez and Cristina Gómez-Calero and Lars Arendt-Nielsen and César Fernández-de-las-Peñas},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15218432},
url = {https://www.mdpi.com/2077-0383/15/21/8432},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Lateral Epicondylalgia as a Nociceptive/Nociplastic Pain Condition According to the International Association for the Study of Pain (IASP) Taxonomy: A Theoretical Hypothesis
AU - Margarita Cigarán-Mendez
AU - Joshua Cleland
AU - Jorge Rodríguez-Jiménez
AU - Cristina Gómez-Calero
AU - Lars Arendt-Nielsen
AU - César Fernández-de-las-Peñas
PY - 2026
DA - 2026/10/29
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218432
UR - https://www.mdpi.com/2077-0383/15/21/8432
AB - Lateral epicondylalgia (LE) is a chronic musculoskeletal pain condition characterized by treatment effect heterogeneity. The identification of specific pain phenotypes may help in subgrouping LE patients based on their predominant pain mechanism, thereby supporting the development of more targeted treatments. In the current proposal, we present a conceptual application of the International Association for the Study of Pain (IASP) taxonomy to identify a predominant LE pain phenotype. The clinical presentation of LE is traditionally considered predominantly nociceptive, with the wrist extensor tendon as the main peripheral driver. Thus, the presence of trigger point (TrP)-associated referred pain has also been considered as a potential peripheral nociceptive drive. However, the treatment of peripheral drivers alone has shown limited short-term effects in LE, requiring research beyond possible peripheral inputs. Furthermore, evidence supports the presence of altered pain processing in some individuals with LE, suggestive of nociplastic pain features in a subgroup of patients. The potential presence of nociplastic features would imply the need to address maladaptive neuroplasticity associated with pain processing in these patients with LE. The current proposal hypothesizes that LE is a heterogeneous pain condition in which different pain phenotypes, e.g., nociceptive-alone, nociplastic, or mixed-type, can coexist in some patients with different relevance according to the duration, intensity, stage and severity of the disease. Recognizing the relative predominance of nociceptive and nociplastic phenotypes may guide more individualized treatment selection in individuals with LE. However, these hypotheses require prospective validation before they can be established as a clinical decision-making tool. Future studies should identify high-value care options for the treatment of people with LE, as current approaches only yield short-term effects.
SN - 2077-0383
ER -