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Elbow News

Pain of Tennis Elbow May Be Made Worse with Depression and Anxiety

Tennis elbow is the second most diagnosed injury of the neck and upper body in the United States. It occurs in between four and seven people out of every 1,000 who are seen in a general physician's office. It is caused by repetition of the elbow or wrist, flexibility problems, poor circulation, and psychological factors, among others.

Because this is such a common injury, the researchers in this study wanted to compare the levels of pain and functional disability, and the relationship between anxiety and depression, with tennis elbow. The researchers studied eight men and eight women who ranged in age from 40 to 66 years, with most being around 49 years. Fourteen were still working; two were retired. All had been treated for their tennis elbow with corticosteroid injections to the painful site, medications to treat the inflammation (non-steroidal anti-inflammatory drugs), and even acupuncture. None of the patients were taking anti-anxiety medications or antidepressants. The tennis elbow group was compared with a control group of 16 healthy students and university staff.

All subject, those with tennis elbow and controls, completed questionnaires measuring their functional ability and their levels of anxiety and depression. At the end of the study, the researchers found that the DASH (Disabilities of the Arm, Shoulder, and Hand) scores were significantly higher among the patients with tennis elbow than the controls. The TE group scored and average of 54 while the control group scored an average of 2. There were similar findings with the PRFEQ (Patient-Related Forearm Evaluation Questionnaire) and the PRWEQ (Patient-Related Wrist Evaluation Questionnaire). For the PRFEQ, the TE group reported an average score of 31 on the pain subscale, the control group, 1. The TE group reported an average of 29. On the function scale, the control group, 0. With the PRWEQ, the TE reported an average of 30 on the pain scale, the control group, 1. On the function scale, the TE group reported an average score of 26, the control group, 0.

The HADS (Hospital Anxiety and Depression Scale) scored anxiety and depression. Among the TE group, the anxiety score was between 3 and 16, and the depression score between 2 and 15. For the control group, the anxiety score was between 1 and 9, the depression between 0 and 6.

The researchers pointed out that the results were not surprising, that both depression and anxiety are related to pain. They noted, though, that their only real measurement for anxiety and depression was the HADS and that there are no other appropriate questionnaires available for patients with upper body injuries. There has also been a recent interest in "fear avoidance" among patients with chronic pain. In an earlier study, a researcher used a questionnaire called the Fear-Avoidance Beliefs Questionnaire (FABQ) and found that fear of pain does play a role in anxiety as well.

The authors conclude that it is important to use tools (questionnaires) that are specific to this type of injury to be able to adequately assess a patient. They say that their findings show that there is a connection between anxiety and depression, and tennis elbow.


Omid Alizadehkhaiyat MD, PhD, et al. Pain, Functional Disability, and Psychologic Status in Tennis Elbow. In Clinical Journal of Pain. July/August 2007. Vol. 23. No. 6. Pp. 482-489.

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