Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, MOVE Research Institute Amsterdam, VU University Amsterdam, Amsterdam, The Netherlands.
Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, MOVE Research Institute Amsterdam, VU University Amsterdam, Amsterdam, The Netherlands Department of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia.
Br J Sports Med. 2016 Aug;50(16):1004-7. doi: 10.1136/bjsports-2015-095476. Epub 2015 Dec 23.
Tendinopathy is often a chronic condition. The mechanisms behind persistent tendon pain are not yet fully understood. It is unknown whether, similar to other persistent pain states, central pain mechanisms contribute to ongoing tendon pain.
We investigated the presence of altered central pain processing in Achilles tendinopathy by assessing the conditioned pain modulation (CPM) effect in people with and without Achilles tendinopathy.
20 people with Achilles tendinopathy and 23 healthy volunteers participated in this cross-sectional study. CPM was assessed by the cold pressor test. The pressure pain threshold (PPT) was recorded over the Achilles tendon before and during immersion of the participant's hand into cold water. The CPM effect was quantified as the absolute difference in PPT before and during the cold pressor test.
An increase in PPT was observed in the Achilles tendinopathy and control group during the cold pressor test (p<0.001). However, the CPM effect was stronger in the control group (mean difference=160.5 kPa, SD=84.9 kPa) compared to the Achilles tendinopathy group (mean difference=36.4 kPa, SD=68.1 kPa; p<0.001).
We report a reduced conditioned pain modulation effect in people with Achilles tendinopathy compared to people without Achilles tendinopathy. A reduced conditioned pain modulation effect reflects altered central pain processing which is believed to contribute to the persistence of pain in other conditions. Altered central pain processing may also be an important factor in persistent tendon pain that has traditionally been regarded to be dominated by peripheral mechanisms.
肌腱病通常是一种慢性疾病。持续性肌腱疼痛的机制尚未完全阐明。目前尚不清楚，是否与其他持续性疼痛状态一样，中枢疼痛机制是否会导致持续性肌腱疼痛。
我们通过评估有和没有跟腱病的人的条件性疼痛调制（CPM）效应，来研究跟腱病中是否存在改变的中枢疼痛处理。
本横断面研究纳入了 20 名跟腱病患者和 23 名健康志愿者。通过冷加压测试评估 CPM。在参与者的手浸入冷水之前和期间，在跟腱上记录压痛阈值（PPT）。CPM 效应被量化为冷加压测试前后 PPT 的绝对值差异。
在冷加压测试中，跟腱病组和对照组的 PPT 均增加（p<0.001）。然而，与跟腱病组相比，对照组的 CPM 效应更强（平均差异=160.5 kPa，SD=84.9 kPa），差异有统计学意义（p<0.001）。
与无跟腱病的人相比，跟腱病患者的条件性疼痛调制效应降低。CPM 效应降低反映了中枢疼痛处理的改变，这被认为是导致其他情况下疼痛持续存在的原因之一。中枢疼痛处理的改变也可能是持续性肌腱疼痛的一个重要因素，而传统上认为持续性肌腱疼痛主要由外周机制引起。
