School of Physiotherapy, The University of Notre Dame Australia, Fremantle, WA, Australia; SportsMed Subiaco, St John of God Health Care, Subiaco, WA, Australia.
Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, VIC, Australia.
J Sci Med Sport. 2021 May;24(5):441-447. doi: 10.1016/j.jsams.2020.10.015. Epub 2020 Nov 4.
Our primary objective was to report the presence of a conditioned pain modulation (CPM) effect in people with localised mid-portion Achilles tendinopathy and whether changes occur over a 12-week period. Our secondary objectives were to quantify the proportion of participants who present for tendinopathy research with previous interventions or co-morbidities, which may impact the CPM-effect and investigate modulating factors.
Prospective, observational cohort pilot study.
215 participants presented for this Achilles tendinopathy research and were screened for inclusion with nine being included. Included participants had the CPM-effect (cold-pressor test) assessed using pressure pain thresholds at the Achilles tendon and quantified as absolute, relative and meaningful change at baseline and 12-week follow-up.
The most common reasons for exclusion were failure to meet a load-related diagnosis for Achilles tendinopathy (15.5%), presence of confounding other injury (14.1%) and previous injection therapy (13.6%). All participants had a meaningful CPM-effect at baseline and 12-week follow-up. The mean (SD, n) baseline relative CPM effect (reduction in PPTs) was -40.5 (32.7, 9) percent. Moderators of the CPM-effect as well as follow-up changes were not statistically analysed due to a small sample size.
Based on these data, we would suggest that a homogenous population of patients with chronic, unilateral mid-portion Achilles tendinopathy and no other co-morbidities are likely to exhibit a meaningful CPM-effect. Impairments to endogenous analgesic mechanisms seen in people presenting with mid-portion Achilles tendinopathy may be due to other confounding variables.
我们的主要目的是报告局部中段跟腱病患者存在条件性疼痛调制（CPM）效应，并观察其在 12 周内的变化。我们的次要目的是量化有既往干预或合并症的跟腱病患者的比例，这些因素可能会影响 CPM 效应，并探讨调节因素。
前瞻性、观察性队列研究。
215 名参与者参加了这项跟腱病研究，并进行了纳入标准筛查，其中 9 名符合纳入标准。纳入的参与者采用跟腱处压痛阈值评估 CPM 效应（冷加压试验），并在基线和 12 周随访时分别以绝对值、相对值和有意义的变化进行量化。
最常见的排除原因是未能满足跟腱病的负荷相关诊断（15.5%）、存在合并其他损伤（14.1%）和既往注射治疗（13.6%）。所有参与者在基线和 12 周随访时均存在有意义的 CPM 效应。平均（标准差，n）基线相对 CPM 效应（压痛阈值降低）为-40.5（32.7，9）%。由于样本量较小，CPM 效应的调节因素和随访变化未进行统计学分析。
根据这些数据，我们可以推断，患有慢性单侧中段跟腱病且无其他合并症的同质患者群体可能会表现出有意义的 CPM 效应。在出现中段跟腱病的患者中观察到的内源性镇痛机制受损可能归因于其他混杂变量。
