Zhang Yuwen, Xue Xiao'ao, Guo Guangxin, Cao Rongqian, Yu Le, Tao Weichu, Pan Siqi, Hua Yinghui, Wang He
Department of Sports Medicine, Huashan Hospital.
Institute of Science and Technology for Brain-Inspired Intelligence, and.
J Athl Train. 2025 Mar 1;60(3):210-217. doi: 10.4085/1062-6050-0214.24.
Pain-related movement fear is a contributing factor to residual pain and functional deficits in chronic ankle instability (CAI), but its underlying neural mechanisms remain unclear.
We aimed to (1) delineate whether participants with CAI exhibit discernible differences in specific emotion- and pain-related brain regions compared with a healthy control (HC) cohort and (2) explore potential neural mechanisms underlying pain and fear in participants with CAI, with an emphasis on investigating possible associations with pain-related neural plasticity.
Cross-sectional study.
University research laboratory.
Twenty-eight participants with CAI (17 men and 11 women; age = 31.28 ± 6.31 years) and 28 HCs (16 men and 12 women; age = 30.18 ± 7.59 years).
MAIN OUTCOME MEASURE(S): We analyzed T1 structural imaging data from participants and assessed their fear of movement and pain intensity using the Tampa Scale of Kinesiophobia (TSK) and the visual analog scale (VAS) for pain, respectively. We compared the mean gray matter (GM) density of pain-related area between the 2 groups and their correlations with the TSK and VAS scores.
In comparison with the HC group, participants with CAI showed a significant decrease in the mean GM density in the prefrontal cortex (PFC) (Cohen d = -0.808) and periaqueductal gray (PAG) (Cohen d = -0.934). In participants with CAI, the mean GM density of the PFC was negatively correlated with TSK scores (r = -0.531). During intense exercise, the mean GM density of the PAG was negatively correlated with VAS scores (r = -0.484). Additionally, TSK scores were positively correlated with VAS scores (r = 0.455).
Our exploratory findings suggest that, in participants with CAI, the atrophy of the PFC and PAG may be associated with pain-related fear. In future clinical diagnosis and treatment for CAI, practitioners should consider the impact of psychological barriers on functional recovery.
与疼痛相关的运动恐惧是导致慢性踝关节不稳（CAI）患者残留疼痛和功能缺陷的一个因素，但其潜在的神经机制仍不清楚。
我们旨在（1）确定与健康对照组（HC）相比，CAI患者在特定的与情绪和疼痛相关的脑区是否表现出明显差异；（2）探索CAI患者疼痛和恐惧背后的潜在神经机制，重点研究与疼痛相关神经可塑性的可能关联。
横断面研究。
大学研究实验室。
28名CAI患者（17名男性和11名女性；年龄=31.28±6.31岁）和28名HCs（16名男性和12名女性；年龄=30.18±7.59岁）。
我们分析了参与者的T1结构成像数据，并分别使用坦帕运动恐惧量表（TSK）和疼痛视觉模拟量表（VAS）评估了他们对运动的恐惧和疼痛强度。我们比较了两组之间疼痛相关区域的平均灰质（GM）密度及其与TSK和VAS评分的相关性。
与HC组相比，CAI患者前额叶皮质（PFC）（Cohen d=-0.808）和导水管周围灰质（PAG）（Cohen d=-0.934）的平均GM密度显著降低。在CAI患者中，PFC的平均GM密度与TSK评分呈负相关（r=-0.531）。在剧烈运动期间，PAG的平均GM密度与VAS评分呈负相关（r=-0.484）。此外，TSK评分与VAS评分呈正相关（r=0.455）。
我们的探索性研究结果表明，在CAI患者中，PFC和PAG的萎缩可能与疼痛相关的恐惧有关。在未来CAI的临床诊断和治疗中，从业者应考虑心理障碍对功能恢复的影响。
