Potter Morgan N, Smitheman Hayley Powell, Butera Katie, Pohlig Ryan T, Silbernagel Karin Grävare
Department of Physical Therapy University of Delaware.
Department of Epidemiology University of Delaware.
Int J Sports Phys Ther. 2025 May 1;20(5):696-705. doi: 10.26603/001c.134038. eCollection 2025.
There is concern that the prolonged symptom duration commonly observed in Achilles tendinopathy may alter pain processing and lead to development of central sensitization. If true, presence of altered pain processing could explain why nearly one third of individuals with Achilles tendinopathy do not respond to gold standard treatment. Currently, the relationship between symptom duration, symptom severity, pain, and central sensitization in Achilles tendinopathy is unclear.
The purpose of this study was assess the proportion of individuals with midportion Achilles tendinopathy who may have central sensitization, as defined by the Central Sensitization Inventory (CSI) part A questionnaire. A secondary aim was to assess the relationship between symptom duration, pain intensity, symptom severity and CSI scores.
Cross-Sectional Study.
Individuals diagnosed with midportion Achilles tendinopathy were included (n=182, 57% female (47.3±12.7 years). Bivariate correlations were used to evaluate relationships between symptom duration (time between date of symptom onset and date of study enrollment), symptom severity (assessed by Victorian Institute of Sport Assessment-Achilles, VISA-A), and pain intensity (assessed by Patient-Reported Outcomes Measurement Information System 29, PROMIS-29) with CSI scores.
Nine of 182 individuals (4.9%, 9 females) scored above the clinical cut off for CSI, indicating likely presence of central sensitization. Duration of symptoms did not correlate with CSI score (r = 0.037, 95% CI [-.109, .181] p=0.622). VISA-A had a significant negative correlation with CSI score (r=-0.293, [-.420, -.154] p<0.001), and pain intensity had a significant positive correlation with CSI score (r=0.195, [.051, .331] p=0.008).
Less than five percent of individuals with midportion Achilles tendinopathy met criteria for likely presence of central sensitization as defined by the CSI screening questionnaire. The study findings suggest prolonged symptom duration among those with midportion Achilles tendinopathy is unlikely to increase the occurrence of symptoms associated with central sensitization.
Level 4.
人们担心跟腱病中常见的症状持续时间延长可能会改变疼痛处理过程，并导致中枢敏化的发展。如果真是这样，疼痛处理改变的存在可以解释为什么近三分之一的跟腱病患者对金标准治疗没有反应。目前，跟腱病中症状持续时间、症状严重程度、疼痛与中枢敏化之间的关系尚不清楚。
本研究的目的是评估根据中枢敏化量表（CSI）A部分问卷定义的可能存在中枢敏化的跟腱中部病变患者的比例。次要目的是评估症状持续时间、疼痛强度、症状严重程度与CSI评分之间的关系。
横断面研究。
纳入诊断为跟腱中部病变的个体（n = 182，57%为女性，年龄47.3±12.7岁）。采用双变量相关性分析来评估症状持续时间（症状出现日期与研究入组日期之间的时间）、症状严重程度（通过维多利亚运动评估-跟腱量表，VISA-A评估）和疼痛强度（通过患者报告结局测量信息系统29，PROMIS-29评估）与CSI评分之间的关系。
182名个体中有9名（4.9%，9名女性）的CSI评分高于临床临界值，表明可能存在中枢敏化。症状持续时间与CSI评分无相关性（r = 0.037，95%CI[-.109，.181]，p = 0.622）。VISA-A与CSI评分呈显著负相关（r = -0.293，[-.420，-.154]，p < 0.001），疼痛强度与CSI评分呈显著正相关（r = 0.195，[.051，.331]，p = 0.008）。
根据CSI筛查问卷定义，不到5%的跟腱中部病变患者符合可能存在中枢敏化的标准。研究结果表明，跟腱中部病变患者症状持续时间延长不太可能增加与中枢敏化相关的症状发生率。
4级。
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