Local Anesthetic Injection Resolves Movement Pain, Motor Dysfunction, and Pain Catastrophizing in Individuals With Chronic Achilles Tendinopathy: A Nonrandomized Clinical Trial
Local Anesthetic Injection Resolves Movement Pain, Motor Dysfunction, and Pain Catastrophizing in Individuals With Chronic Achilles Tendinopathy: A Nonrandomized Clinical Trial
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局麻药注射可缓解慢性跟腱病患者的运动疼痛、运动功能障碍和疼痛突变：一项非随机临床试验
DOI：
10.2519/jospt.2020.9242
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发表时间：
2020-06-01
影响因子：
6.1
通讯作者：
Sluka, Kathleen A.
中科院分区：
文献类型：
--
作者：
Chimenti, Ruth L.;Hall, Mederic M.;Sluka, Kathleen A.
目的：外周定向治疗（有针对性的运动，手术）可以减轻，但不能完全消除高达40%的跟腱病变患者的疼痛。本研究的目的是(1)确定与对照组相比，跟腱病变参与者中枢加工改变的指标，以及(2)确定跟腱病变患者局部麻醉后中枢加工改变的哪些指标会持续存在。设计：机械临床试验。方法：46名成年人（23名患有慢性跟腱病，23名对照组）重复(1)运动诱发疼痛评分，(2)运动表现评估，(3)疼痛心理问卷，(4)定量感觉测试。跟腱病变的参与者在重复测试前接受局部麻醉注射，对照组没有。方差的混合效应分析检验了组、时间和按时间分组的影响。结果：与对照组相比，跟腱病组有运动诱发性疼痛、运动功能障碍和更高的疼痛心理因素（疼痛灾难化、运动恐惧症）（p < 0.05）。在跟腱病变患者中，局部麻醉注射消除了疼痛，并使观察到的足跟提升能力和疼痛灾难性化的缺陷正常化（按时间分组效应，P.05）。结论：定量感觉测试显示跟腱病患者疼痛心理因素和运动功能障碍升高，但无致伤性疼痛的迹象。去除伤害性输入可使运动诱发的疼痛和中枢加工改变的一些指标（运动功能障碍、疼痛巨灾化）正常化，但不影响运动恐惧症。
OBJECTIVES: Peripherally directed treatments (targeted exercise, surgery) can reduce, but not fully eliminate, pain for up to 40% of patients with Achilles tendinopathy. The objectives of the present study were (1) to identify indicators of altered central processing in participants with Achilles tendinopathy compared to controls, and (2) to determine which indicators of altered central processing would persist after a local anesthetic injection in patients with Achilles tendinopathy.DESIGN: Mechanistic clinical trial.METHODS: Forty-six adults (23 with chronic Achilles tendinopathy, 23 matched controls) repeated (1) a movement-evoked pain rating, (2) motor performance assessment, (3) pain psychology questionnaires, and (4) quantitative sensory testing. Participants with Achilles tendinopathy received a local anesthetic injection before repeat testing and controls did not. Mixed-effects analyses of variance examined the effects of group, time, and group by time.RESULTS: The Achilles tendinopathy group had movement-evoked pain, motor dysfunction, and higher pain psychological factors (pain catastrophizing, kinesiophobia) compared to controls (P.05). In those with Achilles tendinopathy, local anesthetic injection eliminated pain and normalized the observed deficits in heel-raise performance and pain catastrophizing (group-by-time effect, P.05).CONCLUSION: People with Achilles tendinopathy had elevated pain psychological factors and motor dysfunction but no signs of nociplastic pain with quantitative sensory testing. Removal of nociceptive input normalized movement-evoked pain and some indicators of altered central processing (motor dysfunction, pain catastro phizing), but not kinesiophobia.