TY - JOUR
T1 - Local anesthetic injection resolves movement pain, motor dysfunction, and pain catastrophizing in individuals with chronic achilles tendinopathy
T2 - A nonrandomized clinical trial
AU - Chimenti, Ruth L.
AU - Hall, Mederic M.
AU - Dilger, Connor P.
AU - Merriwether, Ericka N.
AU - Wilken, Jason M.
AU - Sluka, Kathleen A.
N1 - Funding Information:
1Department of Physical Therapy and Rehabilitation Science, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA. 2Department of Orthopedics and Rehabilitation, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA. 3Department of Physical Therapy, Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY. This clinical trial was approved by the University of Iowa Institutional Review Board (IRB-01 Biomedical). This study was registered at www.clinicaltrials.gov as “Achilles Pain Block” (NCT03316378) and was funded by National Institutes of Health grants K99AR071517, T32 NS045549-12, and 54TR001013 (for REDCap electronic data-capture tools). Preliminary data were collected with the support of an Academy of Orthopaedic Physical Therapy grant from the American Physical Therapy Association. The authors certify that they have no affiliations with or financial involvement in any organization or entity with a direct financial interest in the subject matter or materials discussed in the article. Address correspondence to Dr Ruth Chimenti, University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Department of Physical Therapy and Rehabilitation Science, 500 Newton Road, 1-252 Medical Education Building, Iowa City, IA 52242. E-mail: [email protected] U Copyright ©2020 Journal of Orthopaedic & Sports Physical Therapy®
Publisher Copyright:
© 2020 Journal of Orthopaedic & Sports Physical Therapy.
PY - 2020/6
Y1 - 2020/6
N2 - 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). The Achilles tendinopathy group did not have indicators of nociplastic pain with quantitative sensory testing (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<.01), but not in kinesiophobia (P = .45). Injection did not affect measures of nociplastic pain (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 catastrophizing), but not kinesiophobia.
AB - 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). The Achilles tendinopathy group did not have indicators of nociplastic pain with quantitative sensory testing (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<.01), but not in kinesiophobia (P = .45). Injection did not affect measures of nociplastic pain (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 catastrophizing), but not kinesiophobia.
KW - Central sensitization
KW - Kinesiophobia
KW - Kinetics
KW - Movement-evoked pain
KW - Nociceptive
KW - Anesthetics, Local/administration & dosage
KW - Tendinopathy/diagnostic imaging
KW - Movement
KW - Humans
KW - Middle Aged
KW - Male
KW - Catastrophization
KW - Ropivacaine/administration & dosage
KW - Nociceptive Pain/prevention & control
KW - Ultrasonography
KW - Adult
KW - Female
KW - Achilles Tendon/diagnostic imaging
KW - Chronic Disease
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U2 - 10.2519/jospt.2020.9242
DO - 10.2519/jospt.2020.9242
M3 - Article
C2 - 32349638
AN - SCOPUS:85085905408
SN - 0190-6011
VL - 50
SP - 334
EP - 343
JO - Journal of Orthopaedic and Sports Physical Therapy
JF - Journal of Orthopaedic and Sports Physical Therapy
IS - 6
ER -