Is Chronic Tendon Pain Caused by Neuropathy? Exciting Breakthroughs may Direct Potential Treatment.

IF 3.2 2区医学 Q2 CLINICAL NEUROLOGY Current Pain and Headache Reports Pub Date : 2024-07-19 DOI:10.1007/s11916-024-01299-3

Suwannika Palee, Ugur Yener, Alaa Abd-Elsayed, Sayed Emal Wahezi

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Abstract

Background: Tendinopathy significantly impacts the quality of life and imposes a high economic burden, accounting for a large proportion of sports and musculoskeletal injuries. Traditionally considered a collagen-related inflammatory disorder, emerging evidence suggests a critical role of neuropathic processes in chronic tendon pain.

Objective: This review aims to evaluate the neuropathic mechanisms in tendinopathy and discuss innovative treatments targeting these pathways.

Methods: We analyze recent studies highlighting the tendon innervation, pathological nerve sprouting neuronal ingrowth in tendinopathy, and the associated increase in pain and neuronal mediators.

Results: Chronic tendinopathy exhibits nociceptive sprouting from paratenon into the fibrous tendon proper. Innovative treatments such as Percutaneous Ultrasound-Guided Tenotomy (PUT) or high-frequency ultrasound interventions show promise in targeting these neuropathic components by paratenon separation. These approaches focus on disrupting the pathological innervation cycle.

Conclusion: Chronic tendon pain may be predominantly neuropathic, driven by pathologic neuronal ingrowth from paratenon into the tendon proper. Interventions that accurately target and disrupt these nerve pathways could revolutionize the treatment of tendinopathy. Further research is required to validate these findings and refine treatment modalities to ensure safety and efficacy.

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慢性肌腱疼痛是由神经病变引起的吗？令人兴奋的突破可能指引潜在的治疗方法。

背景：肌腱病严重影响着人们的生活质量，并带来沉重的经济负担，在运动和肌肉骨骼损伤中占很大比例。传统上，肌腱病被认为是一种与胶原蛋白相关的炎症性疾病，但新出现的证据表明，神经病理过程在慢性肌腱痛中起着至关重要的作用：本综述旨在评估肌腱病的神经病理机制，并讨论针对这些途径的创新治疗方法：我们分析了最近的研究，这些研究强调了肌腱的神经支配、肌腱病中病理性神经萌芽神经元的生长，以及相关的疼痛和神经元介质的增加：慢性肌腱病的痛觉萌芽从肌腱旁进入纤维肌腱本体。经皮超声引导腱切开术（PUT）或高频超声干预等创新疗法有望通过腱旁分离来治疗这些神经病理性成分。这些方法的重点是破坏病理神经支配循环：结论：慢性肌腱痛可能主要是神经病理性的，是由病理神经元从肌腱旁向肌腱本体生长引起的。准确定位并破坏这些神经通路的干预措施可彻底改变肌腱病的治疗方法。要验证这些发现并改进治疗方法以确保安全性和有效性，还需要进一步的研究。

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来源期刊

Current Pain and Headache Reports CLINICAL NEUROLOGY-

CiteScore

6.10

自引率

2.70%

发文量

审稿时长

6-12 weeks

期刊介绍： This journal aims to review the most important, recently published clinical findings regarding the diagnosis, treatment, and management of pain and headache. By providing clear, insightful, balanced contributions by international experts, the journal intends to serve all those involved in the care and prevention of pain and headache. We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas, such as anesthetic techniques in pain management, cluster headache, neuropathic pain, and migraine. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. An international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research. Commentaries from well-known figures in the field are also provided.