Nearly half of patients with chronic tendinopathy may have a neuropathic pain component, with significant differences seen between different tendon sites: a prospective cohort of more than 300 patients

Abstract

ObjectivesIdentifying the prevalence of neuropathic pain components in patients with chronic tendinopathy conditions using the Self-Administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) questionnaire.MethodsPatients with chronic tendinopathy and ‘tendon-like’ conditions treated within a single hospital outpatient clinic specialising in tendinopathy were identified. Pain scores, plus global function patient-reported outcome measures (5-Level version of EuroQol-5 Dimension and Musculoskeletal Health Questionnaire (MSK-HQ)), were completed and compared with the S-LANSS questionnaireResults341 suitable patients with chronic tendinopathy and potentially similar conditions were identified. Numbers: lateral elbow tendinopathy (39), greater trochanteric pain syndrome (GTPS; 112), patellar tendinopathy (11), non-insertional Achilles tendinopathy (40), insertional Achilles tendinopathy (39), plantar fasciopathy (100). 68% were female, with a mean age of 54.0±11.3 years and a mean symptom duration of 38.1±33.7 months.There was a mean S-LANSS score of 11.4±6.4. Overall, 47% of patients scored 12 or greater points on S-LANSS, indicating the possible presence of neuropathic pain. The highest proportion was in patients with plantar fasciopathy (61%), the lowest in those with GTPS (33%). Weak correlations were found between the S-LANSS score and MSK-HQ score, the numerical rating scale (0–10) values for ‘average pain’ and for ‘worst pain’, but not with the MSK-HQ %health value.ConclusionS-LANSS identified nearly half of patients with chronic tendinopathy as possibly having a neuropathic pain component. This is of unclear clinical significance but worth further study to see if/how this may relate to treatment outcomes. These results are from a single hospital clinic dealing with patients with chronic tendinopathy, without a control group or those with shorter symptom duration. However, this reinforces the probability of neuropathic pain components in at least some patients with chronic tendinopathy.

Is shockwave therapy effective in the management of greater trochanteric pain syndrome? A systematic review and meta‐analysis

“…However, there were limitations identified that impact the applicability of conclusions to clinical practice. All but two studies (Wheeler, 2022a; Wheeler et al., 2022) failed to consider confounding subject baseline psychological comorbidities such as centrally sensitised pain states, anxiety and depression, that can adversely impact GTPS symptomology (Boyd et al., 2020; French et al., 2019; Wheeler, 2022b), and potential SWT treatment response (Peinemann et al., 2013; Walker et al., 2006). Consistent with the literature (Appendixs and ), clinical assessment and diagnosis of GTPS varied across included studies (Appendix ), reducing the likelihood that GTPS was the primary pathology being treated with SWT.…”

“…As GTPS symptoms are often aggravated by sitting, walking, climbing stairs and with ipsilateral side lying (Fearon et al., 2012; McAuliffe et al., 2020), sufferers often complain of reduced mobility, sleep and function (Grimaldi & Fearon, 2015; Long et al., 2013). Consequently, GTPS has been linked with heightened levels of psychological and psychosocial dysfunction (Boyd et al., 2020; Ferrer‐Pena et al., 2019b; McAuliffe et al., 2020) leading to central sensitisation (French et al., 2019; Wheeler, 2022b) and a subsequent chronic pain state (Boyd et al., 2020; Ferrer‐Pena et al., 2019a), further reducing the likelihood of symptom resolution (Anderson et al., 2014; Main et al., 2008). Given the detrimental impact of GTPS on the quality of life, optimising management strategies becomes imperative.…”