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5. <strong>QST</strong> in patients with tendinopathy 3.3. Questionnaires None of the injured athletes scored 3 points or higher on the DN-4. The SCL-90 and the POMS demonstrated no significant differences between injured and non-injured athletes (Table 5-3). Table 5-3: Results on the Mann Whitney U test; SCL-90 and POMS.
5. <strong>QST</strong> in patients with tendinopathy 4. Discussion Although most quantitative sensory tests demonstrated similar results for the patient group and the control group, we found several interesting differences. We found significant differences in mechanical pain threshold and vibration disappearance threshold in athletes with a chronic PT compared to healthy controls. In patients with PT no signs of mechanical dynamic allodynia could be found. No psychological differences between the two groups could be detected. Mechanisms of peripheral and central sensitisation have been described in several musculoskeletal disorders, such as chronic low back pain, fibromyalgia, whiplash, myofascial pain syndrome and other pain syndromes such as irritable bowel syndrome, chronic headache etc. (Nijs et al 2010; Winkelstein 2004; Yunus 2009). In sports injuries the role of sensitisation or lowered pain thresholds i.e. hyperalgesia has been described in patients with shoulder impingement (Hidalgo-Lozano et al 2010) and patellofemoral pain syndrome (Jensen et al 2008). In our study injured athletes showed considerable and significant aberrations of the mechanical pain threshold (MPT). This pinprick allodynia reflects the involvement of central sensitisation upon the peripheral input from the myelinated (Aδ-fibre) nociceptive input (Davis & Pope 2002; Keizer et al 2008). A reduced pain threshold of Aδ-fibre nociceptors is a plausible explanation why pain occurs during or shortly after sports activities. Such phenomenon is described to be very characteristic for (patellar) tendinopathy and is referred to in the classification of PT (Blazina et al 1973). A reduction of mechanical pain thresholds can be an explanation why sports activities that normally do not induce pain now become painful. Sensitisation accounts for the presence of a mechanical or kinetic allodynia in PT and is therefore a logical explanation for the occurrence of pain in the patellar tendon during or after activities. The vibration disappearance threshold (VDT) is a continuum measure, the differences found in VDT means that patients feel the vibration for a longer (median 6.25) period of time compared to the healthy subjects. This hyperesthesia could be regarded as a sign of an increased sensitivity in somatosensory function. The clinical relevance of this finding is difficult to interpret and has not been described previously. Further evidence that sensitisation might play a role in PT is that mechanical pain sensitivity was increased in patients. Webborn (2008) indicated that the pain in tendinopathy can possibly be seen as neuropathic pain (Webborn 2008). According to the IASP definition neuropathic pain is related to lesions within the nervous system (diagnoses such as diabetes, herpes zoster, poly-neuropathy or post surgery neuralgias) or as a dysfunction (low back pain, fibromyalgia) (Merskey & Bogduk 2004). Treede et al. (2008) suggested replacing the word ‘dysfunction’ with ‘disease’. Neuropathic pain should be demonstrated with
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Quantitative Sensory Testing (QST)
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Promotores: Prof. dr. M.M.R.F. Stru
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Paranimfen Marten Harbers Aribert B
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Contents 3.3.4. Sensory changes at
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0 Contents Chapter 5 Do patients wi
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Chapter 1 General introduction
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1. General introduction stimuli. C-
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1. General introduction Patients re
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1. General introduction 0 drugs (NS
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1. General introduction Table 1-2:
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Chapter 2 Bilateral sensory abnorma
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2. Bilateral abnormalities in neuro
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Quantitative Sensory Testing (QST) - Does assessing ... - TI Pharma

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