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Review
. 2022 Jul 20;10(7):1749.
doi: 10.3390/biomedicines10071749.

Tendinopathies and Pain Sensitisation: A Meta-Analysis with Meta-Regression

Davide Previtali  1 , Alberto Mameli  1 , Stefano Zaffagnini  2 , Paolo Marchettini  3   4 , Christian Candrian  1   5 , Giuseppe Filardo  1   5   6
Affiliations
Review

Tendinopathies and Pain Sensitisation: A Meta-Analysis with Meta-Regression

Davide Previtali et al. Biomedicines. .

Abstract

The presence of pain sensitisation has been documented and reported as being a possible cause of treatment failure and pain chronicity in several musculoskeletal conditions, such as tendinopathies. The aim of the present study is to analyse existing evidence on pain sensitisation in tendinopathies comparing the local and distant pain thresholds of healthy and affected subjects with distinct analysis for different tendinopathies. PubMed, Cochrane Central Register, Scopus, and Web Of Science were systematically searched after registration on PROSPERO (CRD42020164124). Level I to level IV studies evaluating the presence of pain sensitisation in patients with symptomatic tendinopathies, documented through a validated method, were included. A meta-analysis was performed to compare local, contralateral, and distant pain thresholds between patients and healthy controls with sub-analyses for different tendinopathies. Meta-regressions were conducted to evaluate the influence of age, activity level, and duration of symptoms on results. Thirty-four studies out of 2868 were included. The overall meta-analysis of local pressure pain thresholds (PPT) documented an increased sensitivity in affected subjects (p < 0.001). The analyses on contralateral PPTs (p < 0.001) and distant PPTs (p = 0.009) documented increased sensitivity in the affected group. The results of the sub-analyses on different tendinopathies were conflicting, except for those on lateral epicondylalgia. Patients’ activity level (p = 0.02) and age (p = 0.05) significantly influenced local PPT results. Tendinopathies are characterized by pain sensitisation, but, while features of both central and peripheral sensitisation can be constantly detected in lateral epicondylalgia, results on other tendinopathies were more conflicting. Patients’ characteristics are possible confounders that should be taken into account when addressing pain sensitisation.

Keywords: pain; pain sensitisation; tendinopathy.

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Conflict of interest statement

The authors declare that P.M. is a consultant for Chiesi Farmaceutici Parma, and is a paid speaker for Pfizer Italia; C.C. has received institutional support outside the present work from Medacta International SA, Johnson & Johnson, Lima Corporate, Zimmer Biomet, and Oped AG; S.Z. received personal fees from I+ SRL, research grants outside the submitted work from Fidia Farmaceutici SPA, CartiHeal Ltd., IGEA clinical biophysics, BIOMET, and Kensey Nash, and has a patent Springer with royalties paid.

Figures

Figure 1
Figure 1
PRISMA flowchart of the study selection process.
Figure 2
Figure 2
Results of the meta-analysis on local pressure pain thresholds.
Figure 3
Figure 3
Results of the meta-analysis on local heat and cold pain thresholds.
Figure 4
Figure 4
Results of the meta-analysis on contralateral pressure pain thresholds.
Figure 5
Figure 5
Results of the meta-analysis on distant pressure pain thresholds.
See this image and copyright information in PMC

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