UBC Theses and Dissertations
Nervous system sensitisation in musculoskeletal pain syndromes Solomons, Lyndal
There is evidence that nervous system sensitisation plays a role in the chronicity of persistent musculoskeletal pain syndromes. The component mechanisms of sensitisation involved, however, and the extent to which they contribute to overall pain states, are not well understood. It is expected that a better understanding of the role these mechanisms play in chronic musculoskeletal pain would inform more effective intervention strategies. This thesis aimed to contribute to this understanding by investigating nervous system sensitisation processes involved in chronic musculoskeletal pain syndromes in general, and also specifically in two common persistent tendon pain problems - midportion Achilles tendinopathy and subacromial pain syndrome. The first study in this thesis is a randomised controlled trial that investigates whether Gunn Intramuscular Stimulation (IMS), a form of intramuscular dry needling (IMDN) which aims to reduce nervous system sensitisation, adds therapeutic benefit beyond the use of rehabilitative exercise for midportion Achilles tendinopathy. The second study is an observational study that uses quantitative sensory testing (QST) and pain mapping to investigate nervous system sensitisation processes in subacromial pain syndrome. The third study is a systematic review and meta-analysis that investigates whether impaired condition pain modulation, a type of nervous system sensitisation, is present in chronic musculoskeletal pain syndromes. The general conclusions were: (1) that no additional therapeutic benefit was gained by the addition of IMDN to rehabilitative exercise for midportion Achilles tendinopathy, (2) that there is nervous system sensitisation to pressure pain present locally, segmentally and remotely/extrasegmentally in SAPS, as well as spreading pain, i.e., pain that is experienced outside the receptive fields of nociceptors innervating the affected tissue, and (3) that conditioned pain modulation is impaired in chronic musculoskeletal pain syndromes, but that only a low level of confidence can be placed in this conclusion as the quality of the body of research in this area is only moderate and there is evidence of publication bias.
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