Neural Modification To Treat Chronic Tendinopathy: Emerging Evidence and Opportunities for Pain Practitioners - A...

Area of Science:

• Orthopedics
• Pain Medicine
• Regenerative Medicine

Background:

• Chronic tendinopathy significantly impacts athletes and the general population, often necessitating surgical intervention.
• Neurogenic mechanisms, including nerve ingrowth and neovascularization, are increasingly recognized as central to chronic tendon pain.
• Conventional treatments for tendinopathy have limited success, driving the need for novel therapeutic strategies.

Purpose of the Study:

• To systematically review procedural interventions for chronic tendinopathy, focusing on neurogenic mechanisms.
• To evaluate the efficacy and safety of treatments targeting chronic tendon neurogenesis.
• To assess percutaneous and surgical approaches for managing tendinopathy effectively.

Main Methods:

• Systematic review of eleven clinical studies.
• Inclusion of interventions targeting nerve ingrowth: high-volume injections (HVIs), sclerosing injections, radiofrequency microtenotomy, minimally invasive stripping, electrocoagulation, and surgical procedures.
• Analysis of studies with moderate methodological quality (MINORS scores 10-13).

Main Results:

• Pooled analysis showed significant pain reduction (VAS pain: -33.15 mm) and functional improvement (VAS function: -29.28 mm).
• Notable improvements in VISA scores (23.90 points) and reduced disability levels (mean change: 3.20).
• Interventions targeting nerve ingrowth demonstrated promising outcomes in reducing pain and enhancing function.

Conclusions:

• Procedural treatments targeting neurogenic mechanisms are effective for chronic tendinopathy.
• These interventions significantly reduce pain and improve functional capabilities.
• Further robust trials are needed due to variability in study quality, but neurogenic targeting strategies show potential to revolutionize tendinopathy treatment.