Local hyperalgesia, normal endogenous modulation with pain report beyond its origin: a pilot study prompting further exploration into plantar fasciopathy

Henrik Riel 1 , Melanie L. Plinsinga 2 , Rebecca Mellor 2 , Shellie A. Boudreau 3 , Viana Vuvan 2  and Bill Vicenzino 2
  • 1 Center for General Practice at Aalborg University, Fyrkildevej 7, Aalborg East, Denmark
  • 2 The University of Queensland, School of Health and Rehabilitation Sciences: Physiotherapy: Sports Injury Rehabilitation and Prevention for Health, St. Lucia QLD, Australia
  • 3 Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Fredrik Bajers Vej 7D, Aalborg East, Denmark
Henrik Riel
  • Corresponding author
  • Center for General Practice at Aalborg University, Fyrkildevej 7, Aalborg East, Denmark
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, Melanie L. Plinsinga
  • The University of Queensland, School of Health and Rehabilitation Sciences: Physiotherapy: Sports Injury Rehabilitation and Prevention for Health, St. Lucia QLD, Australia
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, Rebecca Mellor
  • The University of Queensland, School of Health and Rehabilitation Sciences: Physiotherapy: Sports Injury Rehabilitation and Prevention for Health, St. Lucia QLD, Australia
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, Shellie A. Boudreau
  • Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Fredrik Bajers Vej 7D, Aalborg East, Denmark
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, Viana Vuvan
  • The University of Queensland, School of Health and Rehabilitation Sciences: Physiotherapy: Sports Injury Rehabilitation and Prevention for Health, St. Lucia QLD, Australia
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and Bill Vicenzino
  • The University of Queensland, School of Health and Rehabilitation Sciences: Physiotherapy: Sports Injury Rehabilitation and Prevention for Health, St. Lucia QLD, Australia
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Abstract

Background and aims

Persistent tendinopathies were previously considered solely as peripheral conditions affecting the local tendinous tissue until quantitative sensory testing identified involvement of altered pain processing. In similar fashion, pain in patients with persistent plantar fasciopathy may also involve more than local tissue. The aim of this pilot study was to investigate potential differences in conditioned pain modulation and pressure and thermal pain thresholds, between individuals with PF and healthy pain-free controls, as a precursor to a larger-scale study.

Methods

We assessed 16 individuals with plantar fasciopathy and 11 pain-free controls. Plantar fasciopathy diagnosis was: palpation pain of the medial calcaneal tubercle or the proximal plantar fascia, duration ≥3 months, pain intensity ≥2/10, and ultrasound-measured plantar fascia thickness ≥4 mm. Quantitative sensory tests were performed locally at the plantar heel and remotely on the ipsilateral elbow. Assessments included pain thresholds for pressure, heat and cold, and conditioned pain modulation measured as change in local resting pressure pain threshold with cold water hand immersion. Participants rated pain intensity at pain threshold. Additionally, the area and distribution of plantar fasciopathy pain was drawn on a digital body chart of the lower limbs. Descriptive analyses were performed and between-group differences/effects expressed as standardised mean differences (d).

Results

There was no conditioned pain modulation difference between participants with plantar fasciopathy and controls (d = 0.1). Largest effects were on local pressure pain threshold and reported pain intensity on pressure pain threshold (d > 1.8) followed by pain intensity for heat and cold pain thresholds (d = 0.3–1.5). According to the digital body chart, pain area extended beyond the plantar heel.

Conclusions

The unlikelihood of a difference in conditioned pain modulation yet a pain area extending beyond the plantar heel provide a basis for exploring altered pain processing in a larger-scale study.

Implications

This was the first study to investigate the presence of altered pain processing in individuals with plantar fasciopathy using a conditioned pain modulation paradigm and thermal pain thresholds. We found no indication of an altered pain processing based on these measures, however, patients rated pain higher on thresholds compared to controls which may be important to clinical practice and warrants further exploration in the future.

    • Supplementary material
  • [1]

    Taunton JE, Ryan MB, Clement DB, McKenzie DC, Lloyd-Smith DR, Zumbo BD. A retrospective case-control analysis of 2002 running injuries. Br J Sports Med 2002;36:95–101.

    • Crossref
    • PubMed
    • Export Citation
  • [2]

    Albers IS, Zwerver J, Diercks RL, Dekker JH, Van den Akker-Scheek I. Incidence and prevalence of lower extremity tendinopathy in a Dutch general practice population: a cross sectional study. BMC Musculoskelet Disord 2016;17:16.

    • Crossref
    • Export Citation
  • [3]

    Riel H, Cotchett M, Delahunt E, Rathleff MS, Vicenzino B, Weir A, Landorf KB. Is ‘plantar heel pain’ a more appropriate term than ‘plantar fasciitis’? Time to move on. Br J Sport Med 2017;51:1576–7.

    • Crossref
    • Export Citation
  • [4]

    Landorf KB. Plantar heel pain and plantar fasciitis. BMJ Clin Evid 2015.

    • PubMed
    • Export Citation
  • [5]

    Goff JD, Crawford R. Diagnosis and treatment of plantar fasciitis. Am Fam Physician 2011;84:676–82.

    • PubMed
    • Export Citation
  • [6]

    Tompra N, van Dieën JH, Coppieters MW. Central pain processing is altered in people with Achilles tendinopathy. Br J Sports Med 2016;50:1004–7.

    • Crossref
    • PubMed
    • Export Citation
  • [7]

    Coombes BK, Bisset L, Vicenzino B. Cold hyperalgesia associated with poorer prognosis in lateral epicondylalgia. Clin J Pain 2015;31:30–5.

    • Crossref
    • PubMed
    • Export Citation
  • [8]

    Heales LJ, Lim ECW, Hodges PW, Vicenzino B, Vicenzino B. Sensory and motor deficits exist on the non-injured side of patients with unilateral tendon pain and disability–implications for central nervous system involvement: a systematic review with meta-analysis. Br J Sports Med 2014;48:1400–6.

    • Crossref
    • Export Citation
  • [9]

    Skou ST, Graven-Nielsen T, Rasmussen S, Simonsen OH, Laursen MB, Arendt-Nielsen L. Widespread sensitization in patients with chronic pain after revision total knee arthroplasty. Pain 2013;154:1588–94.

    • Crossref
    • PubMed
    • Export Citation
  • [10]

    Vaegter HB, Handberg G, Graven-Nielsen T. Similarities between exercise-induced hypoalgesia and conditioned pain modulation in humans. Pain 2014;155:158–67.

    • Crossref
    • PubMed
    • Export Citation
  • [11]

    Lannersten L, Kosek E, Kosek E. Dysfunction of endogenous pain inhibition during exercise with painful muscles in patients with shoulder myalgia and fibromyalgia. Pain 2010;151:77–86.

    • Crossref
    • PubMed
    • Export Citation
  • [12]

    Plinsinga ML, Brink MS, Vicenzino B, Van Wilgen CP. Evidence of nervous system sensitization in commonly presenting and persistent painful tendinopathies: a systematic review. J Orthop Sports Phys Ther 2015;45:864–75.

    • Crossref
    • PubMed
    • Export Citation
  • [13]

    Plaza-Manzano G, Ríos-León M, Martín-Casas P, Arendt-Nielsen L, Fernández-de-las-Peñas C, Ortega-Santiago R. Widespread pressure pain hypersensitivity in musculoskeletal and nerve trunk areas as sign of altered nociceptive processing in unilateral plantar heel pain. J Pain 2019;20:60–67.

    • Crossref
    • PubMed
    • Export Citation
  • [14]

    Fernández-Lao C, Galiano-Castillo N, Cantarero-Villanueva I, Martín-Martín L, Prados-Olleta N, Arroyo-Morales M. Analysis of pressure pain hypersensitivity, ultrasound image, and quality of life in patients with chronic plantar pain: A preliminary study. Pain Med (United States) 2016;17:1530–41.

  • [15]

    Saban B, Masharawi Y. Pain threshold tests in patients with heel pain syndrome. Foot Ankle Int 2016;37:730–6.

    • Crossref
    • PubMed
    • Export Citation
  • [16]

    Backonja MM, Attal N, Baron R, Bouhassira D, Drangholt M, Dyck PJ, Edwards RR, Freeman R, Gracely R, Haanpaa MH, Hansson P, Hatem SM, Krumova EK, Jensen TS, Maier C, Mick G, Rice AS, Rolke R, Treede R-D, Serra J, et al. Value of quantitative sensory testing in neurological and pain disorders: NeuPSIG consensus. Pain 2013;154:1807–19.

    • Crossref
    • PubMed
    • Export Citation
  • [17]

    Rolke R, Baron R, Maier C, Tölle TR, Treede R-D, Beyer A, Binder A, Birbaumer N, Birklein F, Bötefür IC, Braune S, Flor H, Huge V, Klug R, Landwehrmeyer GB, Magerl W, Maihöfner C, Rolko C, Schaub C, Scherens A, et al. Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): standardized protocol and reference values. Pain 2006;123:231–43.

    • Crossref
    • PubMed
    • Export Citation
  • [18]

    Vaegter HB, Handberg G, Graven-Nielsen T. Hypoalgesia after exercise and the cold pressor test is reduced in chronic musculoskeletal pain patients with high pain sensitivity. Clin J Pain 2016;32:58–69.

    • Crossref
    • PubMed
    • Export Citation
  • [19]

    Boudreau SA, Royo AC, Matthews M, Graven-Nielsen T, Kamavuako EN, Slabaugh G, Thorborg K, Vicenzino B, Rathleff MS. Distinct patterns of variation in the distribution of knee pain. Sci Rep 2018;8:16522.

    • Crossref
    • PubMed
    • Export Citation
  • [20]

    Boudreau SA, Kamavuako EN, Rathleff MS. Distribution and symmetrical patellofemoral pain patterns as revealed by high-resolution 3D body mapping: a cross-sectional study. BMC Musculoskelet Disord 2017;18:160.

    • Crossref
    • PubMed
    • Export Citation
  • [21]

    von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007;370:1453–7.

    • Crossref
    • PubMed
    • Export Citation
  • [22]

    World Medical Association Declaration of Helsinki. JAMA 2013;310:2191.

    • PubMed
    • Export Citation
  • [23]

    McMillan AM, Landorf KB, Gilheany MF, Bird AR, Morrow AD, Menz HB. Ultrasound guided corticosteroid injection for plantar fasciitis: randomised controlled trial. BMJ 2012;344:e3260.

    • Crossref
    • PubMed
    • Export Citation
  • [24]

    Skovdal Rathleff M, Moelgaard C, Lykkegaard Olesen J. Intra- and interobserver reliability of quantitative ultrasound measurement of the plantar fascia. J Clin Ultrasound 2011;39:128–34.

    • Crossref
    • PubMed
    • Export Citation
  • [25]

    Pud D, Granovsky Y, Yarnitsky D. The methodology of experimentally induced diffuse noxious inhibitory control (DNIC)-like effect in humans. Pain 2009;144:16–9.

    • Crossref
    • PubMed
    • Export Citation
  • [26]

    Soon B, Vicenzino B, Schmid AB, Coppieters MW. Facilitatory and inhibitory pain mechanisms are altered in patients with carpal tunnel syndrome. PLoS One 2017;12:e0183252.

    • Crossref
    • PubMed
    • Export Citation
  • [27]

    Boudreau SA, Badsberg S, Christensen SW, Egsgaard LL. Digital pain drawings: Assessing touch-screen technology and 3D body schemas. Clin J Pain 2016;32:139–45.

    • Crossref
    • PubMed
    • Export Citation
  • [28]

    Boudreau SA, Spence R, Vasov G, Egsgaard LL. Feature extraction APP for pain profiles. Biosyst Biorobotics 2014;7:853–4.

    • Crossref
    • Export Citation
  • [29]

    Budiman-Mak E, Conrad KJ, Roach KE. The foot function index: a measure of foot pain and disability. J Clin Epidemiol 1991;44:561–70.

    • Crossref
    • PubMed
    • Export Citation
  • [30]

    Kelly KG, Cook T, Backonja M-M. Pain ratings at the thresholds are necessary for interpretation of quantitative sensory testing. Muscle Nerve 2005;32:179–84.

    • Crossref
    • PubMed
    • Export Citation
  • [31]

    Billingham SAM, Whitehead AL, Julious SA. An audit of sample sizes for pilot and feasibility trials being undertaken in the United Kingdom registered in the United Kingdom Clinical Research Network database. BMC Med Res Methodol 2013;13:104.

    • Crossref
    • PubMed
    • Export Citation
  • [32]

    Eldridge SM, Chan CL, Campbell MJ, Bond CM, Hopewell S, Thabane L, Lancaster G. CONSORT 2010 statement: extension to randomised pilot and feasibility trials. BMJ 2016;355:i5239.

    • PubMed
    • Export Citation
  • [33]

    Plinsinga ML, van Wilgen CP, Brink MS, Vuvan V, Stephenson A, Heales LJ, Mellor R, Coombes BK, Vicenzino B. Patellar and Achilles tendinopathies are predominantly peripheral pain states: a blinded case control study of somatosensory and psychological profiles. Br J Sports Med 2018;52:284–91.

    • Crossref
    • Export Citation
  • [34]

    Bisset L, Carty M, Smith A. Unilateral lateral epicondylalgia demonstrates a pro-nociceptive pain profile: a case control observational study. Clin J Pain 2018;34:954–59.

  • [35]

    Schmid AB, Soon BT, Wasner G, Coppieters MW. Can widespread hypersensitivity in carpal tunnel syndrome be substantiated if neck and arm pain are absent? Eur J Pain 2012;16:217–28.

    • Crossref
    • PubMed
    • Export Citation
  • [36]

    Cotchett M, Lennecke A, Medica VG, Whittaker GA, Bonanno DR. The association between pain catastrophising and kinesiophobia with pain and function in people with plantar heel pain. Foot 2017;32:8–14.

    • Crossref
    • Export Citation
  • [37]

    Martin RL, Davenport TE, Reischl SF, McPoil TG, Matheson JW, Wukich DK, McDonough CM. Heel Pain – Plantar Fasciitis: Revision 2014. J Orthop Sport Phys Ther 2014;44:A1–33.

    • Crossref
    • Export Citation
  • [38]

    Moseley GL. Reconceptualising pain according to modern pain science. Phys Ther Rev 2007;12:169–78.

    • Crossref
    • Export Citation
  • [39]

    Zangger P, Keystone EC, Bogoch ER. Asymmetry of small joint involvement in rheumatoid arthritis: prevalence and tendency towards symmetry over time. Joint Bone Spine 2005;72:241–7.

    • Crossref
    • PubMed
    • Export Citation
  • [40]

    Hansen L, Krogh TP, Ellingsen T, Bolvig L, Fredberg U. Long-term prognosis of plantar fasciitis: A 5- to 15-year follow-up study of 174 patients with ultrasound examination. Orthop J Sport Med 2018;6:232596711875798.

    • Crossref
    • Export Citation
  • [41]

    van Leeuwen KDB, Rogers J, Winzenberg T, van Middelkoop M. Higher body mass index is associated with plantar fasciopathy/’plantar fasciitis’: systematic review and meta-analysis of various clinical and imaging risk factors. Br J Sports Med 2016;50:972–81.

    • Crossref
    • PubMed
    • Export Citation
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