Chronic pain in athletes: Is it time to change our point of view?   March 19th, 2016

The prevalence of chronic sports injuries is high, while the etiology and pathophysiological mechanisms have largely remained unknown. To date, the most commonly used approach is limited to a biomedical one, focused on abnormalities and inflammation. However, several cases have been described where nociception, inflammation and/or abnormalities cannot be regarded as plausible causes for a chronic sport injury. In these cases, it is reasonable to consider the possibility that sensitization mechanisms may contribute to the persistence of pain.

The presence of sensitization can be considered as an important neuropathic mechanism with dysfunction of the nervous system, seen in patients with fibromyalgia (Cagnie et al. 2014) and in subgroups of patients with chronic low back pain (Roussel et al. 2013). This dysfunction of the nervous system could be an explanation for the pain in chronic sports injuries as described by authors from both our and other research groups (Van Wilgen et al. 2011; Plinsinga et al. 2015; Jensen et al. 2008). This knowledge may have serious impact on the rehabilitation approach of athletes with chronic sports injuries, shifting from a pure biomedical to a biopsychosocial and neurophysiological point of view.

A neurophysiological rehabilitation approach could lead to the use of “anti-neuropathic drugs” such as tricyclic antidepressants and anticonvulsants instead of classic analgesics. Also, the use of behavioural treatments with established efficacy in other chronic pain populations might be considered in athletes with chronic sports injuries, shifting the primary focus to functionality instead of pain relief.

Anneleen Malfliet

2016  Pain in Motion

References and further reading:

Van Wilgen CP & Keizer D. (2011) Neuropathic pain mechanisms in patients with chronic sports injuries: a diagnostic model useful in sports medicine? Pain Medicine, 12(1), 110-7.

Plinsinga ML et al. (2015) Evidence of Nervous System Sensitization in Commonly Presenting and Persistent Painful Tendinopathies: A Systematic Review. J Orthop Sports Phys Ther, 21, 1-34.  

Jensen R et al. (2008) Is pain in patellofemoral pain syndrome neuropathic? Clin J Pain, 24, 384–94.