Abstract
BackgroundSympathetic activity and insulin resistance have recently been linked with chronic tendon and musculoskeletal pain. Polycystic ovarian syndrome is linked with insulin resistance and increased sympathetic drive and was therefore an appropriate condition to study the effects of modulating sympathetic activity on Achilles tendon and musculoskeletal symptoms.MethodsA secondary analysis of a double-blinded, randomised controlled trial on women with polycystic ovarian syndrome was conducted. Participants received 12 weeks of moxonidine (n = 14) or placebo (n = 18). Musculoskeletal symptom and Victorian Institute of Sport Assessment – Achilles (VISA-A) questionnaires were distributed, and ultrasound tissue characterisation quantified tendon structure at 0 and 12 weeks. 2-way ANOVA was used for multiple comparisons.ResultsThere was no difference in mean change in musculoskeletal symptoms (− 0.6 ± 1.7 vs − 0.4 ± 1.8, p = 0.69) or VISA-A (moxonidine − 0.2 ± 8.8 vs placebo + 4.2 ± 14.6, p = 0.24) attributable to the intervention. There was no difference in any measures of Achilles structure. Moxonidine did not reduce sympathetic drive when compared to placebo.ConclusionsThis was the first study to investigate the effects of blocking sympathetic drive on musculoskeletal and Achilles tendon symptoms in a metabolically diverse population. While the study was limited by small sample size and lack of sympathetic modulation, moxonidine did not change tendon pain/structure or musculoskeletal symptoms.Trial registrationClinicalTrials.gov, NCT01504321. Registered 5 January 2012.
Highlights
Sympathetic activity and insulin resistance have recently been linked with chronic tendon and musculoskeletal pain
The sympathetic nervous system (SNS), insulin resistance, type 2 diabetes mellitus (T2DM), dyslipidaemia, and visceral adiposity have been identified as potential contributors to MSK pain, including tendinopathy [5,6,7]
The study was conducted in accordance with the Declaration of Helsinki and the protocol was granted ethics approval by the Alfred Hospital Human Research Ethics Committee and amended to include the outcomes required for this portion of the study
Summary
Sympathetic activity and insulin resistance have recently been linked with chronic tendon and musculoskeletal pain. Polycystic ovarian syndrome is linked with insulin resistance and increased sympathetic drive and was an appropriate condition to study the effects of modulating sympathetic activity on Achilles tendon and musculoskeletal symptoms. Among individuals with tendon pain, SNS activity is higher in people with longer symptom duration and correlates with poorer tendon structure [11]. Together, these observations raise the possibility that the SNS plays a role in the chronicity of tendinopathy and structural change within the tendon
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