Pain is the main symptom in entheseal diseases (enthesopathies) despite a paucity of nerve endings in the enthesis itself. Eicosanoids, cytokines, and neuropeptides released during inflammation and repeated nonphysiologic mechanical challenge not only stimulate or sensitize primary afferent neurons present in structures adjacent to the enthesis, but also trigger a “neurovascular invasion” that allows the spreading of nerves and blood vessels into the enthesis. Nociceptive pseudounipolar neurons support this process by releasing neurotransmitters from peripheral endings that induce neovascularization and peripheral pain sensitization. This process may explain the frequently observed dissociation between subjective symptoms such as pain and the structural findings on imaging in entheseal disease.

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附着点痛的概念

尽管附着点本身缺乏神经末梢，但疼痛是附着点疾病（附着点病）的主要症状。在炎症和反复的非生理性机械挑战期间释放的类花生酸、细胞因子和神经肽不仅刺激或敏感存在于附着点附近结构中的初级传入神经元，而且还会引发“神经血管入侵”，从而使神经和血管扩散到附着点中. 伤害性假单极神经元通过从外周末梢释放神经递质来支持这一过程，这些神经递质诱导新血管形成和外周痛敏化。这个过程可以解释在附着点疾病中经常观察到的主观症状（如疼痛）与影像学结构发现之间的分离。