ABSTRACT
Background The presence of high blood flow in the structurally abnormal and painful regions of tendinosis, but not in the normal pain-free tendons, was recently confirmed by colour Doppler (CD) ultrasound (US). Biopsies from the regions with high blood flow demonstrated the presence of sympathetic and sensitive nerve fibres juxtapositioned to neovessels. Grey-scale US and CD are reliable methods used to evaluate structural homogeneity, thickness, and blood flow in the peripheral tendons. The aim of this study was to utilize CD to qualitatively evaluate for the presence of abnormal high blood flow in paravertebral tissues after whiplash injuries in patients with chronic neck pain. Methods Twenty patients with chronic neck pain after whiplash-associated disorder (WAD) and 20 pain-free control subjects were included in the study. The same experienced radiologist performed all grey-scale US and CD examinations. Results More regions with high blood flow were observed in the patient group than in the control group. At all levels, the high blood flow pattern was detected at the enthesis of the spinous processes and bilaterally juxtapositioned to the facet joints. Conclusion All regions identified by the patients as painful and tender corresponded to the positive high blood flow found during the CD examination. Implications These findings document increased blood-flow/neovascularisation at insertions of neck muscles which may indicate that there are pathological neovascularisation with accomanying pain-and sympathetic nerves, similar to what has been found in Achilles-tendinosis. These findings promise that similar treatments that now is successful with Achilles tendinosis, may be effective in the WAD-painful muscle insertions of the neck.
ABSTRACT
Significant progress has been made in interventional pain management. Despite this progress, patients continue to present a diagnostic and therapeutic challenge. Steroidal and nonsteroidal anti-inflammatory medications have limited use in degenerative painful conditions of connective tissue. Regenerative injection therapy, also known as prolotherapy, is a viable, type-specific treatment for such pathology. Several placebo-controlled studies, together with uncontrolled studies, indicate the effectiveness of regenerative injection therapy in treating painful ligament and tendon pathology. As stated in July 2003 by Mooney, this treatment has advanced "from the fringe to the frontier of medical care."
