Alfredson Håkan
Umeå University, Department of Surgical and Perioperative Science, Sports Medicine, Umeå, Sweden.
Curr Drug Targets. 2004 Jul;5(5):407-10. doi: 10.2174/1389450043345353.
In previous studies we found high concentrations of the neurotransmitter glutamate in chronic painful tendons. To evaluate the possible importance, the high intra-tendinous glutamate concentrations had for the pain suffered in chronic Achilles tendinosis, microdialysis was performed before and after treatment. The results showed that in patients that were pain-free after treatment there were no significant differences in the glutamate levels before compared to after treatment. With this finding in mind, also other possibly pain-related mechanisms were evaluated. Using ultrasonography and colour doppler technique, we found that in chronic painful tendinosis tendons, but not in normal pain-free tendons, there was a neovascularisation inside and outside the area with structural tendon changes and pain. To test the hypothesis that there was an association between neovascularisation and pain, in a pilot study, under ultrasound and colour doppler guidance the area with neovascularisation was destroyed by injecting the sclerosing agent Polidocanol. The clinical results showed that 8/10 patients were pain-free and had no remaining neovessels. The 2 patients that were not pain-free had remaining neovessels. In a following investigation combining ultrasonography + colour doppler, immunohistochemical analyses of biopsies, and diagnostic injections, the results showed that in the area with tendon changes and neovascularisation, biopsies showed nerve structures in close relation to the blood vessels, and injections of local anaesthesia temporarily cured the pain in all patients. Altogether, the findings indicate that the area with neovascularisation (neovessels and nerves) might be responsible for the pain suffered in chronic Achilles tendinosis, and that a locally administrated (in the area with neovascularisation) sclerosing drug (Polidocanol) has the potential to cure the pain.
在之前的研究中，我们发现慢性疼痛的肌腱中神经递质谷氨酸盐的浓度很高。为了评估肌腱内谷氨酸盐高浓度对慢性跟腱炎疼痛的可能重要性，在治疗前后进行了微透析。结果显示，治疗后无痛的患者，治疗前和治疗后的谷氨酸水平没有显著差异。基于这一发现，我们还评估了其他可能与疼痛相关的机制。使用超声和彩色多普勒技术，我们发现，在慢性疼痛性肌腱病的肌腱中，而非正常无痛的肌腱中，在结构发生改变且疼痛的区域内外存在新生血管形成。为了验证新生血管形成与疼痛之间存在关联这一假设，在一项初步研究中，在超声和彩色多普勒引导下，通过注射硬化剂聚多卡醇破坏新生血管形成的区域。临床结果显示，10名患者中有8名无痛且没有残留的新生血管。另外2名仍有疼痛症状的患者有残留新生血管。在接下来一项结合超声 + 彩色多普勒、活检组织的免疫组化分析以及诊断性注射的研究中，结果显示，在肌腱发生改变且有新生血管形成的区域，活检显示神经结构与血管密切相关，并且局部注射麻醉剂能暂时缓解所有患者的疼痛。总之，这些发现表明，新生血管形成的区域（新生血管和神经）可能是慢性跟腱炎疼痛的原因，并且局部应用（在新生血管形成区域）硬化药物（聚多卡醇）有治愈疼痛的潜力。
