polidocanol and Pain

Several pharmacological interventions have been proposed for the management of Achilles tendinopathy, with no agreement on which is the overall best option available. This systematic review investigates the efficacy and safety of different local pharmacological treatments for Achilles tendinopathy.. We included only randomized controlled studies (RCTs) focusing on clinical and functional outcomes of therapies consisting in injection of a substance or local application. Assessment of the methodological quality was performed using a modified version of the Coleman methodology score (CMS) to determine possible risks of bias.. Thirteen RCTs were included with a total of 528 studied patients. Eleven studies reported the outcomes of injection therapies. Two studies examined the outcomes of patients who applied glyceryl trinitrate patch. The mean modified CMS was 70.6 out of 90.. There was no significant evidence of remarkable benefits provided by any of the therapies studied.. There is not univocal evidence to advise any particular pharmacological treatment as the best advisable non-operative option for Achilles tendinopathy as equivalent alternative to the most commonly used eccentric loading rehabilitation program. However, potential was shown by the combination of different substances administered with physical therapy.. There is a need for more long-term investigations, studying large enough cohort with standardized scores and evaluations shared by all the investigations to confirm the healing potential, and provide a stronger statistical comparison of the available treatments.

Topics: Achilles Tendon; Blood Transfusion, Autologous; Humans; Pain; Platelet-Rich Plasma; Polidocanol; Polyethylene Glycols; Practice Guidelines as Topic; Randomized Controlled Trials as Topic; Sclerosing Solutions; Tendinopathy; Treatment Outcome; United Kingdom; Wound Healing

The chronic painful tendon (tendinopathy, tendinosis) is generally considered difficult to treat, not seldom causing long-term disability and sometimes ending the sports or work carreér. Most common sites for tendinopathy are the Achilles-, patellar-, extensor carpi radialis brevis (ERCB)-, and supraspinatus tendons. The origin of pain has for many years been unknown, but recently, by using ultrasound (US) + colour Doppler (CD), immunohistochemical analyses of tendon biopsies, and diagnostic injections of local anaestesia, we found a close relationship between areas with vasculo-neural ingrowth and tendon pain. Sensory nerves (Substance-P-SP and Calcitonin Gene Related Peptide-CGRP) were found inside and outside the vascular wall. In following clinical studies we have demonstrated good short-and mid-term clinical results using treatment with US+CD-guided sclerosing polidocanol injections, targeting the area with neovessels outside the tendon. Two-year follow ups have showed remaining good clinical results, and sonographically signs of remodelling with a significantly thinner tendon with a more normal structure. Whether the effects of polidocanol are mediated through destruction of neovessels, activity on nerves or a combination, is under evaluation.

Topics: Humans; Neovascularization, Pathologic; Pain; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Tendons; Ultrasonography, Doppler, Color

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.

Topics: Achilles Tendon; Chronic Disease; Humans; Neovascularization, Pathologic; Pain; Pain Management; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Tendinopathy; Ultrasonography

This single-center, single-arm, prospective open-label trial is being conducted to evaluate the short-term efficacy and safety of percutaneous sclerotherapy with polidocanol foam for painful venous malformations. This study will include patients who were clinically diagnosed with venous malformation by using ultrasound and/or magnetic resonance imaging, and whose pain persisted even after treatment with medications. Written informed consent for sclerotherapy will be obtained from all patients. The institutional review board approved this prospective study protocol. The primary endpoint is pain relief at three months after sclerotherapy. Local pain related to venous malformation will be evaluated using a numeric rating scale. Patient recruitment commenced in December of 2020. Enrolment of 13 patients is planned over a 3-year recruitment period. Herein, we describe the details of the clinical trial protocol.

Topics: Humans; Pain; Polidocanol; Prospective Studies; Sclerosing Solutions; Sclerotherapy; Treatment Outcome; Vascular Malformations

Sclerotherapy is the treatment of choice for first-grade haemorrhoidal disease. Numerous studies have shown that sclerotherapy with foamed sclerosants is more efficacious than liquid in the treatment of varicose veins. The aim of this study was to assess the efficacy and safety of polidocanol foam in comparison with liquid for haemorrhoidal disease.. A total of 130 patients were randomised to foam or liquid sclerotherapy (polidocanol 3%). Patients with first-grade haemorrhoidal disease were included and blinded to treatment assignment. The primary endpoint was the stopping of perianal bleeding after one sclerotherapy session. Sclerotherapy was repeated until patients were free of bleeding (2-week intervals). The final follow-up was 12 weeks after the last sclerotherapy session.. In the foam group, significantly more patients (88%) were treated successfully after one sclerotherapy session compared to the liquid group (69%; p = 0.01). There was high patient satisfaction in both groups, but significantly more patients were satisfied with their treatment in the foam group than in the liquid group (99 vs. 84%; p = 0.009). Additionally, in the foam group, significantly less treatment sessions were required (p < 0.001), and the total amount of injected polidocanol was reduced (p < 0.001).. In the therapy of first-grade haemorrhoidal disease, polidocanol 3 % foam is more effective and equally safe compared to liquid polidocanol. The results of this trial show that foam sclerotherapy is a new, innovative, effective and safe non-surgical treatment option for haemorrhoidal disease.

Topics: Adult; Demography; Female; Hemorrhoids; Humans; Male; Pain; Patient Satisfaction; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy; Single-Blind Method; Treatment Outcome

Varicose veins are a common disorder and many treatment methods are available.. The aim of this study was to evaluate the short-term efficacy of foam sclerotherapy and the safety of performing the treatment in an outpatient clinic without ultrasound guidance. METHODS This was a prospective, nonrandomized study with foam sclerotherapy. All the patients were assessed before and after the procedure with a CEAP (Clinical, Etiology, Anatomy, Pathology) class and clinical score. At the same visit, duplex scanning was performed to evaluate the anatomic distribution of the varicose disease. The mean age of the patients was 49.2 years (SD,+/-10.6 years; median, 50.0 years). Altogether 41% of the legs had undergone a previous operation and 24% were recurrences. The follow-up time was 3 months.. Twenty-five patients with 27 legs were treated successfully using foam sclerotherapy without ultrasound guidance. Twenty-one cases (78%) involved the great saphenous vein and 6 cases (22%) involved the small saphenous vein. The mean bandage time was 7.7 days (SD,+/-2.50 days; median, 8.50 days). The CEAP score decreased 73% after the procedure from 2.61 (SD,+/-0.80; median, 2.0) to 0.71 (SD,+/-0.95; median, 0; p<.001). and the mean clinical score decreased 45% from 4.45 (SD,+/-1.96; median, 4.0) to 2.46 (SD,+/-1.50; median, 2.0; p<.001), respectively. Three months after the treatment, duplex scanning showed saphenofemoral reflux in 63% of the legs and saphenopopliteal reflux in 40% of the legs. The most common complication was postoperative thrombophlebitis (66%). Other minor complications included pain (38%) and hematoma (4%). There were no major complications. Subjectively, 71% of the patients assessed the procedure as good or excellent and 29% as acceptable or poor.. Foam sclerotherapy is also an effective and safe procedure when performed without duplex guidance. Thrombophlebitis is frequent when using a high concentration of polidocanol and a short bandage time. The high frequency of saphenofemoral and saphenopopliteal junction reflux after the procedure can have a negative effect on the long-term results.

Topics: Ambulatory Care; Female; Follow-Up Studies; Hematoma; Humans; Male; Middle Aged; Pain; Polidocanol; Polyethylene Glycols; Prospective Studies; Recurrence; Sclerosing Solutions; Sclerotherapy; Treatment Outcome; Ultrasonography; Varicose Veins

Sclerosing injections targeting neovascularisation have been demonstrated to give promising clinical results in patients with chronic painful Achilles tendinosis. In this study, fifteen elite or recreational athletes (12 men and three women) with the diagnosis patellar tendinosis/Jumper's knee in 15 patellar tendons were included. All the patients had a long duration of pain symptoms (mean = 23 months) from the patellar tendon, and ultra-sonography + colour doppler examination showed structural tendon changes with hypo-echoic areas and a neovascularisation, corresponding to the painful area. The patients were treated with ultrasound and colour doppler-guided injections of the sclerosing substance Polidocanol, targeting the area with neovascularisation. At follow-up (mean = 6 months) after a mean amount of three treatments, there was a good clinical result in 12/15 tendons. The patients were back to their previous (before injury) sport activity level, and the amount of pain recorded on a VAS-scale had decreased significantly (VAS from 81 to 10). Our findings indicate that treatment with sclerosing injections, targeting the area with neovessels in patellar tendinosis, has the potential to cure the pain in the tendons and also allow the patients to go back to full patellar-tendon loading activity.

Topics: Adult; Chronic Disease; Female; Follow-Up Studies; Humans; Injections, Intra-Articular; Knee Injuries; Knee Joint; Male; Neovascularization, Pathologic; Pain; Pain Measurement; Patella; Patient Satisfaction; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Tendinopathy; Tendons; Treatment Outcome; Ultrasonography

The mechanism that causes pain in chronic Achilles tendinosis is not known. However, high resolution colour Doppler ultrasound has shown that neovascularisation may be involved.. To investigate if sclerosing the neovessels would affect the level of tendon pain.. The effect of colour Doppler ultrasound guided injection of a sclerosing agent, polidocanol, against neovessels was studied in 10 patients (seven men and three women, mean age 55 years) with painful chronic mid-portion Achilles tendinosis.. Eight patients were satisfied with the results of treatment. There was significantly reduced pain during activity (reported on a visual analogue scale (VAS)) and no remaining neovascularisation after an average of two injections. Two patients were not satisfied, and neovascularisation remained. At the six month follow up, the same eight patients remained satisfied and could perform Achilles tendon loading activities as desired. Their VAS score had decreased from 74 before treatment to 8 (p<0.01).. Sclerosing neovessels appears to be an effective treatment for painful chronic Achilles tendinosis, suggesting that neovessels play a key part in causing chronic tendon pain.

Topics: Achilles Tendon; Adult; Aged; Female; Follow-Up Studies; Humans; Male; Middle Aged; Neovascularization, Pathologic; Pain; Pain Measurement; Patient Satisfaction; Pilot Projects; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy; Tendinopathy; Treatment Outcome; Ultrasonography, Doppler

Chronic venous hypertension, triggered by venous reflux and/or obstruction, leads to skin changes and venous leg ulcers (VLUs). Compression therapy is the standard of care, but many wounds remain unhealed. The objectives of this study were to observe the effects of endovenous chemical ablation with commercially available 1% polidocanol injectable microfoam on VLU healing and recurrence rates.. The VIEW VLU study was a multicenter, open-label, phase IV registry of patients with active VLUs resulting from venous insufficiency of the great saphenous vein and/or anterior accessory saphenous vein systems who underwent ablation with 1% polidocanol microfoam. Primary outcomes included wound healing rate (change in wound perimeter), wound closure at 12 weeks after treatment, and time to wound closure. Secondary outcomes included VLU recurrence, numeric pain score at the ulcer location, EuroQol five-dimension five-level questionnaire quality-of-life index, and the Venous Clinical Severity Score. Patients were followed for 12 months.. We enrolled 76 patients (80 ulcers) from 14 sites across the United States and Canada (mean age 63.6 ± 13.7 years, 39.5% female, mean body mass index 36.3). Of the enrollees, 96.3% presented with great saphenous vein incompetence. The mean baseline wound perimeter was 117.2 ± 107.4 mm and 26.3% of wounds (21/80) were circumferential. The mean ulcer age was 34.8 ± 51.8 weeks at first presentation and the mean compression therapy duration was 26.4 ± 35.9 weeks. The median wound perimeter decreased by 16.3% from baseline in the first 2 weeks after the procedure and by 27.0% at 12 weeks. By 12 weeks, 53.8% of wounds (43/80) were healed. The median time to ulcer closure by Kaplan-Meier analysis was 89 days (95% confidence interval, 62.0-117.0). In a Kaplan-Meier analysis of initially healed wounds, 88.9% (95% confidence interval, 76.9-94.8) remained closed at 12 weeks after closure. The mean numeric pain scores (ulcer site) improved by 41.0% and 64.1% at 12 weeks and 12 months after the procedure, respectively. The health-related quality-of-life index (scale of 0-1) improved from 0.65 ± 0.27 at baseline to 0.72 ± 0.28 at 12 weeks and 0.73 ± 0.30 at 12 months. By 12 weeks after treatment, the mean target leg Venous Clinical Severity Score had significantly decreased by 5.8 points, and by 12 months it had decreased by 10.0 points.. Treatment with 1% polidocanol microfoam was associated with promising wound healing rates and low recurrence rates for VLUs, despite a challenging patient population with recalcitrant ulcers, a large percentage of which were circumferential, in patients with high body mass indexes.

Topics: Aged; Female; Humans; Infant; Male; Middle Aged; Pain; Polidocanol; Sclerotherapy; Treatment Outcome; Ulcer; Varicose Ulcer; Wound Healing

This study aimed to evaluate the value of fat-suppressed T2-weighted imaging (FS-T2WI) for predicting short-term pain relief after polidocanol sclerotherapy for painful venous malformations (VMs) in the extremities.. This retrospective study included patients with painful VMs in the extremities between October 2014 and September 2021, had their first sclerotherapy without history of surgical therapy, and underwent magnetic resonance imaging before sclerotherapy. Pain relief was assessed 2 months after 3% polidocanol sclerotherapy and was categorized as follows: progression, no change, partial relief, or free of pain. The associations between pain relief and imaging features on FS-T2WI were analyzed.. The study included 51 patients. The no change, partial relief, and free of pain groups included 6 (11.8%), 25 (49.0%), and 20 (39.2%) patients, respectively. No patient experienced progressive pain. The lesion diameter was ≤ 50 mm in 13 (65.0%) patients in the free of pain group, whereas it was > 50 mm in all patients in the no change group (p = 0.019). The lesions showed well-defined margin in 15 (75.0%) patients in the free of pain group, whereas they showed ill-defined margin in 5 (83.3%) patients in the no change group (p = 0.034). The most common morphological type was cavitary in the free of pain group (14 [70.0%] patients), whereas there was no patient with cavitary type lesion in the no change group (p = 0.003). Drainage vein was demonstrated in 6 (100%), 22 (88.0%), and 11 (55.0%) patients in the no change, partial relief, and free of pain group, respectively (p = 0.011).. A lesion size of 50 mm or less, a well-defined margin, a cavitary type, and no drainage vein on FS-T2WI were significant features for predicting short-term pain relief after polidocanol sclerotherapy for painful VMs in the extremities.

Topics: Extremities; Humans; Magnetic Resonance Imaging; Pain; Polidocanol; Retrospective Studies; Sclerosing Solutions; Sclerotherapy; Treatment Outcome; Vascular Malformations

Vascular malformations are rare diseases and treatment remains controversial. Sclerotherapy is accepted as a minimally invasive treatment with good results; however, some patients do not report good response to sclerotherapy, and it is not clear which variables influence treatment outcome, preventing optimal patient selection. We hypothesized that large diameter lesions have reduced efficacy and satisfaction with sclerotherapy. Therefore, we prospectively evaluated the clinical response of low-flow vascular malformations treated with 1% polidocanol foam sclerotherapy and determined the correlation of symptom improvement with clinical variables.. Prospective cohort study of patients with symptomatic low flow vascular malformations treated at the Hospital das Clínicas between December 2016 and November 2018. Lesions were classified according to location, extension, diameter, type of vessels, margins, and symptoms. Sclerotherapy was performed by direct injection of 1% polidocanol foam, with a maximum volume of 10 ml per session. Symptom improvement was evaluated using the visual analog scale and patient-reported quality of life was assessed by the Short-form 6 dimensions (SF-6D) questionnaire. Follow-up was performed every 3 months after treatment.. Forty lesions were treated in 38 patients, with 19 women and 19 men; median age was 20.5 years (range 4 months to 63 years). Most lesions (80%) were venous, and most commonly in the lower limbs (47.5%); 27.5% were superficial, 35% were deep, and 37.5% affected both compartments. The most common clinical presentations were deformity (95%), pain (78%), and functional limitation (58%); deep compartment lesions were more associated with functional limitation (69% vs. 27%; P = 0.030). Fifty-three per cent of lesions were >10 cm and were associated with increased numbers of psychosocial symptoms (P = 0.038). Two-hundred and forty-two sessions of sclerotherapy were performed, with 6 mean treatments per lesion (range 1-15). The mean follow-up time was 23 months (range 2-23 months). The most common complications were pain and local edema, without any major complications; some patients reported symptom recurrence (15% pain, 10% deformity, and 12% functional limitation). Sclerotherapy was associated with significant improvement of all symptoms (P < 0.001). However, lesions >10 cm were associated with poor improvement in deformity (P = 0.003). Quality of life improved for most patients (60%) and treatment satisfaction was high (82%).. Treatment of low-flow vascular malformations with 1% polidocanol foam is safe and effective; sclerotherapy improves symptoms and quality of life. Large diameter lesions (>10 cm) are associated with increased treatment failure. A small percentage of patients reported recurrent symptoms and require other modalities for successful treatment.

Topics: Female; Humans; Infant; Male; Pain; Polidocanol; Prospective Studies; Quality of Life; Retrospective Studies; Sclerosing Solutions; Sclerotherapy; Treatment Outcome; Vascular Malformations

The aim of the present study was to investigate the early results of mechanochemical ablation (MOCA) for the treatment of small saphenous vein (SSV) incompetence.. We performed a single-center, retrospective analysis of a prospectively collected database of 60 patients treated with MOCA for single-axis SSV incompetence. All procedures were performed with the patient under local anesthesia using the ClariVein catheter (Merit Medical, South Jordan, Utah) combined with 2% polidocanol and, where appropriate, additional microphlebectomy. The primary study endpoint was to assess the SSV occlusion rate at the 1-, 6-, and 12-month follow-up examinations. The secondary endpoints included the Venous Clinical Severity Score, quality of life (QoL) assessment, periprocedural pain, and further complications after the intervention and during the follow-up period. Patient QoL was assessed using the Aberdeen Varicose Vein Questionnaire. Pain was measured using a 100-mm visual analog scale.. Technical success was achieved in 100% of the cases. The mean visual analog scale score on the first postoperative day was 15 mm. No major events were recorded. No neurological complications or deep vein thrombosis were observed. Minor complications included ecchymosis in 3.3% of cases (2 of 60), transient phlebitis of the SSV in 5% of cases (3 of 60), and itching in 3.3% of cases (2 of 60). At the 1-, 6-, and 12-month follow-up examinations, the occlusion rate was 100% (60 of 60), 98.3% (57 of 58), and 92.6% (50 of 54). The median Venous Clinical Severity Score had significantly decreased from 5 (interquartile range [IQR], 3-6) at baseline to 2 (IQR, 1-4) at the 1-month follow-up (P < .001), 1 (IQR, 1-2) at the 6-month follow-up (P < .001) and 1 (IQR, 0-1) at the 12-month follow-up (P < .001). The mean Aberdeen Varicose Vein Questionnaire score had improved from the baseline score of 25 ± 14.61 to 15.81 ± 13.76 at the 1-month follow-up (P < .001), to 9.81 ± 7.42 at the 6-month follow-up (P < .001) and 4.73 ± 3.32 at the 12-month follow-up (P < .001).. The results of our study have shown that MOCA is a feasible, safe, and painless procedure for the treatment of SSV incompetence with an occlusion rate of 92.6% at the 12-month examination. No sural nerve injuries or other major complications were observed. The procedure also provided good clinical results and positive effects on patient QoL.

Topics: Adult; Aged; Catheterization, Peripheral; Chronic Disease; Female; Humans; Male; Middle Aged; Pain; Polidocanol; Quality of Life; Retrospective Studies; Sclerosing Solutions; Sclerotherapy; Time Factors; Treatment Outcome; Varicose Veins; Venous Insufficiency

Topics: Edema; Female; Forearm; Humans; Injections, Subcutaneous; Medication Errors; Pain; Polidocanol; Sclerosing Solutions; Young Adult

The aim of our study was to report our experience regarding the safety, efficacy of duplex-guided polidocanol (POL) foam sclerotherapy on the overall status of signs and symptoms in patients with venous malformations (VMs).. Thirty seven patients with symptomatic extratruncular VMs were treated with duplex-guided POL foam sclerotherapy using Tessari's method. Twenty five patients had limited VMs, while twelve had infiltrating VMs. Postsclerotherapy surveillance was done 6 months after the last sclerotherapy session and comprised both clinical and duplex evaluation. Clinical evaluation entailed a patient self-assessment questionnaire using a four-point scale to rate the degree of symptoms improvement as follows: disappeared, decreased, worsened, or recurred. Findings obtained by duplex scanning were divided into four groups: 1) disappeared group; 2) partially recanalized group; 3) totally recanalized group; and 4) worsened group.. There were 20 males and 17 females with mean age of 22.8±5.5 years. There was a significant reduction in the total amount of POL (P=0.0037), the number of sclerotherapy sessions was significantly lesser (P=0.0019), and treatment success was significantly higher (P=0.0495) in patients with limited VMs in comparison to those with infiltrating VMs. No major complications related to sclerotherapy were encountered in both groups.. Polidocanol foam sclerotherapy is effective, and safe for treatment of VMs, with high success rate and low risk of major complications. Although associated with relatively high recurrence rate compared with ethanol sclerotherapy, this can be overcome by additional treatment sessions, given the relative simplicity, speed, and safety.

Topics: Adolescent; Adult; Egypt; Female; Humans; Male; Pain; Polidocanol; Polyethylene Glycols; Prospective Studies; Sclerosing Solutions; Sclerotherapy; Treatment Outcome; Ultrasonography, Doppler, Duplex; Vascular Malformations; Veins; Young Adult

To investigate the safe and effective treatment for painful venous malformation (VM) in limbs.. (1) 97 cases with painful VM underwent MRI to detect the location of VM, as well as its size and structure, its relationship with the surrounding tissue. Statistical analysis was also performed. (2) The embolic agent (ethanol) was first injected to embolize the draining vessels of VM, then the Polidocanol plus Methotrexate (MTX) was followed to keep the embolization effect on VM. The therapeutic effect was observed and analyzed.. From January 2010 to January 2012, 97 patients with painful VM were treated. A Spearman correlation analysis showed no significant correlation between symptoms of pain and lesion growth, volume, or MRI grades (P > 0.05). The lesions in the muscle space are more likely to have the symptoms of pain (P < 0.01), followed by the lesions in the muscle, then the lesions in the joint and subcutaneous tissue. The pain relieve percentage was 95.9% (93/97) after one time embolic sclerotherapy. No severe complication, such as distant embolization, nerve damage, or muscle atrophy happened. No pain reoccurrence happened after 0.5-1.5 years of follow-up period.. The treatment of embolic scleratherapy is minimal invasive, safe and effective for painful VM with stable results.

Topics: Ethanol; Extremities; Humans; Methotrexate; Pain; Pain Management; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy; Statistics, Nonparametric; Vascular Malformations; Veins

The aim of this study was to retrospectively evaluate the safety and efficacy of polidocanol sclerotherapy in pain relief for painful venous malformations (VMs). Thirty-one patients with painful VMs underwent polidocanol sclerotherapy. Pain intensity was assessed with an 11-point verbal numerical rating scale. Sclerotherapy was technically successful in 58 (98.3%) of 59 sessions. Twenty-six (89.7%) out of 29 patients experienced an improvement in pain after sclerotherapy at follow-up, a mean of 46 months after treatment. The mean pain score improved from 6.6 + or - 2.5 before treatment to 2.4 + or - 2.9 after treatment (P <.001). The factors that significantly influenced the therapeutic effect were size of lesion (P = .008), margin of lesion (P = .006), and stasis of sclerosant (P = .032). Adverse events included hypotension and bradycardia during the procedure. No major complication occurred. Polidocanol sclerotherapy is safe and most efficacious in providing pain relief for patients with small VMs (equal to or less than 10 cm in diameter), VMs with a well-defined margin, and VMs with good stasis of sclerosant during sclerotherapy.

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Female; Humans; Male; Middle Aged; Pain; Pain Measurement; Polidocanol; Polyethylene Glycols; Retrospective Studies; Sclerosing Solutions; Sclerotherapy; Treatment Outcome; Veins; Young Adult

Topics: Achilles Tendon; Adrenal Cortex Hormones; Athletic Injuries; Bursitis; Chronic Disease; Follow-Up Studies; Humans; Low Back Pain; Male; Pain; Pilot Projects; Polidocanol; Polyethylene Glycols; Randomized Controlled Trials as Topic; Sclerosing Solutions; Soft Tissue Injuries; Sports Medicine; Tendinopathy; Tenosynovitis; Time Factors

The chronic painful tendinosis tendon is generally considered a degenerated and weak tendon. However, this has not been scientifically verified, and is to be considered a hypothesis. We present here a case study involving a high-level Olympic weightlifter with chronic painful patellar tendinosis who started heavy-weight training very early after successful treatment with sclerosing injections. A 25-year-old super heavy-weight (+105 kg) Olympic weightlifter with 9 months duration of severe pain (prohibiting full training) in the proximal patellar tendon, where ultrasound and Doppler showed a widened tendon with structural changes and neovascularisation, was given one treatment with ultrasound and Doppler-guided injections of the sclerosing agent polidocanol. The injections targeted the neovessels posterior to the tendon. The patient was pain-free after the treatment, and already after 2-weeks he started with heavy-weight training (240 kg in deep squats) to try to qualify for the Olympics. Additional very heavy training on training camps, most often without having any discomfort or pain in the patellar tendon, resulted in Swedish records and ninth place at the European Championships 17 weeks after the treatment. Despite beating the national records, he did not qualify for the Olympics. Ultrasound and Doppler follow-ups have shown only a few remaining neovessels, and little structural tendon changes. This case questions previous theories about the weak tendinosis tendon, and stresses the importance of studies evaluating tendon strength.

Topics: Adult; Chronic Disease; Humans; Injections, Intra-Articular; Knee Joint; Male; Neovascularization, Physiologic; Pain; Pain Management; Pain Measurement; Patellar Ligament; Polidocanol; Polyethylene Glycols; Recovery of Function; Sclerosing Solutions; Tendinopathy; Ultrasonic Therapy; Ultrasonography; Weight Lifting

The purpose of this study was to investigate where the pain comes from in chronic mid-portion Achilles tendinosis, by using ultrasonography and colour Doppler, immunohistochemistry, and diagnostic injections. Twenty-five tendons in 24 patients (mean age 47 years) with the clinical diagnosis of painful chronic mid-portion Achilles tendinosis, and 20 tendons in 14 controls (mean age 48 years) with pain-free Achilles tendons were examined with ultrasonography and colour Doppler. For the 25 painful tendons, a local anaesthetic was injected in the area with neovascularisation outside the ventral part of the tendon. Biopsies taken from tendinosis tissue in six patients were used for PGP 9.5 immunohistochemistry. A neovascularisation, inside and outside the ventral part of the area with tendon changes, was demonstrated in all painful tendinosis tendons, but not in any of the pain-free control tendons. After injection of the local anaesthetic towards the neovessels outside the ventral part of the tendon, the pain during tendon-loading activity was temporarily cured in all patients. The mean VAS-score for heel-raises decreased significantly from 75 mm to 6 mm. In biopsies, PGP 9.5 immunohistochemistry showed nerve structures in the vicinity of blood vessels. In conclusion, we demonstrate findings which support neovessels and accompanying nerves being the possible source of pain in chronic mid-portion Achilles tendinosis.

Topics: Achilles Tendon; Adult; Aged; Anesthetics, Local; Biopsy; Case-Control Studies; Female; Humans; Immunohistochemistry; Male; Middle Aged; Neovascularization, Pathologic; Pain; Polidocanol; Polyethylene Glycols; Tendinopathy; Ubiquitin Thiolesterase; Ultrasonography, Doppler, Color

This retrospective study evaluated the safety and efficacy of using polidocanol with X-ray fluoroscopy for percutaneous sclerotherapy of venous malformations of the limbs, head, and neck. The subjects were 16 of 18 patients who presented to our department with venous malformations. Two patients were excluded because they were unlikely to benefit from the treatment. Of the 16 included in the study, 1 could not be treated because of inaccessibility, and another was lost to follow-up. Among the 14 cases that we were able to follow-up, 11 cases had had pain as their primary symptom. Following treatment, this symptom remained unchanged in 1 patient, was improved in 4, and had disappeared in 6; however, there was a recurrence of pain for 3 of these patients. Two patients had sought treatment for cosmetic purposes; following treatment, the lesion disappeared in one and showed a significant reduction in the other. The remaining patient presented with a primary symptom of mouth bleeding, which disappeared following treatment. There were no critical complications. Percutaneous sclerotherapy of venous malformations using polidocanol is safe and effective, and permits repeat treatments. The efficacy is especially good for resolving pain, and complications are minor. It is desirable to use fluoroscopy for these procedures

Topics: Administration, Cutaneous; Adolescent; Adult; Cerebrovascular Circulation; Child; Congenital Abnormalities; Extremities; Female; Fluoroscopy; Humans; Male; Middle Aged; Neck; Pain; Polidocanol; Polyethylene Glycols; Retrospective Studies; Sclerosing Solutions; Sclerotherapy; Veins

Polidocanol sclerotherapy is a well-established therapeutic modality for the treatment of venous malformations. Systemic complications are extremely rare.. To report a case of cardiac complication after polidocanol injection of peripheral venous malformation.. A case report and a review of the English language literature using a published MEDLINE search strategy.. A patient undergoing polidocanol sclerotherapy for a symptomatic venous malformation of the right inferior limb developed cardiac arrest shortly after injection of the sclerosing agent which was promptly reversed.. Systemic complications following sclerotherapy may occur even when the sclerosant is injected in peripheral veins or venous malformations. Clinicians should be alerted to the possibility of uncommon but life-threatening adverse effects.

Topics: Arteriovenous Malformations; Cardiopulmonary Resuscitation; Child, Preschool; Diagnosis, Differential; Heart Arrest; Humans; Iliac Vein; Leg; Pain; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy; Ultrasonography