<<返回上一页

Technology : `Cooking' eases the pain of whiplash

发布时间:2019-02-27 02:16:05来源:未知点击:

By Emma Young Melbourne BY MODIFYING a technique that most doctors believed did not work, researchers in Australia say they have developed a highly effective treatment for the chronic pain that can follow whiplash injury. Some 15 per cent of people with acute whiplash injury suffer for years afterwards with chronic pain in certain neck joints. One potential treatment, called percutaneous radiofrequency neurotomy, has been tried in several studies worldwide. It involves inserting heat-conducting electrodes into the neck, with the aim of “cooking” and destroying the nerves around the joints that send pain messages. But the pain persisted in nearly all the patients treated, leading many to conclude that the procedure acted merely as a placebo. Now doctors at the Cervical Spine Research Unit at the University of Newcastle in New South Wales say the technique can work—as long as doctors perform it correctly. The team, led by Nikolai Bogduk, recently published its results in the New England Journal of Medicine (vol 335, p 1721). “You have to know where the nerves are, and that was a problem with some of the [earlier] studies,” says Susan Lord, another of the authors. “They based their assumptions on one or two incorrect books of anatomy—the chances of them actually hitting the nerve was remote.” As part of her PhD thesis, Lord worked on human cadavers to identify the exact location of the key nerves and update the relevant anatomical knowledge. Another problem involved the angle at which the electrodes were inserted, says Lord. The electrode generates heat sideways from the metal shaft, but previous experimenters were placing the needle at 90 degrees to the nerve, she says, and so were only destroying surrounding tissue. “Coming in at 90 degrees to the normal approach was part of our modification.” The Newcastle team found that the technique, which they carried out under local anaesthetic using X-ray guidance, stopped all pain in three-quarters of their 24 trial patients. The effect lasted up to 9 months, the average time for nerves to grow back. “We’re not cooking the whole nerve,” says Lord, “only the tail end of it. And like the tail of a lizard, it will regrow.” When the pain returns, doctors can repeat the treatment, which appears to be equally effective the second time around. One patient has had seven treatments over seven years, each as effective as the last. The researchers do not yet know how many times the procedure can be successfully repeated in the same patient. “It’s a dramatic breakthrough for people suffering this kind of pain,