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I received two ultrasound treatments for shoulder and upper neck pain. At first I felt better. At the third session I had sharp prickly pain during the ultrasound. Is that a sign the ultrasound is working? I didn't feel it the first two times.

Ultrasound (US) is a form of heat produced by sound waves. It can be used in several different ways to reduce pain and inflammation of soft tissue. It also improves blood flow to injured or damaged tissue.

US treatment shouldn't be painful. In fact most patients don't feel anything except the applicator moving over the skin. US over the bones or nerves can cause the kind of symptoms you report.

Discomfort, pain, or symptoms of any kind should be reported right away. The therapist can adjust the intensity. You'll get a more effective treatment at the lower intensity.

Reference: 

Javid Majlesi, MD, and Halil Ünalan, MD. High-Power Pain Threshold Ultrasound Technique in the Treatment of Active Myofascial Trigger Points: A Randomized, Double-Blind, Case-Control Study. In Archives of Physical Medicine and Rehabilitation. May 2004. Vol. 85. No. 5. Pp. 833-836.

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