Injection Options to Speed Healing and Reduce Pain
With medicine always growing and changing there are now more injection options available to you for alleviating your symptoms. Our office offers the following injection options to our patients.
Injection of Corticosteroids
The purpose of this injection is to provide strong anti-inflammatory activity to a localized area and provide pain reduction or relief. Corticosteroids are not pain relievers, they reduce inflammation. When corticosteroids relieve pain it is because they have relieved the inflammation in the area.
The corticosteroid is mixed with local anesthetics before being injected, often times lidocaine and/or marcaine. These medicines quickly numb the area and often times provide an additional two to four hours of relief. Corticosteroids can provide increasing relief for up to six weeks. Some studies have shown it is not safe to have more than three injections in the same joint within a one-year period, or roughly one injection per joint every four months.
After the injection:
Do not resume normal exercises or physical therapy for 72 hours following the injection.
Do not over use the joint even though it may be relatively pain free.
It is important to perform gentle and frequent range of motion for the injected joint.
Some side effects of corticosteroids can include:
An elevation in blood sugar levels if you have diabetes.
A localized increase in pain at the injection site often called a “steroid flare.”
Retention of fluids.
These side effects are not serious and will normally pass with time. If needed ice may be applied to the injection site or medicines such as Advil, Ibuprofen, or Tylenol may be used as needed and if tolerated.
More serious side effects include infection or allergic reaction to the medication used for the injection. An infection would be extremely rare. Signs of infection include heat, increasing pain, red streaks traveling up from the injection site, feeling systemically ill, and a temperature above 100 degrees fahrenheit.
A true allergic reaction can occur after the use of any medicine, symptoms may include a rash, nausea, swelling, shortness of breath, and anaphylaxis. Any of these symptoms are possible but would be extremely rare after a corticosteroid injection.
Synvisc - One
Synvisc-One is an injection that supplements the fluid in your knee to help lubricate and cushion the joint, and can provide up to six months of osteoarthritis knee pain relief. Synvisc-One is for people with knee osteoarthritis who have not received enough pain relief from diet, exercise, over-the-counter pain medication, and failed steroid injection. The injection contains a gel-like mixture made from a substance called hyaluronan (pronounced hy-al-u-ROE-nan) that comes from chicken combs. Hyaluronan is a natural substance found in the body and is present in very high amounts in joints. The body’s own hyaluronan acts like a lubricant and a shock absorber in the joint and is needed for the joint to work properly
Synvisc-One is a single-dose treatment that is injected directly into your knee by a doctor, usually a specialist trained in treating knee osteoarthritis, sports medicine specialist. Everyone responds differently but many experienced pain relief starting one month after the injection of Synvisc-One and have knee pain relief up to six months. Synvisc-One can be repeated safely.
After the injection
It is recommended you avoid strenuous activities (for example, high-impact sports such as tennis or jogging) or prolonged weight-bearing activities for approximately 48 hours following the injection. You should consult your doctor regarding the appropriate time to resume these activities.
Some side effects of Synvisc-One can include
The most common side effects are pain, swelling, heat, redness and/or fluid build-up around the knee. In a medical study less than 6% of patients experienced these side effects, which were generally mild and did not last long.
Synvisc-One is covered by Medicare and most insurance plans.
For more information visit www.synviscone.com
Platelet Rich Plasma Injections
Platelet Rich Plasma (PRP) Therapy is a relatively new treatment gaining popularity in the sports medicine field. PRP injections are prepared from one or more tubes of the patient’s own blood. The blood is centrifuged and the activated platelets are removed and prepped for injection. The platelets are then taken and injected into the abnormal or damaged tissue. This type of therapy releases growth factors that recruit and increase the proliferation of reparative cells.
The Theory Behind PRP Treatments
Platelet activation plays a key role in the process of wound and soft tissue healing. Using this theory, PRP injections are used to promote healing of injured tendons, ligaments, muscles, and joints. This allows PRP to be applied to various musculoskeletal problems. Small studies have been conducted to compare the efficacy of PRP injections to that of hyaluronic acid in the treatment of knee osteoarthritis. Results of these studies show that PRP treatments may be just as effective, if not more so than hyaluronic acid in the treatment of OA.
Things To Remember
Patients who receive PRP injections should avoid exercise for a short period of time before beginning a rehabilitation or exercise program. Because a patient’s own blood is used, PRP therapy is considered a relatively low risk treatment that can potentially improve or speed up the healing process.
Key Points on PRP
PRP comes from the patient’s own blood.
PRP is a concentrated source of growth factors and cellular
signaling factors that play a role in healing.
Basic studies show it may improve healing in many tissues.
It is important that anti-inflammatory medications be stopped
before and after PRP treatments.
Whole Blood Injections
Whole blood injections are also referred to as autologous blood injections. For whole blood injections, blood is taken from the patient by a standard blood draw and is injected into and around the damaged tendon. This approach is thought to promote healing by triggering stem cell recruitment, angiogenesis, and fibroblast stimulation.
The injection of blood contains small cells called platelets which contain platelet derived growth factor. This is thought to promote tendon healing.
PRP injections are a variation of this technique. As of yet, there have been no studies that demonstrate PRP injections are superior to whole blood injections. Some studies have shown both techniques to demonstrate improvement in 70-80% of patients which have had an injection performed on them.
A local anesthetic is usually used and ultrasound may provide the physician with visual guidance while performing the injection itself. Patients are usually advised to avoid strenuous or excessive use of the tendon for a few weeks. The procedure may be repeated if the physician feels it is necessary. There have been no major safety concerns related to autologous blood injection.
Bone Marrow Injections
We DO NOT currently offer Bone Marrow Injections at our clinic. But it is an option to keep in mind with recalcitrant pain symptoms.
Bone marrow injections, also known as bone marrow cell concentrate (BMCC) injections involve removing stem cell rich material from one area of the body and replacing it into injured tissues. A significant population of our bodies’ stem cells are contained within our bone marrow. Harvesting blood and tissue from the bone marrow space of an area like the hip, an injectable product can be produced by concentrating platelets and cells withdrawn through a simple outpatient needle aspiration procedure. The procedure is usually done with local anesthetic and light sedation. BMCC contains all of the growth and healing factors in PRP along with concentrated “Pluripotent” or stem-like cells, which further contribute to the regenerative process.
Once the bone marrow has been drawn the material is placed in a special processing unit which separates platelets, white blood cells, and serum from red blood cells. The platelets and white blood cells are then concentrated and collected into a sterile syringe to be re-injected into the injured tissue. Skin and soft tissue is usually anesthetized with local anesthetic before the BMCC is injected.
Treatment varies based on the severity and duration of the injury being treated. Based on the injury which BMCC is being used to treat, one to three injections are suggested. Chronic injuries often require more than one injection and the efficacy of the injection(s) is often increased when combined with exercise or physical therapy programs.
Because the injectable products are produced from the patient’s own blood, there is no concern for rejection or disease transmission with minimal risk for adverse reactions or complications. There is a very small risk of infection because a foreign substance is being injected into the body, however this is rare.
Conditions commonly treated with PRP/whole blood
Ligament Sprains or Tears
Muscle Pain or Injury
Greater Trochanteric Bursitis
Sacroiliac Joint Pain
Hamstring Tendonitis or Tears
Shoulder and Arm Pain:
Rotator Cuff Tendonitis, Tendinopathy, or Partial Tears
Medial and Lateral Epicondylitis (Golfer’s and Tennis Elbows)
Ulnar Collateral Ligament Sprain or Tear
Lower Leg and Foot Pain:
Ankle Sprains/Ligament Injury
Achilles Tendonitis or Partial Tears
Botox For Migraines
What is Botox®?
Therapeutic Botox® refers to the use of Botulinum Toxin Type A (Botox®) for relief of migraine headaches and neck pain that causes headaches. In these diagnostic situations, the drug works by not only relaxing muscles that may spasm, but through other mechanisms as well. The Botox® can also block stinging impulses that travel to effected painful areas, as well as deactivating natural chemicals produced by the brain that cause migraine headaches.
What is the cost?
Botox® is a nationally recognized treatment for prevention of migraine headaches and chronic head pain. Most private insurances cover the Botox® drug, however, there likely will be a fee for the administration of the product. For more information on coverage for this treatment, call your insurance company today and ask for an explanation of benefits.
Am I A Candidate?
If you experience 15 or more head pain days in one month and these headaches last for 4 hours or longer, you could be a candidate for this treatment. As your primary care provider for a referral today!
5 Things to Know About Botox® Treatment
It prevents headaches and migraines before they even start!
It’s given every 12 weeks
It’s a small needle
It’s injection by a Botox specialist
It takes about 20 minutes
Amniotic Stem Cell Injections
Chronic joint pain from Osteoarthritis or from past injuries can be improved by amniotic stem cell injections. These injections can help heal damage and reduce or eliminate joint pain.
Amniotic fluid has a high concentration of stem cells and hyaluronic acid. Hyaluronic acid helps to lubricate joints and tendons, this can reduce pain and can help restore mobility. It also promotes cartilage growth This treatment also helps to increase proteins, cytokines and other important compounds. Hyaluronic acid occurs naturally in our joints and adding more can help to cushion your bones so that there is less pain from bone on bone friction.
Studies show that amniotic fluid regenerates joints, helps reduce inflammation and minimizes scars. Amniotic fluid is the fluid surrounding a fetus in pregnancy. It also contains nutrients, hormones, and antibodies. In the past, this fluid has been thrown away after birth. Now, consenting mothers of cesarean section babies can donate this fluid with no harm to mother or baby because it is not part of the embryo.
Amniotic stem cell therapy is very safe and effective. Not a single adverse side effect has been reported with over 10,000 injections performed. The fluid contains growth factors that help stimulate tissue growth, stem cell activity and naturally reduce inflammation. Cortisone and other drugs can provide temporary pain relief but stem cells actually restore damaged tissues as well as providing relief from pain.
This treatment is ideal for the following conditions:
Lower back pain
Rotator cuff injuries
Soft tissue injuries
Tears in Tendons or ligaments