Dr. Jessica has completed additional training in Advanced Injection Therapies and offers prolotherapy, corticosteroid, trigger point and perineural injections.
After an initial assessment and discussion, injection therapy may be recommended as part of your treatment plan. A description of each injection is located below for educational purposes.
Prolotherapy Injections
The increasing prevalence of muskuloskeletal and chronic pain conditions has led to an interest in nonsurgical solutions. Prolotherapy is one of these, and has the benefit of having lower risk and a shorter recovery time than surgery.
Prolotherapy, also known as regenerative injection therapy, sclerotherapy, and proliferative therapy, is an orthopedic procedure that stimulates the body’s healing process by injecting a dextrose solution into the damaged tissue. Prolotherapy induces increased blood flow to the damaged area, which can help regenerate new tissue and stimulate cell growth and differentiation. This regeneration of new tissues is used to repair weakened tissues (ligament, tendon, cartilage, muscle) and decrease pain.
What type of tissue are typically treated with Prolotherapy?
Ligaments, joints, tendons, joint capsules and cartilage are all types of tissue that can benefit from Prolotherapy.
What’s the rate of success in treatment with Prolotherapy?
The anticipated rate of success depends on a number of variables. These variables include disease, patient compliance, and technique. Research on benefits range from a 50-80% success rate in reducing pain and improving function with Prolotherapy.
What side effects can I expect?
Side effects of prolotherapy injections may include temporary soreness, stiffness, and occasional bruising around the injection site. Depending on the agent used, patients may experience flushing or warmth, in addition to localized pressure at the site of injection. Symptoms usually resolve after 24-48 hours. Use Tylenol post injection to decrease pain. In addition, ice applied to the area can be beneficial.
Corticosteroid Injections
Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex. These corticosteroids have a wide range of physiological processes including stress response, immune response, regulating inflammation, carbohydrate metabolism, protein catabolism, blood electrolyte levels, and behaviour. Cortisone is a type of ‘corticosteroid’ and functions as an anti-inflammatory. Corticosteroid injections are used to reduce inflammation associated with pain, swelling, and loss of function. Treatment can be on joints, tendons, muscles, and fascia. Conditions that can be treated with corticosteroid injections include arthritis, synovitis, tendonitis, bursitis and fasciitis. Corticosteroid injections are generally used as an adjunct to a multifactorial treatment plan.
What can I expect at my Corticosteroid Injection treatment?
The skin is prepared with an antiseptic and numbing spray. Sometimes the injection is performed using ultrasound guidance to enhance accuracy and improve outcomes. Strict aseptic technique will be implemented for increased patient safety, especially if the injection is into a joint. The pain experienced during the injection is minimal, and in most cases, the patient can leave the clinic post treatment.
What are the benefits of Corticosteroid Injections?
The corticosteroid injection can have both diagnostic and therapeutic benefits. If symptoms are reduced by the effect of the local anesthetic, this provides clinical evidence that the structure injected is a partial source of the pain, hence being ‘diagnostic’. Depending on the current balance between mechanical and inflammatory components, the injection may provide a ‘therapeutic’ effect by reducing inflammation. The success of this depends on many factors, including: duration of pain, severity of the problem, associated mechanical components, and biological factors. For a small number of patients, there is no therapeutic benefit. When administered, corticosteroid injections can greatly assist in definitively treating many conditions, as well as assisting with rehabilitation of an active lifestyle.
Trigger Point Injections
Trigger points are parts of a dysfunctional muscle belly that are sometimes referred to as ‘knots.’ These trigger points can occur in various regions of the body, but most common in the upper back, shoulder, lower back and neck regions. Trigger Point Injections can help provide pain relief in these areas by inactivating the trigger point and thereby reducing pain. The injection accomplishes this by relaxing the muscle, reducing inflammation and desensitizing the nerves. The Trigger Point Injection involves a precise injection of a particular agent directly into and around the trigger point.
Who can benefit from Trigger Point Injections?
Trigger points are commonly associated with: chronic pain disorders, low back pain, neck pain, fibromyalgia, myofascial pain syndrome, headaches, and extremity deformities. Repetitive motion, minor injuries, or acute traumatic events can lead to the development of trigger points.
The Trigger Point Injection Procedure
The trigger points are identified in office using palpation and ultrasound guidance techniques, along with information from your history and presentation. The procedure takes approximately less than 15 minutes to perform. The patient will be provided with an aftercare information sheet. Prior to the appointment it is beneficial to stretch the involved muscle group.
Side Effects and Recovery
After the procedure, the injected area may experience some tenderness. Patients can apply ice or heat to the tender area to help reduce pain, in addition to possibly taking acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs) if needed for pain control. Remain active after the procedure in an effort to put the affected muscle through its full range of motion in the week after the injection. However, refrain from strenuous activity, particularly for the first three to four days after the injection. Trigger point injections side effects are rare, but may include infection and bleeding.
Perineural Injections
Perineural injections are a safe and effective way for treatment of persistent pain. The injections aim to help reduce the neural inflammation such as neuralgia, low back pain, shingles, fibromyalgia, headaches/migraines, nerve impingement and neuropathy. This therapy supports the body to heal itself. Perineural therapy is subcutaneous injections below the skins surface. Using Dextrose or mannitol in a saline solution combine with sodium bicarbonate. This focuses on areas of skin above nerve pathways to address pain at the root cause.
How does this therapy work?
Perineural injections supply the painful skin nerves with a dilute sugar solution and this almost immediately shuts off production of the painful substances and helps the nerve swelling to go down. We don’t know the exact mechanism at the cellular level, but it has been postulated that the dextrose works on the TRVP1 receptors to decrease Substance P and other chemicals that produce pain. Dextrose is also thought to work on ion channels in the affected nerve, once again aiding healing at the cell level.
Goals of Perineural Injections
Every treatment aims to extinguish the pain. After the first treatment pain relief may last for a period of four hours to four days. Repeated treatments (4-6 sessions) usually done weekly, result in gradual reduction of the overall pain, with the aim of complete resolution – a zero pain score – and allow return of full function. Success rates vary between 80-100% depending on the condition. For most conditions recurrence is unlikely unless re-injury occurs.
What are the risks?
Since this is drug-free treatment, and dextrose is a part of normal human function, side effects are rare and include occasional small bruises at the site of injection. Allergy is not an issue.
Think Injection Therapies could help you? Book your initial visit to discuss the best treatment options available for you.