If you have chronic muscle, joint or tendon pain, targeted injection therapy may offer you some relief. Doctors use a chemical irritant in these injections in order to cause an inflammatory response. This, in turn, works to restore the tissue.
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There are various kinds of injections doctors may use to create this healing response. These include platelet-rich plasma (PRP) or, alternatively, prolotherapy, which involve injections of a solution of dextrose, sugar water and lidocaine, says Jason Genin, DO.
“The hope with these injections is to increase inflammation in a positive response to help restore natural function to damaged tissue or joint linings and so on,” Dr. Genin says.
He says doctors use the injections to treat chronic muscle or soft connective tissue pain (joint and tendon damage possibly resulting from a sports injury), back pain, osteoarthritis and other forms of arthritis.
Deciding where injections should go
Prior to the injections, you will consult with your doctor to determine the best location for treatment. Your doctor will consider these factors:
- Medical history.
- Physical examination results.
- Diagnostic imaging findings.
Typically, Dr. Genin says, several areas are treated at once. For example, your doctor may treat pain in an elbow, hip and knee.
Setting a treatment schedule
You and your doctor will develop a treatment program, setting a specific day for your injection. It is a significant procedure that will require some recovery time, Dr. Genin says.
“It isn’t a case where you just come in and get a shot,” he says. “You should have an assistant who can drive you. Also, you’ll need some downtime from work or sports with these injections, so you should be prepared for that before you come in.”
He says physicians typically treat one to three areas on the same visit. They also often use a multimodal approach, which means that they may use braces or therapy or combination medicine along with the injections to further enhance your treatment.
PRP vs. prolotherapy
For the PRP treatment, a lab technician draws blood and spins it in a centrifuge to create a concentrated platelet injection.
Prolotherapy also uses injections, but the content is basically sugar water, Dr. Genin says. The injected solution is typically dextrose combined with a numbing medicine, usually lidocaine, he says. As with PRP, the injected mixture is a chemical irritant which causes a similar inflammatory response to restore the tissue.
“We call it regenerative medicine in the U.S., but it’s more likely to be a restorative therapy,” Dr. Genin says. “I’m not sure we can clearly identify that it creates new tissue, but it can restore normal function and make the patient feel better.”
Prolotherapy is particularly effective in patients who have marked “loose” ligaments, Dr. Genin says. It is often used to treat pain in the sacral or bottom end of the spine, for chronic tendinous (tendon tissues) injuries or for plantar fasciitis.
Ongoing studies in regenerative medicine continue to explore the potential of stem-cell therapy using stem cells that can differentiate into a variety of cell types. This process could potentially actually rebuild or reverse tissue damage, Dr. Genin says.
- It is best to work with a physician experienced in musculoskeletal pain who uses ultrasound to guide the injections.
- The FDA does not approve the use of these injections at this point, so it is still a cash-based procedure. “It’s important to understand that the more expensive the treatment doesn’t necessarily mean it’s a better treatment,” Dr. Genin says.
- When you first consult with your doctor on this procedure, be sure to tell him or her about any anti-inflammatory medicines or herbal supplements you use.
- Remember that the PRP injections or prolotherapy are a process. Sometimes it takes several injection sessions or use of a multimodal approach to return you to a reasonable level of function, Dr. Genin says.
“Although results can be immediate, it often takes four to six weeks to regain what you and your physician think is normal function,” he says.