Treatments
Prolotherapy
Prolotherapy is a simple, natural technique that stimulates the body to repair the painful area when the natural healing process needs a little assistance. That's all the body needs, the rest it can take care of on it's own. In most cases, commonly prescribed anti-inflammatory medications and more drastic measures like surgery and joint replacement may not help, and often hinder or even prevent the healing process.
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The basic mechanism of Prolotherapy is simple. A substance is injected into the affected ligaments or tendons, which leads to local inflammation. The localized inflammation triggers a wound healing cascade, resulting in the deposition of new collagen, the material that ligaments and tendons are made of. New collagen shrinks as it matures. The shrinking collagen tightens the ligament that was injected and makes it stronger. Prolotherapy has the potential of being 100 percent effective at eliminating and chronic pain due to ligament and tendon weakness.
Back Pain Therapy
Many people suffer from back pain which can follow injury or result from arthritis. Back pain following injury resolves in approximately 90% of patients within 6-7 weeks, regardless of treatment modality. For the remaining 10%, life can become a challenge.
There are many good approaches to the treatment of chronic back pain. Oral anti-inflammatories are often helpful. Muscle relaxants, if properly selected, can be useful, as well. Chiropractic care and Physical therapy will improve range of motion, and improve strength. Epidural Steroid Injections are helpful, in perhaps 30% of selected patients.
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In those unfortunate people who undergo surgery, however, only 1/3 can be expected to improve, 1/3 will stay the same, and 1/3 will get worse. Common sense might dictate that surgery is best avoided, if relief of symptoms can be achieved in some other way.
One useful alternative to laminectomy, spinal fusion, and foramenotomy, is the technique of Radio Frequency (RF) Neuroablation. This technique involves the placement of a special needle into the portion of the bony spine that is causing pain. The needle tip is quickly heated, using RF current, which destroys small nerves that innervate the joint, bursa, or tendon. The nerves that are targeted are purely sensory, which is to say, provide sensation only, and destruction of these nerves alleviates the pain.
Patient selection is critical, and diagnosis must be precise, or pain relief is unlikely.
In experienced hands, successful relief can be expected in over 70% of patients treated with RF Neuroablation.
Interventional Pain Management
Interventional pain management generally benefits from a multidisciplinary approach that includes pharmacologic measures (analgesics such as narcotics or NSAIDs and pain modifiers such as tri-cyclic antidepressants or anticonvulsants), non-pharmacologic measures (such as interventional procedures, physical therapy and physical exercise, application of ice and/or heat), and psychological measures (such as biofeedback and cognitive therapy).Interventional pain management practitioners come from all fields of medicine.
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Most often, pain fellowship trained physicians are anesthesiologists, neurologists, physiatrists or psychiatrists.Some practitioners focus more on the pharmacologic management of the patient, while others like ourselves are very proficient at the interventional management of pain. Interventional procedures - typically used for chronic back pain - include: epidural steroid injections, facet joint injections, neurolytic blocks, Spinal Cord Stimulators and intrathecal drug delivery system implants, etc. Over the last several years the number of interventional procedures done for pain has grown to a very large number.
Platelet Rich Plasma
Stem Cell Therapy
Stem cell treatments are a type of intervention strategy that introduces new adult stem cells into damaged tissue in order to treat disease or injury. Many medical researchers believe that stem cell treatments have the potential to change the face of human disease and alleviate suffering. The ability of stem cells to self-renew and give rise to subsequent generations with variable degrees of differentiation capacities, offers significant potential for generation of tissues that can potentially replace diseased and damaged areas in the body, with minimal risk of rejection and side effects.
Medical researchers anticipate that adult and embryonic stem cells will soon be able to treat cancer, Type 1 diabetes mellitus, Parkinson's disease, Huntington's disease, Celiac Disease, cardiac failure, muscle damage and neurological disorders, and many others. Nevertheless, before stem cell therapeutics can be applied in the clinical setting, more research is necessary to understand stem cell behavior upon transplantation as well as the mechanisms of stem cell interaction with the diseased/injured microenvironment.
Botox Injections
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Botox injections are used for the management of back and neck pain, as well as headaches. Botox is a poison that can paralyze nerves. The theory behind using Botox as back and neck pain medicine is that it interrupts the signals that go from nerves to muscles, and increases range of motion (ROM).
Botox works by blocking the release of a chemical messenger (neurotransmitter) which is formally known as acetylcholine. This neurotransmitter found in the nerve cells usually transmits a nerve impulse to a muscle cell and causes it to contract. With the absence of acetylcholine the muscle cell is weakened leading to paralysis of the muscle. The Botox injection is restricted to the area under treatment simply because the effect is temporary and the nerve fibers have the capability of regenerating after a few months.
Radio Frequency Neuroablation
(Denervation)
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Radio Frequency Neuroblation is the destruction of nerves by "burning" the nerve using heat generated by an electric current. By destroying the nerves, the "cause of the pain" is removed. The nerves may "re-grow" after a year or so, or the destruction may be permanent. The hope is that if the nerve grows back in, it may be less irritable, and result in resolution of pain; if not, the nerve may need to be re-treated.
Radio Frequency denervation is done as an outpatient or office procedure. The physician generally sedates the patient, and a needle is placed through the skin until it enters or approaches the appropriately identified area. Once the needle is positioned, and this position is checked with an X-ray (fluoroscope), a little local anesthetic medicine is injected, again to verify needle placement, and an electrical current is passed through an element in the tip of the needle, which heats it to approximately 150 degrees. Once the nerve is destroyed with the heat, the needle is withdrawn.
For approximately 2 to 4 weeks after the procedure, pain may be experienced in the involved structures, a direct result of the tissue burn. This pain resolves, and successful resolution or reduction in pain levels can be expected in approximately 70% of patients treated with RF neuroablation.
Patelet rich plasma or PRP is an "autologous blood therapy" that uses a patient's own blood components to stimulate a healing response in damaged tissues. In response to an injury or tissue damage, your body naturally recruits platelets and white blood cells from the blood to initiate a healing response. Under normal conditions, platelets store numerous growth factors which are released in response to signals from the injured tissue. Modern technology allows us to concentrate platelets and white blood cells from your blood, and induce this growth factor release as we inject the solution directly into injured tissue, simulating this same healing response in a more powerful form. By enhancing the body's natural healing capacity, the treatment may lead to a more rapid, more efficient, and more thorough restoration of the tissue to a healthy state.
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What conditions can be treated with PRP?
Knee Pain,
Patellar tendonitis/tendinosis ,
Quadriceps muscle injuries
Ligament sprains or tears
Bursitis
Hip Pain
Hip girdle muscle pain or injury
Pyriformis syndrome
Greater trochanteric Bursitis
Ischial bursitis
Pubic symphysis pain
Sacroiliac joint pain
Hamstring tendonitis or tears
Shoulder and Arm Pain
Rotator Cuff tendonitis, tendonopathy or partial tears
Acromio-clavicular joint pain or arthritis
Bicipital tendonitis
Medial and Lateral epicondylitis (golfers & tennis elbow)
Ulnar Collateral Ligament sprain or tear
Back Pain
Spinal nerve inflammation
Facet Joint arthritis
Disc herniation or tear
Interspinous ligament sprain
Lower Leg and Foot
Plantar Fasciitis
Shin Splints
Peroneal tendonitis
Ankle sprains
Achilles tendonitis
or partial tears
Research and clinical data show that PRP injections are extremely safe, with minimal risk for any adverse reaction or complication. Because PRP is produced from your own blood, there is no concern for rejection or disease transmission.
