INJECTION TREATMENT FOR CHRONIC PAIN
A muscle attaches by way of ligaments to a bone. There are nerve endings in the ligaments at their attachment to bone. As an example, in a whiplash injury, the powerful muscles pull some of the ligament fibers from the bone. In the normal process of healing, most of the loosened ligamentous fibers are bonded back to the bone again. However, if this healing is not complete, then subsequent muscle contraction will irritate the nerve endings in the loosened ligaments - result in pain and sometimes in pain being referred to another part of the body.
On the initial visit, the patient is asked to draw a pain diagram. The diagnosis of ligamentous instability is made by a "hands on" examination and the areas of tenderness are outlined using a skin-marking pencil. The principal of treatment is to bond the loosened ligaments back to the bone again. This treatment is also called "Stimulated Ligament Repair".
The treatment is done in the office using a local anesthetic in the skin as well as intravenous medication for deep pain and spasm relief. The proliferant solution (to stimulate the proliferation of new cells) consists of a local anesthetic (Procaine) and 15% Dextrose. This solution stimulates tissue growth factors to start the healing cascade. Between 1/3 and ½ cc. of solution is injected at each of the tender spots. The number of injections varies from 3 for a finger joint to up to 300 for a severe low back injury. Then the patient is re-examined. If there are any areas of residual tenderness, these are also injected. If repeat examination shows no areas of residual tenderness, this indicates that the Procaine has anesthetized the nerve endings in the loosened ligaments and that the dextrose (the proliferant stimulus) has been injected in the correct location.
For the first 100 hours or so, the patient will experience some discomfort as the inflammatory phase of the healing process begins. Medication for the associated pain and muscle spasm is given. It is very important to move the involved muscles through their range of motion at least twice per day. Resume the same activities that you did before. Avoid heavy lifting. We advise cold packs for the first 12 hours and then heat including hot showers and a heating pad. The pain intensity may increase between the 2nd and 4th week; this is referred to as the "peak". If there is a "peak" reaction, this usually indicates that a good healing process is taking place.
Patients who smoke, especially females, do not heal as well as non-smokers. It is also important to discontinue any anti-inflammatory medication as it has been proven these drugs will slow the normal healing process. Examples are: aspirin, Ibuprofen, Motrin, Aleve, (or other NSAID's), as well as Cortisone and Prednisone.
Good nutrition facilitates the healing process. We will supply you with our recommended list of nutritional supplements. The patient will be seen first after 3 weeks for an initial visit and at six weeks for a re-examination to note the degree and extent of the healing process.
The cost of this treatment varies depending upon the number and extent of the injections needed. If you have any questions regarding this treatment, please feel free to call our office at 1-918-251-2273.
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