Pain Management Injection Therapy
Inflammation often gets a bad reputation but in certain cases, we want our immune system to signal the inflammatory cascade which is a series of events that occur to help our tissues heal and repair. When we injure our tendons, ligaments, skin, and other tissues, the inflammatory cascade helps increase blood flow to the area to bring white blood cells to help with healing and cleaning up any debris; Platelets arrive to help stop the bleeding; And growth factors help with the process of tissue remodelling and generating new connective tissue that results in scar formation. Over time, the collagenous connective tissue within this scar will get remodelled into a more stable, healed tissue or new skin.
Prolonged or excessive inflammation is what is bad as it can lead to tissue destruction, systemic inflammation, metabolic derangement, and chronic diseases like autoimmune conditions and type 2 diabetes.
Often, for certain reasons, the inflammatory cascade is slow or repair is taking longer than usual and the injury is persisting with decreased range of motion, pain, and a reduction to activities of daily living. Regenerative injections like prolotherapy, PrP, and neural prolotherapy are designed to help “kickstart” the inflammatory cascade by injecting a substance, most commonly dextrose, to help kickstart the inflammatory process to promote tissue repair.
Other types of regenerative injections exist to help reduce pain when rebuilding tissue is not needed such as when we have ‘knots’ in our muscles that need to be relieved to relieve pain. These usually involve injecting an analgesic, commonly procaine or lidocaine, which helps to prolong the time it takes for a nerve impulse to generate an action potential and delays nerve conduction. These injections include trigger point injection therapy and neural therapy.
Types of Injection Treatments
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Prolotherapy is short-form for “proliferative therapy”. This type of injection therapy is used for damage and injuries to tendons, ligaments, and joints. It involves injecting dextrose with an analgesic solution (most commonly, procaine) to help promote the proliferation of the connective tissue within the tendons, ligaments, or cartilage within joints. Think osteoarthritis where the cartilage is degenerating. The proliferation happens due to dextrose stimulating a controlled inflammatory response which instigates the inflammatory repair process outlined above. This helps to strengthen the connective tissue and increase range of motion while decreasing pain.
The more injections, the more opportunity for the connective tissue to develop better tensile strength. Sometimes, multiple prolotherapy treatments are required and you can think of each prolotherapy treatment as “adding a layer of super glue” onto the injured site. Multiple treatments increase the tensile strength and make the joint, ligament, or tendon stronger.
Please note these injection therapies do not address the root cause and are a therapy to help rebuild strength in your joints, tendons, and ligaments so you can perform activities of daily living that you once used to. It is recommended to limit stress on the affected area for a few weeks after the injection treatments and gradually return to your regular activity level.
If you are susceptible to chronic injuries or delayed healing from injuries, there may be an imbalance at the physiological level that should be addressed such as autoimmunity, chronic inflammatory conditions, hormonal imbalances, and, poor digestive health. This is why an initial visit is required to assess your health and if prolotherapy is indicated for you at this time.
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Neural prolotherapy is a prolotherapy technique that uses a lower dose of dextrose and is used to help with neurogenic pain and inflammation “nerve pain”. The reason for using a lower dose of dextrose is because the goal is not to proliferate connective tissue but rather to stop the pain-producing signals from the nerves (reduce the amount of Substance P). This reduces inflammation in the nerves.
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Trigger point injections use procaine (an analgesic). Vitamin B12, magnesium sulfate, or other therapeutic injectable solutions can be added to help relieve trigger points ‘knots’ in muscles. These are great for athletes, anyone involved in any form of physical activity, or just have developed tight muscles from sitting, carrying babies, or working on the computer all day. Trigger points can be identified through palpation of your muscles and identifying areas of pain that feel harder than normal.
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Neural therapy is great for helping to break up scars that can be creating pain. This can be used for cosmetic scars however should be refrained from surgical scars. Depending on the circumstance, breaking up a surgical scar can cause more damage.
Frequently Asked Questions (FAQs)
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Osteoarthritis
Tennis elbow
Golfer’s elbow
Knee pain
Hip pain
ACL/PCL injuries
MCL injuries
Partial meniscal tears
Shoulder pain / Frozen shoulder
Partial ligament tears or sprains
Partial tendon tears or strains
Medial tibial stress syndrome (shin splints)
Ligament/Tendon laxity
Tendonosis
Rotator cuff injuries
Foot and ankle pain
Wrist/finger/thumb pain
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Prolotherapy treatments are typically once every 3-4 weeks and 4-6 treatments are usually recommended for prolonged injuries. Most individuals will experience pain relief after the first few treatments but some may not experience relief until the 5th treatment. For an acute situation, one or two treatments may be sufficient.
Trigger point and neural therapy treatment frequency will be discussed with the naturopathic doctor during your assessment.
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Chiropractic treatments are recommended prior to the injection to help with joint mobilization.
Massage therapy is recommended after the injection to help with moving the fluid around the affected area.
It is advisable to not take any anti-inflammatories (Advil, ibuprofen, Curcumin, Turmeric, Aspirin, Boswellia etc) for 2-3 days prior to your prolotherapy treatment and 2-3 days after. This allows for the controlled inflammatory response needed for tissue repair to take place. If you are wanting to take something for pain, Tylenol is okay.
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Absolute contraindications are:
An allergy to analgesics (procaine, lidocaine)
Surgical implants in the area
Pregnancy
If you are curious to know if these injections are right for you, contact Dr. Shah.
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Cortisone (steroid) injections: These involve injecting a corticosteroid into the joint or area of pain which helps with short-term pain relief. Corticosteroids work by suppressing the immune system to stop the inflammatory process. Less inflammation leads to less pain in the area. This is why corticosteroids are given to people that have received transplants – to suppress their immune system so doesn’t react to the transplanted organ, induce inflammation and lead to rejection.
Since the inflammatory process is needed for healing the injured tissue, suppressing the inflammation can result in weaker tissue over time. In cases of arthritis, the cartilage will stay degenerated and grating/grinding/clicking will continue to occur. As the steroid wears off, inflammation will return and the pain will come back. The important thing to note is that cortisone injections can increase the amount of cortisol in the body and high cortisol (just like when you are always stressed) can affect your blood sugar, other hormones, cholesterol levels, and blood pressure plus contribute to weight gain. For this reason, cortisone injections are usually restricted to 3-4 injections per year.
Prolotherapy: The dextrose triggers a controlled inflammatory response which helps attract immune cells and growth factors to the injured tissue to help it heal. The procaine in the injection helps to act as an analgesic to reduce the pain sensation as the process is occurring. Injections can be provided every 3-4 weeks until the tissue heals. Even though the dextrose is sugar, it has not been shown to affect blood sugar levels and prolotherapy can benefit those with diabetes as well.
If a chronic injury is not improving with prolotherapy, this is a sign to look deeper at what else is going on with the rest of your body!
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Prolotherapy is contraindicated in pregnancy because there is not enough research to show how the solutions injected impact the developing fetus. Joint and back pain along with increased susceptibility to strains and sprains is common in pregnancy. This is especially so in the 3rd trimester as relaxin increases to help relax the pelvic ligaments to prepare for the fetus getting bigger and childbirth. Unfortunately, relaxin is not specific to the pelvis and will weaken other ligaments as well which can increase the tendency to more sprains, strains, and other injuries. Acupuncture can be great to help with hip and back pain during pregnancy and our naturopathic doctor can perform acupuncture.
Prolotherapy treatments post-partum once breastfeeding is not as frequent or has been finished can help strengthen the ligaments and joints again.
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Hydrolyzed collagen supplements and vitamin C are key to help build connective tissue as hydrolyzed collagen contains the amino acids necessary for synthesizing collagen. Vitamin C helps cross-link the amino acids together. The more of the right amino acids you have in the body to make collagen, the more efficient collagen formation will be. Prolotherapy instigates the repair process at the injured site and helps “direct” the collagen to where it is needed.
Book Your Prolotherapy / Regenerative Injection Appointment
As we currently only offer virtual consultations, for your convenience, new patients can book a virtual initial consultation with our naturopathic doctor. Dr. Suhani, ND will then book your injection treatment herself at the end of your initial consultation with her. The injection treatment will be done at our naturopath, Dr. Suhani’s current practice location at the Dr. For Moms Centre in Brentwood, NW Calgary