INJECTION GUIDE

If you’re one of the 30 million adults in the United States who suffer from significant joint pain, you know the pain often is debilitating. It can keep you from staying active and even make daily chores seem impossible. What you might not know is that your doctor can treat you with more than physical therapy, pills, or surgery.

Depending on the severity of your pain, injections can be another option for easing your joint pain and get you moving again. 

There are several injectable options to help minimize pain. The injections range from corticosteroids and lesser-known Prolotherapy and Prolozone, which have been around for decades, to more recent Viscosupplementation (knee only) and orthobiologic injections like platelet-rich plasma (PRP) and Stem Cells which have been popularized.

Corticosteroid Injections

Cortisone injections are sometimes called “corticosteroids” or just “steroid injections”. The injections are made up of the medication “cortisone”. Cortisone is injected right into the troubled joint area and is used to treat inflammation. It does not directly treat pain, but as a side effect of cutting down joint inflammation, pain is relieved.

Conventional medicine typically offers steroid injections which may create some temporary relief and even postpone joint replacement surgery but has no curative capability.  It also carries with it all the metabolic concerns that steroids cause on the human body which include the potential to suppress the immune system (infection), elevate the adrenal hormone cortisol (Cushing's Syndrome), and increasing blood sugar levels (concern to diabetics) not to mention the fact that repeated injections actually de-mineralize bone, weaken tendons and ligaments which may result in rupture, and cause cartilage loss thereby increasing the mechanical instability of the joint long term. 

Nevertheless, this injection continues to be the first line of defense used by the majority of practitioners against osteoarthritis symptoms and other joint pain.

Hyaluronic Acid Injections

Also known as gel injections, viscosupplementation, HA, or rooster comb because it is derived from chickens. Hyaluronic acid is a naturally occurring substance found in the fluid that surrounds the joint. People with osteoarthritis have less than normal hyaluronic acid in their joints. Adding hyaluronic acid theoretically helps "lubricate" the joint and allows greater movement and less pain.

There are over 6 different pharmaceutical companies marketing this product.  HA injections are chemically similar to your natural joint fluid.  It has only recently been approved but only for use in the knee.  It takes approximately two weeks for the benefit to be appreciated.

HA, like steroid injections, have the capability of allowing temporary relief and also may postpone joint replacement surgery but offer no curative benefit.  According to the manufacturer, common side effects include local injection site reactions with pain, stiffness, swelling, or fluid buildup in or around the knee in addition to muscle pain, difficulty walking, fever, chills, nausea, and dizziness.

 

Plasma Rich Protein (PRP)

Platelet-rich plasma (PRP) injections are one of the Regenerative Medicine procedures known as an orthobiologic and considered to be the new kid on the block.  It has been in vogue for musculosketal conditions only during the past decade, although utilized in dentistry and surgery for over 20 years. These injections use your own blood and platelets to reduce pain, improve function and promote healing. Platelets contain growth factors and proteins that aid healing in joints and soft tissues. Research shows PRP injections can also alter the immune response to help reduce inflammation. 

PRP injections are considered safe with few risks or side effects since the injection substance is naturally occurring in your body.  Unfortunately, patients taking NSAIDS or with certain blood disorders are not candidates for this procedure.  It works best with acute conditions.

PRP typically costs $1500 per injection.

 

Stem Cell

Stem cells are also an orthobiologic regenerative medicine procedure and are like a “magic cell” that can turn into other cells and help heal a damaged area. They are found throughout your body and are usually extracted from areas that have a high volume of cells like bone marrow, fat tissue, or circulating blood.  For the procedure, your own stem cells are extracted and reinjected into the damaged area.

Stem cells are anti-inflammatory and regenerative, therefore the idea is that when injected into a joint with arthritis (which is inflamed and degenerative), it can heal the area. If autologous, meaning from your own body, this regenerative medicine procedure is considered safe and without serious side effects.  However, if the donor site requires extracting bone marrow it can be very painful.  It is also not considered reliable for immediate pain relief or rapid functional improvement capabilities and takes months to appreciate the benefit.
 
The cost of stem cell therapy ranges from $5,000 to-50,000.

Prolotherapy

Prolotherapy is a regenerative therapy and has been used for more than 50 years as an injection technique to stimulate the body’s natural healing response. It is based on the fact that when ligaments or tendons (connective tissue) are stretched or torn, the joint they are holding destabilizes and can become painful. 

Irritative solutions are injected in multiple areas in and around the injured joint or body part to stimulate the body to respond through inflammation, which brings new blood cells, nutrients, and the body’s healing response. The solutions most often contain dextrose (d-glucose), a natural form of glucose normally found in the body, but may also contain various other substances.

Injections can be painful and might cause swelling. This pain and swelling must not be treated with anti-inflammatory medicine, as this may interfere with the body’s response to the injection.

Prolotherapy typically costs $250-350 per injection.

 

Prolozone

Prolozone is derived from the Latin word "proli" which means to regenerate or rebuild and the word ozone. Ozone is the most highly active form of oxygen.  It has been extensively researched and widely used in medical practices in Europe for decades.  Prolozone utilizes activated oxygen (O3) and vitamins, minerals, and homeopathic formulations to create a healing effect that allows damaged tissues, joints, ligaments, and tendons to regenerate and the circulation is re-established and healing is essentially complete.  The optimal result is significantly reducing, and in some cases completely eliminating, pain.

In joints afflicted by significant degenerative osteoarthritis, prolozone injections have the ability to not only produce a substantial degree of rapid pain relief and inflammation mitigation resulting in increased function but also a high propensity for regenerating the cartilage in damaged knees and hips. 

There are no known contraindications, documented serious side effects, or adverse interactions with any other medication.  It is used to treat a wide variety of both acute and chronic conditions and is by far the most cost-effective regenerative medicine procedure.

Prolozone typically costs $250-350 per injection.

Summary

It’s rare to find a patient who’s had joint replacement surgery and not tried injections beforehand. Although the reverse is true in that some people have injections but not joint surgery. Generally, patients who get corticosteroid or viscosupplementation injections in their hip or knees are on the road to a replacement. In this sense, injections can be seen as sort of “delaying the inevitable” or buying yourself extra time before seeking a permanent, long-term solution for chronic joint pain, arthritis, and mobility issues.

For joint problems, injections are considered a “middle of the road” treatment. This means that before injections, less invasive alternatives like oral medications or physical therapy have likely been tried but the last resort of surgery may have been considered but not yet employed.

When it comes to injections the stakes are a little higher and there are multiple considerations. There is also a lot of information to take in to be properly informed. For example, what is the best knee injection?

Conventional treatment continues with corticosteroid injections which are potentially capable of allowing temporary relief but have no curative capability and are associated with a myriad of possible serious local and system consequences.  All things considered, many feel that they actually hasten the "inevitable" joint replacement surgery. 

Likewise, Viscosupplementation (HA, Hyaluronic acid) has no curative capability but only can offer relief that is temporary in nature.  This also only postpones the "inevitable" joint replacement surgery.  Furthermore, it can only be used on knees.  It is also a very expensive procedure.

Most Regenerative Medicine Injections usually do not rely on steroids and have no capability for dependency as they contain no habit-forming narcotic medications.

Stem cell replacement therapy, as a regenerative medicine treatment, has pain-relieving and rejuvenating capabilities without serious side effects. However, this process takes a considerable period of time to appreciate benefits.  It is also the most expensive therapy.

Prolotherapy, as a regenerative medicine treatment, has pain-relieving and rejuvenating capabilities also without serious side effects.  However, it also necessitates multiple injections per visit which can be quite painful and has limitations on the conditions treated and whether they are acute manifestations.

Platelet-rich plasma (PRP), as a regenerative medicine treatment, also has pain-relieving and rejuvenating capabilities and is without serious side effects but with certain contraindications involving patient selection and drug interactions.  It is also very expensive.

Prolozone, as a regenerative medicine treatment, has rapid pain-relieving and rejuvenating capabilities and is without serious side effects, atypical contraindications, patient selection compromise, or drug interactions and is utilized in a wide selection of acute and chronic conditions.  Very few injections are required and are delivered with little or no discomfort.   It is the most affordable and least expensive.

 

CONCLUSION

If the goal is to simply postpone surgical intervention and possibly afford temporary pain relief, conventional medical treatment involving steroid or viscosupplementation injections are the way to go.

If the ultimate goal is to minimize or eliminate pain and dysfunction while increasing mobility and potential to repair and regenerate damaged tissue and possibly avoid surgical intervention, Regenerative Medicine injection techniques are the most viable protocols to consider and implement to cure and or relieve the adverse effects of trauma or aging for those fortunate enough to receive such care.  All Regenerative Medicine injection therapies can be effective.

The particular injection therapy chosen will be predicated on the established prerequisite criteria and individual considerations of and for each patient.

Based upon my experience and in consideration of the ability to provide affordable treatment to more patients with a greater number of conditions. the combination of vitamins, minerals, homeopathic agents and medical oxygen/ozone has been chosen as the primary injection protocol for our mobile delivery system.

It is premised on the understanding that this therapeutic injection protocol accomplishes essentially everything offered by the other regenerative medicine techniques and affords the fastest pain relief and anti-inflammatory action.  All injected substances are natural and either non-GMO and organic or without preservatives, adjuvants, dyes, or sugars. It is non-narcotic and without a steroid component.

The response to treatment varies from person to person, but most people only need from 3-5 treatments which certainly makes it the most cost-effective treatment option with little or no discomfort experienced.  According to Dr. Frank Shallenberger, M.D., the physician responsible for bringing this German Prolozone Injection Therapy to the United States, roughly 75% of persistent joint pain sufferers who undergo this therapy become pain-free or have their pain significantly improved.


 




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