Services > Pain Management
Both Dr Neil Hearnden and Dr Michael Yelland have a special interest in pain management and musculoskeletal Medicine.
Dr Hearnden has been a secretary and committee member of the Australasian Association of Musculoskeletal Medicine whilst Dr Yelland is the immediate past president of the Australasian Association of Musculoskeletal Medicine
Prolotherapy In The Treatment Of Chronic Pain
Percutaneous Neural Therapy As A New Therapy For Localised Persistent Pain
Weakened ligaments and tendons are believed to be a common cause of chronic joint pain. Without strong ligaments to hold them together, the joints become unstable, like a tent with its guyropes loosened. The muscles have to compensate for these weakened ligaments. Prolotherapy injections aim to strengthen these weak ligaments by restarting the healing process. They do this causing a small amount of inflammation. The inflammation then stimulates the body to strengthen these weakened ligaments with strong fibres called collagen. Strengthening of these ligaments leads to a reduction in pain and disability. The inflammation is triggered by the mild trauma caused by the needles and to some extent by the solution that is injected. Sometimes a strong solution of dextrose (a type of sugar) is added to increase this inflammation. When glucose is injected into joints, such as the knee or hip, it may also encourage the regeneration of worn cartilage.
Local anaesthetic is included in the injections to reduce pain following the injections. By giving you a short break from the pain, it may allow your nervous system to reset itself to a level that tolerates pain better.
How effective is Prolotherapy?
A number of clinical trials have been done to test the effectiveness of prolotherapy. The largest of these, on the treatment of chronic low back pain, was recently completed at a clinic at Daisy Hill. One hundred and ten patients with low back pain for an average of 14 years were treated. Despite having such chronic pain, the following responses occurred in these patients
At six months, 50% had less than half of their original pain.
- At twelve months, 40% had less than half of their original pain and 75% felt their pain was less than their original pain
- At 12 months the average reduction in pain was 40%
The figures for reductions in disability are very similar for those for reductions in pain.
One trial from the USA on prolotherapy for knee arthritis showed significant reductions in pain with prolotherapy. These were as good or better than those achieved with anti-inflammatory tablets or glucosamine, but gave better improvements in flexibility than these treatments. Similar results to these were found in a similar trial for hand arthritis performed by the same clinic in the USA.
How do you tell if my pain will respond to Prolotherapy?
Before treatment is commenced, an assessment is done by a doctor to decide if your problem is suitable for prolotherapy. This involves giving a history and undergoing a physical examination at the Arana Hills Medical Centre, and sometimes having an Xray and blood test. Prolotherapy is often helpful for pain that is affected by the movement of the painful part, or by sustained postures, eg. prolonged standing or sitting. Because it involves injections, prolotherapy is only used where the pain has been present for over three months (preferably over six months) and has failed to respond well to other treatments. Because prolotherapy aims to treat the cause of the pain, it has the potential to offer longer-lasting relief than some other treatments.
There are a number of conditions that do not respond well to prolotherapy. These include:
- Certain types of arthritis where inflammation is very prominent such as rheumatoid arthritis and gout.
- Pain coming from pinched nerves rather than ligaments, treatments other than prolotherapy will be more suitable.
- Pain coming from discs in the back or neck. This type of pain is hard to distinguish from ligament pain and may only be diagnosed by a process of elimination when prolotherapy fails to help.
- Fibromyalgia, a condition with widespread muscle pain.
- Acute conditions where the pain has been present for less than three months.
If you have had surgery to the painful area, you may require more than the average number of treatments to get a response from prolotherapy.
If your problem is found to be suitable for prolotherapy, you will be offered this treatment. It is important to note that participation is voluntary. Before commencing treatment, you should be aware that prolotherapy is a slow-acting treatment which may not help until you have had several treatments – enough to allow sufficient strengthening of the ligaments. Therefore it is unwise to commence unless you think you are prepared to have at least four treatments. To encourage you to You may be asked to sign a consent form stating that you have understood what treatment involves and the possible side effects and that you are happy to try a course of prolotherapy. It is important to understand that signing this form does not commit you to continue the treatment if you do not want to. You are always free to cease treatment at any time.
How many injection treatments will I need?
To achieve ligament strengthening in a controlled way that has lasting results, the injections need to be given on several occasions, typically six times for the low back, four to five times for the neck and upper back and five to six times for the knee, hip and shoulder. Injections are typically spaced by one or two weeks, but it does not seem to matter if they are given less frequently than this to suit your needs or the doctor’s schedule.
How painful is the treatment?
No injection treatment is totally pain-free, but a lot can be done to reduce the pain of injections. Before injecting the ligaments, the skin overlying the ligaments is numbed with a bleb of local anaesthetic. Although these blebs sting like an ant bite, they reduce the overall level of discomfort with this treatment, and may even make the treatment work better. Taking a painkiller at least half an hour before each treatment is also helpful. Keeping your mind off the pain by talking to the doctor about something interesting during the injections is very helpful. A heat pack is often applied to the treated area after the injections to soothe any discomfort that may occur.
Vitamin and mineral supplements
It is claimed that this treatment is aided by vitamin and mineral supplements. These include vitamin C, zinc and manganese. These should be taken for at least three months from the commencement of treatment.
Will I be able to drive home after the treatment?
The injections themselves do not make you drowsy, so you can drive home after each treatment, as long as any painkiller you have taken does not make you drowsy. Occasionally you may feel a little dizzy from the local anaesthetic, but this passes within a few minutes of having the injections.
What happens then?
If you need extra pain relief during the treatment period, paracetamol, tramadol or codeine may be used. Brand names for these medications include Panamax, Codalgin, Panadeine, Panadeine Forte, and Tramal. No aspirin or other anti-inflammatory drugs (such as Voltaren, Brufen, Feldene, Naprosyn, or Celebrex) should be used for pain relief as they will prevent the inflammatory process that is part of the treatment.
What are the side effects of treatment?
Side effects are minimised by using careful injection techniques however minor side effects are still common. The main side effects of prolotherapy injections are a mild to moderate flare in the pain and stiffness at sometime on days two to seven after the injections. It is temporary and usually well controlled with medication or local heat. In the low back, this occurs in about 80% of patients at some time during treatment and lasts an average of four to five days. It is due to the inflammation deliberately caused by the injections to help the healing process. It is less frequent later in the series of injections and is very rarely bad enough for patients to want to stop treatment. In our study on prolotherapy for low back pain, 95% of people who started treatment completed the full course of six treatments.
Uncommon side effects of prolotherapy for low back problems include sharp leg pains due to irritation of nerves to the leg and headaches due to accidental lumbar puncture with leakage of spinal fluid. Most headaches which occur following prolotherapy are due to muscle contraction in the head or neck or are not related to the prolotherapy. With neck problems, irritation of nerves to the arms occasionally causes sharp pains in the arms. All of these side effects usually last no more than a few days and have no lasting effects.
Occasionally the vitamin and mineral supplements occasionally cause nausea and diarrhoea, but this is easily remedied by stopping them or adjusting the dose.
Can I use other treatments at the same time as Prolotherapy?
Ideally, prolotherapy is just part of a whole treatment programme, and the use of other treatments is usually encouraged during and after a course of prolotherapy. Such treatments include:
General exercise to improve fitness. These include walking, swimming and most gym programmes. Staying active or increasing activity is a very important part of the recovery process with prolotherapy.
- Specific strengthening exercises such as back stabilising exercises and Pilates exercises are usually helpful alongside prolotherapy.
- Rehabilitation programmes to aid return to work.
- Medications such as antidepressants to help improve pain thresholds, most painkillers and glucosamine (Osteoeze or Osteorelief). However, the anti-inflammatory medications described above should be avoided unless they are required for other joints not being treated with prolotherapy.
- Physical therapies such as massage, manipulation and mobilisation.
- Behavioural therapies designed to give you strategies for coping with the pain and disability (eg. relaxation, pacing your activities and focussing on activities rather than pain) are all important in improving your pain threshold and everyday functioning.
What follow-up is offered?
After completing the initial course of four to six injections you will usually be asked to return two months and again four months later. At these visits, you will be offered further injection treatments if it is felt these would be beneficial. Other aspects of your treatment programme will also be reviewed at these visits.
What will the treatment cost?
At this clinic, the initial assessment for prolotherapy will cost $190 TO $300 (EXTENDED CONS). Each prolotherapy treatment session costs $95-$190. There may be some additional costs for prolotherapy injections into joints such as the knee and shoulder. Depending on the site and severity of the pain problem, anywhere from two to 10 treatments will be required. There may be some additional costs for the vitamin, mineral and glucosamine supplements and for any pain medications you need to purchase.