Has someone suggested needling or injection of your muscles or joints? The question I got recently from a former patient opened up a whole can of worms.
She has had chronic low grade neck pain which has flared up at times, and finds that when she adjusts her posture and performs her exercise, she is able to control her symptoms. Someone spoke to her about medical massage and she was told that it was covered by her insurance, so she decided to give it a try. At her first massage appointment, it was also recommended that she undergo injections of dextrose to help heal “microtears” and “scarring” that she was told she has in her neck muscles. She was told that her insurance would also cover these injections, recommended and provided by a physician assistant, so she wanted to know if there was any potential harm.
What she was describing is generally referred to as Prolotherapy. It involves injection of dextrose into ligaments, joint capsules, or other connective tissue around a joint, to limit movement. The theories put forth by it’s practitioners focus on controlling the motion of hypermobile joints, which are theorized to cause pain. Hypermobile means that something moves too much. Think about what the phase “double-jointed” meant to most of us as kids.
This type of treatment has been practiced for hundreds of years, and is also called sclerotherapy.
Despite it’s long term use and several governing bodies, there is no consistent application of prolotherapy (similar techniques) between practitioners, and a lack of high quality research with regard to it’s overall effectiveness.
Dry Needling
There have been quite a few pain treatments involving needles lately that have become popular. They are sold as new, but they are all decades years old, and the same criticisms regarding Prolotherapy apply mostly to other types of needle-based therapies. Safety has been established more or less, by the fact that these techniques have been practiced for so long, with so few injuries, but true effectiveness is a different matter.
Trigger points are tight/taut and painfully sensitive areas of muscle. Trigger point treatment has predominately been focused on getting the tight are of the muscle to release. Whether that’s done by your spouse or a clinician, it’s usually consisted of rubbing, kneading, or directly applying pressure ot the area for relief.
Eventually this treatment advanced to injections of lidocaine – a numbing substance – directly into the trigger point. At some point (still a long time ago) it was found that the action of the needle had the same treatment effect as the lidocaine injection.
Since that time this form of treatment has caught on, and more recently, has been sold as a “cure all” course for physical therapists, physicians, and other healthcare providers. Because there are so many different claims, treatment protocols, and proprosed theories, the scientific research has lagged a little behind in answering big questions that we all ask, like “does it help?” If by “help” you mean to reduce pain, then in some cases, it clearly does. If my “help” you mean to reduce pain over the long term…then it gets a little more sketchy. If it helps in specific situations in the short term, however, it can be helpful as part of a therapy plan of care. I am biased toward education and patient independence, so if I’m going to use a treatment that is complicated and cannot be applied by the patient himself, I will only use it in specific situations (when I feel like I have to) and only temporarily, before moving things toward self-treatment and self-correction.
Other Injection Treatments
There are lots of other things that can be injected in lots of different areas, intended to treat musculoskeletal pain, including injections directly into joints (steroids, stem cells, and even saline) or injected around nerve roots or ther tissues around the spine. The wide range of these treatments currently in use is beyond the scope of this post.
My Advice?
Don’t Believe the Hype: While there are studies that demonstrate some positive effects, generally they cannot be proven to be better than a placebo (sham, or fake) treatment.
Undergo Standard, Evidence-Based Treatments First: Make sure that you have tried other, more conventional, and better proven treatments. Don’t undergo injections or surgery until you have underwent physical therapy, and make sure that any physical therapy that you get is supported by researchevidence.
Know Your Insurance Benefits and Limits: Make sure that your insurance does pay for the therapy, or that you are prepared to pay for it. Check to see what your insurance plan’s limits are with respect to treatment, and make sure that you understand how it is applied. For example, I had a patient come to me a few years ago with a physical therapy limit of 40 visits per year and told me that she had never seen a physical therapist. 40 is far more than I would ever need for her problem, which was a basic shoulder bursitis. However, she had already underwent 40 visits of medical massage in a pain management physician’s office, and did not realize that these visits had been billed as physical therapy. Based on her word, I saw her the same day, before verifying her insurance. She was furious with me when she found that her visit with me was not covered by her insurance, but there was nothing that could be done.
If you have chronic pain, some kind of injection therapy may be helpful, but there are other, more effective, and potentially less expensive treatments available. Contact me or your regular physical therapist, or your primary care physician to discuss your options and find what may be the most effective treatment for your specific situation.
