Pain Control

New Treatment for Chronic Pain

Over 80% of our population will experience chronic pain requiring a visit to a health professional. Therefore, relieving chronic pain is an important part of anti-aging medicine. Low back pain can also be a cause of sexual dysfunction.

The principals described are applicable to all dysfunction of joints, ligaments and tendons. We treat patients with back, neck, hip, shoulder, knee pain and other chronic problems. These patients have generally seen other physicians with little to no improvement.

Hippocrates was the first to use the principles of reconstructive therapy in the Fifth Century B.C. He used a hot iron applied to the front of the shoulder causing scar tissue to be formed preventing recurrent dislocations. Over sixty years ago, physicians were injecting sclerosing (irritating) solutions into ligaments to make them stronger. That is why reconstructive therapy was originally called sclerotherapy or proliferant therapy. It is a means by which an irritating solution is injected into damaged or weakened ligaments, tendons, or joints. The body responds to this directed irritation by making new tissue which has a side effect of strengthening those previously weakened areas. Since these fibro cartilaginous tissues have a poor blood supply, they heal poorly without help. Exercise builds muscle, but does not strengthen ligaments. Joints are mostly held in place by the ligaments.

Ligaments support bones and when they are weak or damaged the bones come together abnormally resulting in damage to the bones or joints. Reconstructive therapy stimulates the body to form those tissues which are damaged helping normal anatomical function to return. The main side effect of returning the body to normal functioning is the elimination of chronic pain to all previously involved areas. Patients often experience a better sleep cycle, and have more strength and energy very soon in the treatment process.

Most patients with low back pain who have not had prior disc surgery require a minimum of six treatment sessions at bi-weekly intervals into the ligaments and fascia that support the low back. Patients with previous disc surgery require at least eight injections to achieve optimal results. After the initial series of back injections, it may be necessary to return at monthly intervals for additional treatments to maximize the healing process. On the day of the first injection, a manipulation (spinal mobilization) is usually performed to improve range of motion of the neck and low back. The treatment usually requires thirty minutes, and it is preferable to have a driver with you since you will be sedated and driving will not be safe for at least two hours. Do not eat the morning of the procedure, water OK up to two hours prior to the procedure.

Even if you have a definite herniated disc, there may be an associated soft tissue problem which we can improve with our treatment. Our approach in the case of proven disc herniations is to allow the inflammation around the herniated disc or nerve to be subside, or to speed the process by use of an injection of synthetic cortisone. This injection is an "epidural" and is very useful in acute back pain or sciatica. If you have bladder or bowel incontinence, neurological deficit (not pain), spinal stenosis, or you are failing to promptly improve, surgical referral may be necessary.

Who is eligible for the treatment? We do not treat patients who are severely depressed or emotionally disturbed. Patients who are heavy drinkers, cigarette smokers, or drug abusers do not do well with the treatment because these interfere with the body's natural healing process.

We will not accept patients who are markedly overweight since the placement of the injections is more difficult. It is not advisable to be on a vigorous weight loss diet while being treated. If you are losing weight your body is breaking down tissue to fuel your daily needs. You will not be able to form strong new tissue as effectively. Not everyone who has back pain should receive this treatment. If your pain is relatively mild or infrequent or you have not tried standard treatments such as physical therapy or medications, it would be best to first seek other forms of relief. Patients who have failed to improve with cervical or lumbar surgery may be candidates, but each case must be carefully reviewed to determine eligibility.

Are there any other specific side effects or concerns I should be aware of?

Soreness and bruising at the injection sites and a 1 to 2 day increase in stiffness and discomfort following each treatment session is often noted. Not infrequently patients report a temporary numb-like or burning sensation or itching of the skin surface in the region of the injections. This is due to the nerve blocking characteristics of the injected medications and always resolves, usually in 6 to 8 weeks. Dr. Garcia has performed hundreds of these injections without serious complications.

Patients who have not had surgery are the best candidates for treatment. Cortisone injections at the initiation of treatment may be needed in the event of prior surgery or if a great deal of tissue irritation is present. Usually there are no side effects from the Triamcinolone (synthetic cortisone) since we use a minimal amount. Occasionally patients report a feverish or flushed feeling of the face and insomnia after Triamcinolone. This may last for several days. There are no long term adverse effects of this single treatment with synthetic cortisone. Rarely, women report an abnormality of the menstrual cycle for up to three months after this injection and occasionally postmenopausal spotting may occur, which should be evaluated by your gynecologist.

Is this treatment program approved by the American Medical Association?

The California Medical Association Review Board reviewed this treatment approach in 1989 and two of the three members of the panel deemed it acceptable medical therapy, while the third member felt more studies were necessary (these have subsequently been completed and published.) The injections we are using have been subjected to peer review by the joint Socioeconomics Committee of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons in July, 1988. They concluded, this form of treatment "offers a reasonable alternative for treatment of "trigger point" or "iliolumbar syndrome" or "myofascial syndrome" and has been demonstrated to be reasonably effective for these syndromes. They also point out, although "not widely employed by neurosurgeons, it should be considered and accepted as a modality of therapy." The Blue Cross Medical Review Committee has reviewed the injection protocol and deemed these injections to be an established form of treatment that will be reimbursed similar to other injection procedures.

Furthermore, prolotherapy has been the subject of many research papers that have proven its effectiveness. The most important journal article appeared in the Lancet July 1987. Dr. Ongley was the author of the research; he remains the leading practitioner of this technique. Dr. Garcia trained with Dr. Ongley.

How painful are the injections?

Most patients prefer to have intravenous sedation induced prior to each back or neck treatment. This makes the injections more tolerable, even for people normally hypersensitive to injections. The injections often become less uncomfortable as the weeks go by and the tissue becomes less sensitive. There are usually 15 to 20 puncture points for the low back injection and 10 to 15 for the neck. Bandages should be removed several hours after each treatment session. The needle is fanned through out the tissues from these entry points, and therefore covers a larger area with minimal tissue trauma.

There is stiffness and soreness for 24 to 48 hours after each treatment session, which is lessened by doing the exercises which you will be taught. You will not receive the full benefits of the treatment if you fail to do these exercises.

The discomfort is rarely intense, and most patients are not greatly inconvenienced.

Sometimes patients report a temporary setback or new pains during one or more weeks of the treatment. It is important not to get discouraged and to remember the healing process is slow, and almost all patients treated with this method will show significant improvements as time goes by and as the healing process proceeds.

Do I need any special examinations MRI or X-rays of the problem area?

Please bring all lab, X-ray or MRI studies with you so they do not have to be repeated.

Is there an age limit?

We have treated teenagers as well as individuals in their 80's. However, the treatment may be more difficult for individuals over the age of 65 especially if there are other serious medical problems.

How many injections are needed?

A minimum of six to eight treatments must be given for the low back and four to six for the neck. These are usually given in bi-weekly intervals with a one month resting period after the sixth in the series of back injections and after the fourth neck treatment. If necessary, the injections can be given every third week without any decrease in effectiveness, if scheduling problems or vacations interfere. Sometimes additional injections must be given.

Can I work the same day?

Most people prefer not to, because they are somewhat groggy from the intravenous relaxing medication. Many patients prefer to have their injection late in the afternoon so they can work prior to the injection during the day, and are able to return to their job the next morning. You must arrange for a ride each time you have an injection, because you may be sedated for each treatment.

How long is each appointment?

Your initial evaluation is usually 60 minutes in duration. Your initial back or neck treatment takes 30 to 60 minutes and subsequent treatments require about 30 minutes. The first treatment usually requires two consecutive weeks. Subsequent treatments are usually once every two weeks.

How long before I notice some improvement?

Some patients notice significant improvement in their usual pain after only three or four treatments. There may temporarily be new pains induced by the injections which may take up to two months to subside. Most patients feel a distinct improvement in their back or neck by the fourth treatment, but occasionally the improvement is not noted for up to one month or longer after the completion of treatment.

How will I know if my back is getting better and stronger?

You should notice a gradual decrease in pain and an increase in strength as the weeks and months go by.

Can I take pain pills during the treatment if I am stiff and sore?

You should avoid Aspirin, Motrin, Naprosym, Feldene, Indocin, Nuprin, Advil, Clinoril, and other anti-inflammatory medicine for up to three months following completion of the injections. You may take extra strength Tylenol every 4 to 6 hours as needed, and if something stronger is necessary we will discuss it with you. Usually ice, exercise, and an occasional Tylenol are adequate to control any discomfort. After the first two treatments the injections are tolerated better and are often associated with less stiffness.

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	Pain Control New Treatment for Chronic Pain Over 80% of our population will experience chronic pain requiring a visit to a health professional. Therefore, relieving chronic pain is an important part of anti-aging medicine. Low back pain can also be a cause of sexual dysfunction. The principals described are applicable to all dysfunction of joints, ligaments and tendons. We treat patients with back, neck, hip, shoulder, knee pain and other chronic problems. These patients have generally seen other physicians with little to no improvement. Hippocrates was the first to use the principles of reconstructive therapy in the Fifth Century B.C. He used a hot iron applied to the front of the shoulder causing scar tissue to be formed preventing recurrent dislocations. Over sixty years ago, physicians were injecting sclerosing (irritating) solutions into ligaments to make them stronger. That is why reconstructive therapy was originally called sclerotherapy or proliferant therapy. It is a means by which an irritating solution is injected into damaged or weakened ligaments, tendons, or joints. The body responds to this directed irritation by making new tissue which has a side effect of strengthening those previously weakened areas. Since these fibro cartilaginous tissues have a poor blood supply, they heal poorly without help. Exercise builds muscle, but does not strengthen ligaments. Joints are mostly held in place by the ligaments. Ligaments support bones and when they are weak or damaged the bones come together abnormally resulting in damage to the bones or joints. Reconstructive therapy stimulates the body to form those tissues which are damaged helping normal anatomical function to return. The main side effect of returning the body to normal functioning is the elimination of chronic pain to all previously involved areas. Patients often experience a better sleep cycle, and have more strength and energy very soon in the treatment process. Most patients with low back pain who have not had prior disc surgery require a minimum of six treatment sessions at bi-weekly intervals into the ligaments and fascia that support the low back. Patients with previous disc surgery require at least eight injections to achieve optimal results. After the initial series of back injections, it may be necessary to return at monthly intervals for additional treatments to maximize the healing process. On the day of the first injection, a manipulation (spinal mobilization) is usually performed to improve range of motion of the neck and low back. The treatment usually requires thirty minutes, and it is preferable to have a driver with you since you will be sedated and driving will not be safe for at least two hours. Do not eat the morning of the procedure, water OK up to two hours prior to the procedure. Even if you have a definite herniated disc, there may be an associated soft tissue problem which we can improve with our treatment. Our approach in the case of proven disc herniations is to allow the inflammation around the herniated disc or nerve to be subside, or to speed the process by use of an injection of synthetic cortisone. This injection is an "epidural" and is very useful in acute back pain or sciatica. If you have bladder or bowel incontinence, neurological deficit (not pain), spinal stenosis, or you are failing to promptly improve, surgical referral may be necessary. Who is eligible for the treatment? We do not treat patients who are severely depressed or emotionally disturbed. Patients who are heavy drinkers, cigarette smokers, or drug abusers do not do well with the treatment because these interfere with the body's natural healing process. We will not accept patients who are markedly overweight since the placement of the injections is more difficult. It is not advisable to be on a vigorous weight loss diet while being treated. If you are losing weight your body is breaking down tissue to fuel your daily needs. You will not be able to form strong new tissue as effectively. Not everyone who has back pain should receive this treatment. If your pain is relatively mild or infrequent or you have not tried standard treatments such as physical therapy or medications, it would be best to first seek other forms of relief. Patients who have failed to improve with cervical or lumbar surgery may be candidates, but each case must be carefully reviewed to determine eligibility. Are there any other specific side effects or concerns I should be aware of? Soreness and bruising at the injection sites and a 1 to 2 day increase in stiffness and discomfort following each treatment session is often noted. Not infrequently patients report a temporary numb-like or burning sensation or itching of the skin surface in the region of the injections. This is due to the nerve blocking characteristics of the injected medications and always resolves, usually in 6 to 8 weeks. Dr. Garcia has performed hundreds of these injections without serious complications. Patients who have not had surgery are the best candidates for treatment. Cortisone injections at the initiation of treatment may be needed in the event of prior surgery or if a great deal of tissue irritation is present. Usually there are no side effects from the Triamcinolone (synthetic cortisone) since we use a minimal amount. Occasionally patients report a feverish or flushed feeling of the face and insomnia after Triamcinolone. This may last for several days. There are no long term adverse effects of this single treatment with synthetic cortisone. Rarely, women report an abnormality of the menstrual cycle for up to three months after this injection and occasionally postmenopausal spotting may occur, which should be evaluated by your gynecologist. Is this treatment program approved by the American Medical Association? The California Medical Association Review Board reviewed this treatment approach in 1989 and two of the three members of the panel deemed it acceptable medical therapy, while the third member felt more studies were necessary (these have subsequently been completed and published.) The injections we are using have been subjected to peer review by the joint Socioeconomics Committee of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons in July, 1988. They concluded, this form of treatment "offers a reasonable alternative for treatment of "trigger point" or "iliolumbar syndrome" or "myofascial syndrome" and has been demonstrated to be reasonably effective for these syndromes. They also point out, although "not widely employed by neurosurgeons, it should be considered and accepted as a modality of therapy." The Blue Cross Medical Review Committee has reviewed the injection protocol and deemed these injections to be an established form of treatment that will be reimbursed similar to other injection procedures. Furthermore, prolotherapy has been the subject of many research papers that have proven its effectiveness. The most important journal article appeared in the Lancet July 1987. Dr. Ongley was the author of the research; he remains the leading practitioner of this technique. Dr. Garcia trained with Dr. Ongley. How painful are the injections? Most patients prefer to have intravenous sedation induced prior to each back or neck treatment. This makes the injections more tolerable, even for people normally hypersensitive to injections. The injections often become less uncomfortable as the weeks go by and the tissue becomes less sensitive. There are usually 15 to 20 puncture points for the low back injection and 10 to 15 for the neck. Bandages should be removed several hours after each treatment session. The needle is fanned through out the tissues from these entry points, and therefore covers a larger area with minimal tissue trauma. There is stiffness and soreness for 24 to 48 hours after each treatment session, which is lessened by doing the exercises which you will be taught. You will not receive the full benefits of the treatment if you fail to do these exercises. The discomfort is rarely intense, and most patients are not greatly inconvenienced. Sometimes patients report a temporary setback or new pains during one or more weeks of the treatment. It is important not to get discouraged and to remember the healing process is slow, and almost all patients treated with this method will show significant improvements as time goes by and as the healing process proceeds. Do I need any special examinations MRI or X-rays of the problem area? Please bring all lab, X-ray or MRI studies with you so they do not have to be repeated. Is there an age limit? We have treated teenagers as well as individuals in their 80's. However, the treatment may be more difficult for individuals over the age of 65 especially if there are other serious medical problems. How many injections are needed? A minimum of six to eight treatments must be given for the low back and four to six for the neck. These are usually given in bi-weekly intervals with a one month resting period after the sixth in the series of back injections and after the fourth neck treatment. If necessary, the injections can be given every third week without any decrease in effectiveness, if scheduling problems or vacations interfere. Sometimes additional injections must be given. Can I work the same day? Most people prefer not to, because they are somewhat groggy from the intravenous relaxing medication. Many patients prefer to have their injection late in the afternoon so they can work prior to the injection during the day, and are able to return to their job the next morning. You must arrange for a ride each time you have an injection, because you may be sedated for each treatment. How long is each appointment? Your initial evaluation is usually 60 minutes in duration. Your initial back or neck treatment takes 30 to 60 minutes and subsequent treatments require about 30 minutes. The first treatment usually requires two consecutive weeks. Subsequent treatments are usually once every two weeks. How long before I notice some improvement? Some patients notice significant improvement in their usual pain after only three or four treatments. There may temporarily be new pains induced by the injections which may take up to two months to subside. Most patients feel a distinct improvement in their back or neck by the fourth treatment, but occasionally the improvement is not noted for up to one month or longer after the completion of treatment. How will I know if my back is getting better and stronger? You should notice a gradual decrease in pain and an increase in strength as the weeks and months go by. Can I take pain pills during the treatment if I am stiff and sore? You should avoid Aspirin, Motrin, Naprosym, Feldene, Indocin, Nuprin, Advil, Clinoril, and other anti-inflammatory medicine for up to three months following completion of the injections. You may take extra strength Tylenol every 4 to 6 hours as needed, and if something stronger is necessary we will discuss it with you. Usually ice, exercise, and an occasional Tylenol are adequate to control any discomfort. After the first two treatments the injections are tolerated better and are often associated with less stiffness. 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