Here at PM&R Associates, we combine new and traditional medicines. We offer a variety of different injections for the treatment of joint pain. All joint injections are done with either X-ray or ultrasound guidance. We prefer ultrasound because it is safer for the patient, since there is none of the ionizing radiation associated with X-ray. We also use a specially formulated “no sting” local anesthetic to numb the skin before all injections. Below you will find different joint injection treatments and the pros and cons of each.
STEROID (CORTISONE) INJECTIONS
Pros: Steroid injections will reduce inflammation, if inflammation is present, and will reduce pain, swelling, and fluid in the joint.
Cons: Steroid injections have a limited use with osteoarthritis (OA) or degenerative joint disease as those are typically not associated with inflammation. It is a pharmaceutical treatment, which means it has a peak action and the effect tapers. Both local and systemic side effects increase with the dose injected and frequency of injections. Side effects of steroid injections may include weakening of the joint, increased blood pressure, elevation of blood sugar, and decreased ability to fight infection. Patients are usually limited to no more than 3 injections per year for any particular joint.
Pros: Non-steroid injections work best in degenerative joint disease or osteoarthritis (OA).It is a biologic treatment, which means it gets better with time and lasts longer than pharmaceutical treatments. Since no cortisone is used, this can be repeated as often as needed and is typically covered by insurance.
Cons: Non-steroid injections do not work for everyone. May be safely repeated more often than every three months.
ARTIFICIAL JOINT FLUID INJECTIONS (VISCO-SUPPLEMENTATION)
Pros: This injection s made of hyaluronic acid from rooster combs, which works like an artificial joint fluid given by injection. It is expensive, but it is usually covered for some joints by most insurances.
Cons: Usually requires multiple injections with limits on how many times it can be repeated. Not all joints are covered by all insurances and it required prior authorization. Given its cost, it’s worth noting that it may be no more effective than cortisone injections. Some experts feel risks are not worth the benefits and can have allergic reactions.
PRP INJECTION (PLATELET-RICH PLASMA)
Pros: PRP injection is a biologic treatment, which means the patient gets better with time and the effect lasts longer than pharmaceutical treatments. Taken from the patient’s own blood and given back the same day, PRP injections are now regularly performed across the country and can last 6 months to a year or longer. Sometimes it lasts longer, but not everyone gets better.
Cons: PRP injections are not covered by insurance, so there is a surcharge above what insurance pays. It may only prevent additional deterioration and even in those studies with symptomatic improvement, there were no MRI changes.
STEM CELL THERAPY
Pros: Stem cell therapy delivers decreased pain scores 75-78% at 6 months. It is able to treat avascular necrosis, which is a condition in which the bone of the joint actually dies. MRI will detect an increase in both cartilage and menisci. Stem cell therapy is not as painful as other options. It typically shows an increase in lifestyle scores by 75% at 6 months. This injection is dissolved in PRP, so the patient gets the benefits of both at one price.
Cons: Stem cell therapy is often expensive and is not yet covered by insurance.
To learn more about our injection treatment options, give us a call today.