When you come in to our Tulsa, OK clinic for an evaluation for your pain we will discuss the history of your pain and a perform a physical exam to determine the areas that need therapy. You can read more information on Tulsa Prolotherapy - Is It Right For You and How Do You Know.
It is important to understand that the location of your pain may NOT be the actual area that needs Prolotherapy treatment or you may also have other areas that are damaged and also need Prolotherapy treatment. I can't tell you how many times someone has asked "I'm hurting here, why are you injecting there?" For example, you may have shoulder pain but the pain may actually be radiating from your neck and not actually a shoulder problem at all. This is akin to the person having angina (chest pain) and having left arm and neck pain.
What to wear:
We will need to be able to adequately examine the entire structures. I recommend athletic clothing: shorts, sports bra (for women), yoga pants, sweat pants, etc. If your clothing will not facilitate the exam then we will need to place you in a gown. I don't know too many people who look forward to wearing one of those!
At this point we will determine the extent of therapy that you will need and we will schedule a specific appointment for you to return for your therapy. We will do everything we can to get you back as quickly as possible - who wants to keep living with pain?
Note: you will have to sign a waiver that the procedure is not covered by your insurance and you will have to pay for the services at the time they are rendered.
I will show you a powerpoint presentation that will show how prolotherapy works, what to expect, risks, benefits, etc. I make sure that all of my patients have watched this video so that we are all 'on the same sheet of music'. You can view that video here:
You can see the prices for Prolotherapy here. Prolotherapy is the most cost effective way of decreasing, and likely completely curing, your pain. Long term, it is cheaper than medications, physical therapy, surgery, and it is significantly cheaper than living with pain!
We will tailor a treatment plan to YOUR individual medical and personal needs to maximize your results. Some patients prefer to work on small areas in sequence. Others want to expedite their healing and get better as fast as possible so they opt for as much treatment at each visit as possible. We will discuss your medical condition as well as likely costs and agree on a plan that works for you!
You will be given an instruction sheet (Prolotherapy - After Your Exam) describing what you need to avoid prior to the procedure and what to do afterwards. You should adhere to these instructions as strictly as possible in order to maximize the benefits. Not following the instructions won't do any additional harm but it may prevent the procedure from working. Why would you endure multiple injections and pay for the procedure only to do something that prevents optimal results?
Here is what you should NOT do before or after your treatment:
- Ice – Limit Ice as much as possible. You can use a limited amount after the procedure but only for pain control. It is not part of the therapy.
- Non-steroidal anti-inflammatory medications such as: ibuprofen, Naprosyn, Aleve, Celebrex, Aspirin, Mobic, indomethacin, etc
- Smoke – major bad, don’t do it! It will inhibit your healing
- Eat poorly – see the diet information below
Your First Prolotherapy Procedure...
Prolotherapy injections can be painful. We are injecting an irritating solution into an area that already hurts. The pain from each injection only lasts for a couple of seconds since the anesthetic should 'numb' the area.
The needle is typically very well tolerated but some patients do have pain from the needles, the response is highly variable. We have a topical anesthetic that can reduce the discomfort of the needle by up to 80%. It takes about 45 minutes to 'kick in' so you'll need to show up a little early if you want the benefits. The topical cream will not reduce the discomfort of the injections down deep.
We also use a Tennant Biomodulator which targets a voltage very specific to the nerves and does an excellent job at distracting them. This device is very effective for reducing the pain and discomfort of the procedure and is highly recommended by most of my patients. Some patients don't like the sensation when it is turned up to the higher settings but the higher we can turn it up the more it decreases the pain.
We want you to be as comfortable as possible during the procedure. Some patients request pain &/or anxiety medication to take before the procedure. These medications can help a significant amount. You will need to have someone with you to drive you home if we are going to use these medications.
If you read 'How Does It Work' then you'll recall that prolotherapy works by stimulating the immune response and causing an inflammatory reaction. Anything that prevents or slows down the inflammatory response can decrease the effectiveness of the injections.
Traditional medicine states that we should R.I.C.E an acute injury. If you are unfamiliar, that stands for Rest, Ice, Compress, and Elevate. All of these things serve to decrease inflammation which can decrease pain in the short term but often inhibits the healing. I often wonder how many athletes and patients have chronic weakness and pain BECAUSE they treated themselves with R.I.C.E.
Instead, we should utilize the M.E.A.T. protocol...
Movement increases circulation and some tissues (articular cartilage for example) rely exclusively on diffusion from surrounding tissues and fluids. Movement dramatically increases the diffusion of nutrients and also increases circulation, both of which are essential for wound healing.
Exercise helps properly align the new collagen being laid down and also increases circulation as with movement.
Analgesics decrease pain and facilitate movement and exercise. However, it is essential that you avoid the things listed below as these will decrease the effects of prolotherapy.
Treatments - There are a number of therapeutic treatments that can increase healing and tissue recovery. Things such as ultrasound, myofascial release, trigger point therapy, and proper nutrition can all contribute to maximize results. I also commonly recommend Chiropractic & physical therapy.
After Your First Prolotherapy Procedure:
Again, prolotherapy injections can be painful but are generally very well tolerated in the office. You should be pain-free at the completion of the procedure indicating that we have treated the appropriate areas. You will, however, have what is generally described as an 'achy fullness' and can last for several days.
The response to prolotherapy is highly variable. Some patients are basically pain free after the procedure and from that point on. Some patients experience extreme pain after the procedure and need pain medications for the first few days. There is no way to accurately predict how you will respond to the procedure. In general, if you have a high pain tolerance and the procedure itself was pretty mild for you then you will probably do pretty well after the procedure.
The immune system is trying to heal the weakened/injured area and this process takes weeks. In fact, most collagen is produced during weeks 3 and 4 after the injection. Most patients describe a fluctuating course of aching that gets progressively better as the days go by. Some patients are completely pain-free after one injection but most patients require 3-6 injections over a 3-6 month period. Some patients are pain-free for a couple of weeks in what I call a "honeymoon period". The pain may come back after this period and it is a normal part of the process. It simply indicates that the area is not yet healed and may need more treatment.
Now for a list of things you SHOULD do after your treatment:
- M.E.A.T. Protocol: this is the prolotherapy analogue to the RICE Protocol which prevents healing.
- Movement & Exercise – these stimulate blood circulation, maintain and improve muscle conditioning, and increase growth factors. Movement of the treated area is essential to insuring that the new collagen is properly aligned. You may be prescribed specific exercises or movements that you should do frequently during your rehabilitation. I typically do not restrict exercise during the treatment process.
- Analgesics – not the anti-inflammatory type! You can use Tylenol or you may be prescribed a stronger medication, such as Tylenol #3, for short term use only. The pain or discomfort after the injections is short-lived. In my experience, most patients simply don’t need any analgesics for pain control. Many prolotherapy physicians recommend Bromelain which is available over-the-counter.
- Treatment – modalities such as ultrasound, myofascial release, trigger point therapy, and nutrition can improve the healing process.
- Weight training – cut your weight in half and increase repetitions if you are exercising an area that is being treated. When the pain at that weight resolves then you can slowly increase the weight as long as you are still pain-free.
- Apply heat – 30 minutes per day applied to the affected area. This increases the circulation to the affected area and is especially important in the first few days.
- Get adequate sleep! Growth Hormone increases healing and it is released during deep sleep (Stages III & IV). We want as much GH as we can get (the natural way, of course).
- Proper Nutrition – avoid fast food and eat a well-balanced diet of natural foods.
- Anti-inflammatory foods: some foods have been thought to have anti-inflammatory properties
- Celery seed
- Skullcap (baicalein source)
- Berberine – found in Hops, barberry, goldenseal, and Oregon grape
- Boswellic acid – found in Boswellia
- Catechins – found in Green tea, rhubarb, and current
- Kaempferol – found in Cabbage & chives
- Clove, lavender, marjoram, and ginseng
- Curcumin – found in Ginger, cardamom, and turmeric
- Ursolic acid – found in Rosemary, thyme, and sage
- Omega 3 Fatty Acids – salmon & other cold water fatty fishes, fish oil supplements
Failing to heed the advice above will not necessarily cause harm. However, following this advice will maximize the results that prolotherapy can provide.
Be sure to wear comfortable clothing that will facilitate a thorough exam of the affected areas.