What Is Your Risk of Cardiovascular Disease?

Chances are you’ve seen ads for some type of injection therapy. These ads commonly claim that an injection can relieve your pain, eliminating the need for medications or surgery.

So are these claims just hype, or can an injection actually relieve your chronic pain? It depends on what type of injection it is, and what is causing your pain.

“Some types of injection therapy have been shown to be effective in clinical studies, but some are considered experimental,” explains Vandana Sood, MD, a physiatrist at Weill Cornell Medicine with subspecialties in interventional spine and sports medicine. “Before receiving any type of injection therapy, make sure you understand exactly what is involved and whether or not it has been evaluated by the U.S. Food and Drug Administration (FDA). If the FDA has not approved the use of a therapy, it usually means that data about its safety and effectiveness is still being gathered. If a treatment has been approved, it’s also important to find out what specific medical conditions it has been approved for.”

Approved Injections

Steroids, hyaluronic acid, and medial branch blocks are injection therapies associated with improvements in joint pain caused by osteoarthritis (OA).

Corticosteroid drugs (steroids) decrease inflammation, a main cause of OA pain; in injectable form, they have been in use the longest. Steroids commonly used in injections include hydrocortisone and methylprednisolone. “For many people, steroid injections are very effective at relieving pain, and they are used often. However, their effects aren’t permanent; many patients have an initial improvement, but the pain comes back,” explains Dr. Sood.

And these injections are not without risk, notes Dr. Sood: “There is evidence that repeated injections are linked with an increased risk of osteoporosis, and they may also raise blood glucose levels and blood pressure. Research also indicates that corticosteroids may have a negative effect on the actual cells of your joint.”

Another substance used in injection therapy is hyaluronic acid; this is commonly referred to as “gel injections.”

Hyaluronic acid is most often used to treat joint pain in the knee. It is similar to synovial fluid, a substance that surrounds your joints and acts as a lubricant and shock absorber. Dr. Sood notes that the effectiveness of gel injections has been mostly studied in the knee, and knee injections are covered by Medicare and many other types of insurance. However, they usually are not covered if used in other joints.

Medial branch blocks and ablation are procedures used to treat back pain. Each vertebra has two joints called facet joints. If arthritis affects the joints in your vertebrae, it can put pressure on the nerves near the joints and produce pain. Medial branch blocks involve injecting a numbing agent near the nerves, which relieves pain temporarily. Once the nerves causing the pain are identified, a procedure called radiofrequency nerve ablation may be done. In ablation, heat is applied to the nerve(s), and the nerve(s) die off.

PRP and Stem Cells: Not Approved for Pain

Injections of platelet-rich plasma (PRP) and stem cells are being investigated for treating pain, but neither has been approved by the FDA for pain. One drawback to these treatments is they are not covered by insurance, and they tend to be expensive; for example, stem cell treatments may run as high as several thousand dollars. If a health-care provider advises costly treatments, get a second opinion before agreeing to treatment.

PRP is obtained by taking blood from the patient, spinning it in a centrifuge, and separating out the plasma and platelets from the other blood components.

“Some studies of PRP have shown good effect for pain caused by knee OA,” notes Dr. Sood.

The FDA has approved stem cells for treating some cancers and conditions that affect the blood and immune system, but they’re not approved for treating any of these conditions:

• Pain caused by OA of the knee, hip, back, neck, or shoulder
• Heart or lung disease
• Infectious diseases
• Neurological disorders.

Factors in Pain Treatment

Dr. Sood stresses the importance of undergoing an evaluation to determine what is causing your pain before receiving any treatment.

She says, “Many factors are considered when determining what pain treatment is most appropriate for each person.” Some of these factors include age, medical history, other current health issues, severity and duration of the pain, and how pain affects the person’s ability to function.

Finally, she advises, “If you are being treated for pain, but the methods aren’t working, ask your doctor whether or not injection therapies might be appropriate for you.”

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