Bi-lateral Hip Pain - Prolotherapy and Steroid Injection
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First let me start by saying, most people who know me and have read some of the articles I have written know that I am not a big fan of giving injections under X-ray.
Here are a few of my objections to performing injections under X-ray:
1. No study anywhere in the world that I know of reports that injections under X-ray actually give better results compared to injections given without X-ray guidance.
2. Insurance companies pay billions of dollars for these injections under X-ray, yet no documentation exists showing improvement in patient care.
3. Steroids are the typical solutions physicians use for these injections under X-ray (called fluoroscopic guidance), yet steroids have been shown to cause cartilage deterioration.
4. Injections under X-ray guidance cost 10 times the amount as normal Prolotherapy injections.
5. Only one injection is typically given when performed under fluoroscopic guidance, so what is the likelihood that the injection is going to give long-term pain relief? I would say the answer to that is "very low."
If you don’t agree with the above, lets look at one example from a patient who was just here at the office last week:
Mark came into the clinic with a two year history of bilateral hip pain, right hip worse than the left. The pain started two years ago during a run. Mark typically ran 28-30 miles per week, but had not run for about two years, since the hip pain started. As a 51-year-old, he was getting pretty discouraged because he had tried physiotherapy, chiropractic care, electrical stimulation, laser treatments, and all the recommendations given to him pointed him toward bilateral hip replacement. The last treatment he tried was a fluoroscopically guided steroid injection into his severely degenerated hip. The net result was almost no pain relief and an expense of $2700.
I hope to provide you with documentation of what I am saying so you will know beyond a shadow of a doubt that what I am saying is true. These are real patients with real stories. I know most of you believe me, but for the skeptics, you will see more real arthroscopy reports, X-ray reports, and invoices from other providers.
Back to Mark. He received a steroid injection under X-ray guidance at some would say is one of the best medical centers for sports medicine care. In other words, Mark received the best of traditional medical care and I am saying it was ridiculous, ludicrous, and consciously unethical to perform an almost $3000 steroid shot on a person with bone on bone osteoarthritis.
This steroid shot was absolutely not indicated and should not have been performed. Another interesting part of his medical chart was the pain diary that he completed post-steroid injection. He reported a 7/10 pain level prior to the injection.
To learn more about the long term effects of corticosteroid injections, read Dr. Hauser’s scientific editorial, published in the Journal of Prolotherapy: The Deterioration of Articular Cartilage in Osteoarthritis by Corticosteroid Injections.
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