Alton Pain Clinic offers injection therapy service delivered by highly trained and specialised physiotherapists who are dual trained both as physiotherapists and in the clinical use of Steroid and Ostenil (Hyaluronic acid) Injections.
This is a highly specialised and innovative service designed to improve accessibility to pain relieving injections; facilitating the patient pathways, minimizing waiting times and maintaining first class level of care. Ostenil and Steroid Injection for pain relief, reducing of stiffness and improvement of joint mobility, as well as for reducing inflammation in joints.
What is OSTENIL PLUS INJECTIONS?
OSTENIL PLUS Injection is a solution containing hyaluronic acid developed specifically for the treatment of osteoarthritis. It can be injected into the knee, or any of the other synovial joints in the body to decrease pain and stiffness and improve the other symptoms of osteoarthritis. It contains a higher concentration of sodium hyaluronate (hyaluronic acid) than standard OSTENIL plus mannitol and offers the option to reduce the number of injections to one per treatment cycle. Ostenil Injection in Knee can improve function and decrease pain.
What is a synovial joint?
A synovial joint is one that allows for movement, like the knee, hip or shoulder. Where the bones meet, their surfaces are covered with a layer of thick cartilage and a thin layer of fluid (synovial fluid) that separates and lubricates the two surfaces and protects the cartilage from wear and tear. The most important component of synovial fluid is hyaluronic acid, which allows the fluid to perform effectively. Normally there is an exact balance between the breakdown of old hyaluronic acid and production of new. However, in osteoarthritis, its breakdown exceeds production, which leads to an imbalance and lack of hyaluronic acid. The synovial fluid becomes watery and stops functioning effectively, allowing the cartilage of the bone to grate and wear more, causing the symptoms of pain, stiffness and the swelling of the joints.
How does OSTENIL PLUS Injections work?
This medication is injected into the space between the joint that contains synovial fluid and works to restore the balance between the breakdown and production of hyaluronic acid. This effect means OSTENIL PLUS injections can help decrease pain and stiffness of the joint. The hyaluronic acid in OSTENIL PLUS is very pure and is manufactured using fermentation. Containing no animal proteins, it is unlikely to cause an allergic reaction, plus the addition of mannitol (a sugar derivative) helps the hyaluronic acid to work for longer and more efficiently in the joint.
Treatment with OSTENIL PLUS Injection
OSTENIL PLUS Injection should be injected directly into the joint(s) like knee, ankle etc, affected by osteoarthritis by a fully qualified clinician. It is unlikely you will notice any benefits straight away, but you should gradually begin to feel a reduction in pain and stiffness over the following few weeks, which is likely to continue for several months. When the effect of OSTENIL PLUS Ijections begins to wear off, if considered appropriate by your clinician, you may safely choose to have another injection whenever necessary.
Does OSTENIL PLUS Injection have any side effects?
OSTENIL PLUS Injections has been extensively tested and has not been found to cause any serious side effects, plus it contains no animal proteins, so is unlikely to cause an allergic reaction. As with all injections there is a very small risk of infection and occasional post injection pain at the site, which may last a day or so. You should always consult with your clinician or ask your physiotherapist before beginning any new treatment.
Viscosupplementation as Part of a Multi-Faceted Physiotherapy Regime
WHAT IS VISCOSUPPLEMENTATION?
Viscosupplementation is an internationally recognised treatment for Osteoarthritis (OA) of the knee and other synovial joints1. It involves the intra-articular instillation of Hyaluronic Acid (HA) derived from either an avian or bio-fermentative source. Historically, a course of between 3 and 5 injections, delivered at weekly intervals, has constituted the treatment regime for mild to moderate knee OA. More recently the introduction of licensed single injection viscosupplement options, which offer effective symptomatic control for 6 months and longer following a single IA injection, have been introduced to the market. This has made the adoption of viscosupplementation as a therapeutic option less time consuming and more convenient to patient and clinician alike, and more economically viable.
HOW CAN IT BE BENEFICIAL AS PART OF A REHABILITATION REGIME?
Joint pain and impaired joint function are common symptoms of Osteoarthritis1. Conservative measures, as recommended by all recognised medical and rehabilitation authorities, include weight loss and exercise to facilitate improved joint function. Failure to engage with weight loss and rehabilitation programmes – often as a result of unremitting joint pain on movement – is a major contributing factor in the failure of some patients to attain satisfactory symptomatic reduction and improved function2. Viscosupplementation has been clinically and statistically proven to significantly reduce pain and improve joint function in OA joints3, 4, 5, both as a singular intervention3 and as part of a multi-faceted physiotherapy programme6.
IMPROVED CLINICAL OUTCOMES
Intra-articular instillation of sodium hyaluronate has been demonstrated to significantly reduce pain and improve joint function. It can significantly reduce the need for potentially gastro-toxic systemic analgesics, demonstrably improves Quality of Life for patients, and is safe and easy to administer in a community setting by an increasing number of qualified MSk clinicians. For those patients who have consistently failed to respond adequately to all conservative measures, but who are unable or unwilling to undergo surgery, viscosupplementation offers a proven and safe intervention to ameliorate suffering, improve clinical outcomes, reduce visits to GP surgeries, and ultimately maintain the integrity of articular function for longer. Some MSk services, often due to CCG directives, have adopted clinical pathways which are failing to adequately treat this cohort of patients, resulting in the frustrating patient experience whereby they are sent back and forth from Primary to Secondary Care without being offered any effective treatment, and thus no improvement in their symptoms.
HOW CAN IT IMPROVE THE PATIENT EXPERIENCE?
Viscosupplementation can enhance the patient’s experience in a variety of ways: studies demonstrate it can delay total knee replacement,7 allowing for a better quality of life for longer, without the trauma and considerable rehabilitation time associated with arthroplasty. The potential complications associated with surgery (e.g. neurological damage, infection, scarring and revision surgery), as well as the costs to Commissioning Services are considerable. Reducing hospital appointments, enabling patients to exercise an informed choice over their preferred treatment modality, and utilising the considerable resource available within Primary Care frameworks, has been shown to improve patient satisfaction3, and reduce expenditure on secondary referrals8. Viscosupplementation can be administered by any clinician qualified to perform an intra-articular injection, creating a more community based care approach. A single intra-articular injection can provide 6 months of symptomatic relief and improved function3, with a corresponding improvement in Quality of Life, and maintenance of independence. Adverse events associated with viscosupplementation are rare9and associated with the transient effects of the injection itself, ensuring patient safety is optimised.
1. Bellamy N, Campbell J, Welch V, Gee TL, Bourne R, Wells GA. Viscosupplementation for the treatment of osteoarthritis of the knee. Cochrane Database of Systematic Reviews. 2006; Issue 35 2:CD005321. DOI:10.1002/14651858.CD005321.pub2. 2. Manek NJ, Lane NE. Osteoarthritis: current concepts in diagnosis and management. Am Fam Physician 2000;61(6):1795-804. 3. A. Borrás-Verderaa,*, V. Calcedo-Bernalb, J. Ojeda-Levenfeldb and C. Clavel-Sainzc Efficacy and safety of a single intra-articular injection of 2% hyaluronic acid and mannitol in knee osteoarthritis over a 6-month period. Rev Esp Cir Ortop Traumatol. 2012;56(4):274-280. 4. Altman RD, Rosen JE, Bloch DA, Hatoum HT, Korner P. A double-blind, randomized, saline-21 controlled study of the efficacy and safety of EUFLEXXA for treatment of painful osteoarthritis 22 of the knee, with an open-label safety extension (the FLEXX trial). Seminars in Arthritis and 23 Rheumatism. 2009; 39(1):1-9. 5. A 40-month multicentre, randomised placebo controlled study to assess the efficacy and carry over effect of repeated intra-articular injections of hyaluronic acid in knee osteoarthritis: the AMELIA project. F Navarro-Sarabia, P Coronel, E Collantes, F J Navarro, A Rodriguez de la Serna, A Naranjo, M Gimeno, G Herrero-Beaumont, on behalf of the AMELIA study group. Ann Rheum Dis 2011;70:1957–1962. doi:10.1136/ard.2011.152017. 6. Hempfling, H. (2007). Intra-articular hyaluronic acid after knee arthroscopy: a two-year study. Knee Surg Sports Traumatol Arthrosc. 15 (1), p537-546. 7. Torrance GW, Raynauld JP, Walker V, et al. Canadian Knee OA Study Group. A prospective, randomized, pragmatic, health outcomes trial evaluating the incorporation of hylan G-F 20 into the treatment paradigm for patients with knee osteoarthritis (Part 2 of 2): economic results. Osteoarthritis Cartilage 2002;10(7): 518–527. 8. Wadell DD, Bricker DC. Total knee replacement delayed with hylan G-F 20 use in patients with grade IV osteoarthritis. J Manag Care Pharm 2007; 13(2): 113–121. 9. Robert J Petrella, Anthony Cogliano, Joseph Decaria. Comparison of avian and non-avian hyaluronic acid in osteoarthritis of the knee. Orth. Res. And Rev. January 2010 Volume 2010:2 Pages 5 – 9.
BENEFITS OF STEROID INJECTION
There is a significant amount of research which demonstrates that steroid injections give better levels of pain relief, give longer lasting effects than medication, and improve the function by reducing the inflammation. Corticosteroid injections, in general, are well tolerated by the body and do not cause the typical side-effects seen by taking oral steroids, or anabolic steroids.
HOW DO I BOOK?
To book for a steroid injection you can call our normal reception line, 0142084487 or email direct to email@example.com requesting an appointment for an injection. Please include your name, date of birth, your address and GP contact details. You will be sent a form to complete and forward back to us or bring along on the day which gives information about the injection. It also asks questions about past medical history and any reasons why we may need to seek advice from your GP before proceeding with the injections, i.e., IDDM or patients taking Warfarin, and allow us to raise the prescription for your injection. You will be seen, assessed and evaluated before receiving an injection. We may have to request X-rays of the joint before injection.
WHICH BODY PARTS ARE YOU ABLE TO INJECT?
Steroid injection like Kenalog can be very effective for frozen shoulder, carpal tunnel syndrome, trigger finger, localised soft tissue inflammation or tenosynovitis, such as tennis elbow or tendon inflammation at the shoulder and subacromial or trochanteric bursitis. For osteoarthritis of the knee or any other joint in the body, Steroid or Ostenil (hyaluronic acid) injections prove to be very beneficial to help relieve pain and inflammation and improving function.
Steroid injection plus cost of steroid: total fee £150 per injection.
Ostenil injection plus cost of hyaluronic acid (Ostenil): total fee: £220 per injection. Discounted price of £375 for two ostenil injections.
If on the day the decision is made not to proceed with the injection, you will only be charged the normal initial assessment fee for the clinic in which you are seen.
STEROID INJECTION FAQ’S:
Below you will find some of the most commonly asked questions concerning steroid injections.
What are steroids?
Corticosteroids are manufactured versions of hormones naturally produced by the adrenal glands. When corticosteroids are injected into a joint or muscle they can help relieve inflammation in a nearby part of the body, which can then reduce any pain and stiffness
What drugs are used?
The most commonly used steroid drugs are known as hydrocortisone, methylprednisolone and triamcinolone. They have brand names too such as Depo-medrone and Kenalog. In addition, a local anaesthetic known as Lidocaine is used.
How are they given?
When steroids are given for the purpose of pain relief, they are often used in conjunction with a local anaesthetic called Lidocaine. This will provide immediate pain relief that lasts a few hours and also has diagnostic value.
What should I do if I get pain?
You may notice your joint pain increasing immediately following an injection, but this should abate within 48 hours. Often the pain can be easily controlled by using some ice wrapped in a towel around the affected area to reduce the pain. Often the pain will not be too bad as a local anaesthetic will be used.
Do I still need to do my exercises?
Yes, you should still complete the exercises set by your physiotherapist after a recommended rest period of 1-2 weeks. Your physiotherapist may also encourage you to complete more intensive mobilisation and rehabilitation in the days after the injection treatment while the joint is less painful.
How many steroid injections am I allowed to have?
You usually need to wait at least 6 weeks between injections. Doctors normally recommend no more than two injections to hip, knee and ankle joints in the space of 12 months and no more than three injection per year in other parts of body.
How quickly does the injection take to work?
Shorter acting soluble steroids usually begin to give relief within a few hours. Longer acting steroids may take around two weeks to become effective, but these types usually ease symptoms for a longer period.
How long will the effects of an injection last?
It really depends on a number of factors. Some longer lasting, less soluble steroids can be effective for two months or longer. Sometimes improvement can be none at all. Factors include what else the patient may be doing to themselves, for example, if you have tennis elbow caused by playing tennis, and you have a steroid injection and then continue playing tennis or aggravating the problem you may get limited benefit. However, if you also make changes to your lifestyle, sports, do rehab exercises, and see a physiotherapist it is likely the effects of the steroid injection will last much longer.
What side effects can an injections cause?
This will depend on where the steroid is injected and what type of steroid you receive. Milder forms such as hydrocortisone tend to have weaker side effects than the stronger mixtures of methylprednisolone and triamcinolone.
- Pain and discomfort for a few days in the injected area
- Temporary bruising or collection of blood under the skin
- A flushed complexion
- An infection, causing redness swelling and pain
- Paler skin at the injected area
- Loss of fat at the injected area
- A rise in blood sugar (more likely for diabetes sufferers)
- Risk of tendon rupture
Can I go straight back to work?
It is advised to wait 30 minutes immediately after the injection at clinic reception before driving a vehicle. If you feel okay and aren’t in too much pain it is fine to return to work immediately. However, if your job involves heavy lifting, you should aim to reduce your workload for several days following injection.
Can I drive straight after the injection?
Yes, as long as you aren’t in too much pain and feel you can safely control the vehicle. However, it is advised to bring someone with you on the day to drive you back home following your injection.
Can I drink alcohol while on steroid injections?
Yes, there is no specific reason to avoid alcohol after receiving a steroid injection.
Do steroid injections affect pregnancy?
Single steroid injections are not likely to affect fertility or pregnancy. However, if you are pregnant it is strongly advised that you seek a doctor’s advice before receiving a steroid injection. If in any doubt, do not have a steroid injection.
Do steroid injections affect breastfeeding?
If an injection is given during breastfeeding, small amounts can pass into your breast milk. While this is unlikely to be harmful to your baby, you should still consult with a doctor before receiving a steroid injection. If in any doubt, do not have a steroid injection.
Can I have other medications while on steroid injections?
Yes. However, if you are taking a type of medication call an anticoagulant (a drug that things the blood), you are highly unlikely to be offered a steroid injection. This is because of the risk of bleeding into the joint. If you are taking an anticoagulant it is important that you inform your doctor before proceeding with a steroid injection.
What should I do if I have diabetes?
You should carefully monitor your blood sugar levels for 48 hours following a steroid injection. This is because sugar levels often rise and you may need more insulin than usual.