SI joint pain

IPSIS: Formerly the Spine Intervention Society
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Not trying to hijack your post,

But since there have been a lot of replies and interest in this one....

Your post # 11, how many of you physicians in practice have had a patient seize with Tramadol?
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SSdoc33 said:
Ding ding ding. We have a winner.
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No winner. This is gluteal pain and it's severity - as reported - does not make any anatomic sense. As described she is desperate and impaired, without a diagnosis, this does not pass the sniff test.

She may be treatable, but HIGHLY unlikely to be CURABLE. How do you CURE disabling, atraumatic, gluteal pain.
 
Jitter Bug said:
Interesting..

So if she's a high functioning logical person, pain should be curable with the right treatment.

If she's a hysterical female, pain is forever and we need to teach her to cope and manage her chronic pain.
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please teach me, oh heavenly one, how you are curing patients with chronic pain...
 
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i stopped reading when the namecalling and psych accusations started...but if she isnt better yet you can PM me. The needle knows as long as u didnt inject too much ala shotgun approach. If you think it's SI and u had a positive diagnostic block, then treat it. FOR GOD's SAKE DO NOT FUSE or STIM HER. The viscosupp is a good idea....the PRP is a better idea. There is one BEST idea.
 
Doctodd said:
i stopped reading when the namecalling and psych accusations started...but if she isnt better yet you can PM me. The needle knows as long as u didnt inject too much ala shotgun approach. If you think it's SI and u had a positive diagnostic block, then treat it. FOR GOD's SAKE DO NOT FUSE or STIM HER. The viscosupp is a good idea....the PRP is a better idea. There is one BEST idea.
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but you have to go to honduras to learn it :eek:
 
Doctodd said:
i stopped reading when the namecalling and psych accusations started...but if she isnt better yet you can PM me. The needle knows as long as u didnt inject too much ala shotgun approach. If you think it's SI and u had a positive diagnostic block, then treat it. FOR GOD's SAKE DO NOT FUSE or STIM HER. The viscosupp is a good idea....the PRP is a better idea. There is one BEST idea.
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I didnt call names. I suggested the dx was wrong and the pain was out of proportion to trauma, exam, and imaging. A good doctor knows when enough is enough. Put your toys away and get additional hx, imaging, or consultation. Not more procedures.
 
lobelsteve said:
I didnt call names. I suggested the dx was wrong and the pain was out of proportion to trauma, exam, and imaging. A good doctor knows when enough is enough. Put your toys away and get additional hx, imaging, or consultation. Not more procedures.
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I wasn't accusing you.......the whole thread was full of it.

Anyhoo......treat it like a knee.....unless you are an ortho or unless you can RF ala "scorched earth" the entire sacrum. Of course rule out piriformis and gluteus tendinitis.....which you can PRP too.
 
For those of you advocating PRP of the SI joint (she did have positive diagnostic blocks, positive transient response to intraarticular steroid but the RF failed) do you advocate 1 injection, 2 or 3, and if multiple injections are recommended, how far apart? Some docs in town are doing a series of 3 each 1 week apart, others are re evaluating in a month or so to see if more injections are needed ( which seems more reasonable) How long does it usually take to see results after the PRP? She does have moderate arthritis of the facets and SI joints.
 
Joints aren't very vascular so PRP being mostly growth factors might not work much especially if the patient is over 40. PRP is great by itself in muscles and tendons and other vascular structures.
 
Doctodd said:
Joints aren't very vascular so PRP being mostly growth factors might not work much especially if the patient is over 40. PRP is great by itself in muscles and tendons and other vascular structures.
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Even if you believe in prolo, which I dont, it would only be indicated if there was some sort of Sij instability.
 
I don't do prolo to patients but it does work(ive done it to myself).........I jump straight to PRP. But for joints u need something to regenerate the cartilage if it's DJD. SI instability should respond to PRP and dry needling of the SI ligaments....but a diagnostic block into the ligaments is more cephalad than the joint entry location which is usually lower.
 
Doctodd said:
I don't do prolo to patients but it does work(ive done it to myself).........I jump straight to PRP. But for joints u need something to regenerate the cartilage if it's DJD. SI instability should respond to PRP and dry needling of the SI ligaments....but a diagnostic block into the ligaments is more cephalad than the joint entry location which is usually lower.
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fair enough. but we are dry needling into ligaments now? i wish someone had thought of that for RG3
 
SSdoc33 said:
fair enough. but we are dry needling into ligaments now? i wish someone had thought of that for RG3
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torn ligaments versus lax or strained ligaments......professional football player vs housewife......not really apples to apples.
 
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PRP is becoming more common with professional atheletes, particularly NFL. The thought is that it can speed the healing of a grade I tear. In the middle of a professional season, if that gets you back a game or two sooner, it's worth it.

My residency attendings did this for a few of the Patriots and Red Sox when I was in Boston.
 
bedrock said:
PRP is becoming more common with professional atheletes, particularly NFL. The thought is that it can speed the healing of a grade I tear. In the middle of a professional season, if that gets you back a game or two sooner, it's worth it.

My residency attendings did this for a few of the Patriots and Red Sox when I was in Boston.
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please explain this to me. i was under the impression that ligaments dont "heal". you have a tear, you have a tear. does PRP consolidate the edges and make you less likely to tear further? didnt work all that well for carl crawford. and if you are injecting within the substance of the ligament, are you not, by definition, causing additional ligament damage? ill buy PRP for tendinopathy, where you can do a peri-tendonous or inject the outside of a tendon. ligaments? really?
 
there is good PRP and not so good PRP.....in laymans terms PRP has growth factors without granulocytes that will promote healing in an organized fashion. In the case of a ligament it will help heal tears instead of forming scar. When ligaments are stretched out it will tighten it up. This is of course in conjunction with physical therapy. I started doing this for facets and results have been very good.....along with all the knees and shoulders i already see. Have done some nonunion fractures too. Im the only guy in the world doing this and it is too hard for you to learn, so just send them to me :D:D
 
Doctodd said:
there is good PRP and not so good PRP.....in laymans terms PRP has growth factors without granulocytes that will promote healing in an organized fashion. In the case of a ligament it will help heal tears instead of forming scar. When ligaments are stretched out it will tighten it up. This is of course in conjunction with physical therapy. I started doing this for facets and results have been very good.....along with all the knees and shoulders i already see. Have done some nonunion fractures too. Im the only guy in the world doing this and it is too hard for you to learn, so just send them to me :D:D
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Do you have studies which show ligament healing and Tightening without scar formation?

How exactly does P.T. tighten ligaments?
 
PT doesn't tighten ligaments much unless the patient is very young and heals very well......prolo or PRP will in our typical older patients. PT just guides the fibers to heal via Wolff's law or whatever that remodelling law is called. Like I said....just send em to me.
 
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Doctodd said:
PT doesn't tighten ligaments much unless the patient is very young and heals very well......prolo or PRP will in our typical older patients. PT just guides the fibers to heal via Wolff's law or whatever that remodelling law is called. Like I said....just send em to me.
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PT Does NOT tighten ligaments no matter what age.
Prolo can scar them which essentially "tightens them"

PRP .... jury is still out, despite your anecdotal success
http://jbjs.org/article.aspx?articleid=488968
 
You are not addicting people to opioids and they are paying out of pocket. Carry on.
 
I agree.....Carry on
 
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101N said:
You are not addicting people to opioids and they are paying out of pocket. Carry on.
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With this logic ....we could also prescribe magnets for pain, sell ground up peach pits for cancer treatment,,etc
 
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Dr. Ice said:
Why not? If it does no harm then why not?
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I thought we were supposed to be ethical, and not charge people for BS that is not proven, with potential risk, or provides false hope.

We could make millions lying to people and selling trinkets, spells, or potions.
But our job is supposed to be as scientists, trained in allopathic or osteopathic medicine.
Failing to be scientists first, we are nothing better than charlatans.
 
How much does PRP cost? I don't think it's in the LSI league.
 
101N said:
If you think it's a placebo why do it at all?
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I'm already there and the patient requests it. As I spin down their whole blood and inject in the spot I am already at, I have added no cost or risk to the the procedure. If it helps more than the trigger point itself, then good.

Free without risk is different than $500 cash without risk or defrauding insurance.
Or injecting medicine that could have risk.
 
lobelsteve said:
I thought we were supposed to be ethical, and not charge people for BS that is not proven, with potential risk, or provides false hope.

We could make millions lying to people and selling trinkets, spells, or potions.
But our job is supposed to be as scientists, trained in allopathic or osteopathic medicine.
Failing to be scientists first, we are nothing better than charlatans.
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U mean like when using corticosteroids?
 
lobelsteve said:
I'm already there and the patient requests it. As I spin down their whole blood and inject in the spot I am already at, I have added no cost or risk to the the procedure. If it helps more than the trigger point itself, then good.

Free without risk is different than $500 cash without risk or defrauding insurance.
Or injecting medicine that could have risk.
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Then you are using crappy PRP. The centrifuges that concentrate the best are big, heavy machines with kits that aren't free. And the more granulocytes, the more unwanted inflammation.
 
Doctodd said:
Then you are using crappy PRP. The centrifuges that concentrate the best are big, heavy machines with kits that aren't free. And the more granulocytes, the more unwanted inflammation.
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Ready to read your literature on the subject.

RCT of spun down whole blood vs RS Medical or Brand XXX PRP kits.

Thought so. I did not drink the kool aid.
 
lobelsteve said:
Ready to read your literature on the subject.

RCT of spun down whole blood vs RS Medical or Brand XXX PRP kits.

Thought so. I did not drink the kool aid.
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U thought so?? I have witnessed poor PRP and a big swollen face in another office....I myself have never used the crappy centrifuges. Since you guys like this journal I'll post one article.....you can do the rest of your own homework. Check out equine studies too.....the thoroughbred horses treated with PRP would race again vs being put out to pasture or glue.


http://jbjs.org/article.aspx?articleid=1361623
 
lobelsteve said:
Ready to read your literature on the subject.

RCT of spun down whole blood vs RS Medical or Brand XXX PRP kits.

Thought so. I did not drink the kool aid.
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Since you guys like this journal I'll post one article.....you can do the rest of your own homework. I'm not here to change anyone's mind any longer.....u practice the way you want and I'll do the same.


http://jbjs.org/article.aspx?articleid=1361623
 
Regenokine in Germany is not the same as Regenokine franchise/satellite offices in the US. Their methods are proprietary so I don't know what machines they use.
 
Below is from Borg-Stein.

Lee Wolfer at both ISIS 2011 and at AAPMR 2012 said the more we study PRP, the less the results appear to be. She is the top myofascist in my book.

The answer is we do not know. Saying one is better than the other is nonsense. It has not been adequately studied. I assume you (Todd) have a particular brand or bought into someone's equipment (RSMedical) or Alan Mishras stuff.

With money to be made, I'll reserve belief from the sales reps until they can drop off peer reviewed data, not horse tendon garbage.

The jury is still out, and if my labs centrifuges are as good as Luz (runs my lab) says, then my patients and I are happy (and they enjoy a placebo response) without additional risk from a procedure that was getting done anyways.
 

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lobelsteve said:
Below is from Borg-Stein.

Lee Wolfer at both ISIS 2011 and at AAPMR 2012 said the more we study PRP, the less the results appear to be. She is the top myofascist in my book.

The answer is we do not know. Saying one is better than the other is nonsense. It has not been adequately studied. I assume you (Todd) have a particular brand or bought into someone's equipment (RSMedical) or Alan Mishras stuff.

With money to be made, I'll reserve belief from the sales reps until they can drop off peer reviewed data, not horse tendon garbage.

The jury is still out, and if my labs centrifuges are as good as Luz (runs my lab) says, then my patients and I are happy (and they enjoy a placebo response) without additional risk from a procedure that was getting done anyways.
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Steve...did u even read the whole article?......cuz Borg Stein and everyone in their office have been doing it for 3+ years even though their CYA conclusion is "needs further study"....their results are the same as mine. And i have been intentionally vague.....when i say i use PRP+. My follow up MRI's are all the proof I need.

Like I said....I'm not here to change your practice. Over and out.
 
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Ducttape said:
please teach me, oh heavenly one, how you are curing patients with chronic pain...
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Ducttape, I should have put that in purple. I was summarizing what seemed to be the two leading philosophies on this particular thread.

Whereas I think logical capable people can have problems with chronic pain coping and unrealistic expectations of pain relief without being a total nutjob.
 
Do you mean the omg from Boston scientific? I thought he was a st juder.
 
it was a (bad) joke. I always thought the OMG was unfortunately named.
 
Doctodd said:
U thought so?? I have witnessed poor PRP and a big swollen face in another office....I myself have never used the crappy centrifuges. Since you guys like this journal I'll post one article.....you can do the rest of your own homework. Check out equine studies too.....the thoroughbred horses treated with PRP would race again vs being put out to pasture or glue.


http://jbjs.org/article.aspx?articleid=1361623
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I'll call you next time my horse pulls up lame..
 
I am not aware of any peer reviewed articles that document efficacy of either prolo or prp in the SI joint. Can anyone currently advocating these modalities point me to some papers?
 
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