Podiatry Arena members do not see these ads

I am looking for injection therapy research studies that support the use of local anaesthetic (Lignocaine, Bupivicaine etc), injections (and repeated injections), and show more favourable or the same results as cortisone injections; without the side effects. So far not having much luck searching and would appreciate any help.
Regards
Dyn

========================
Mr Dyn Parry
www.physio-first.org.uk
referrals@physio-clinic.org.uk
Tel: 0845 166 2176
or 0845 166 2976

There was that paper in (I think) the British Journal of Podiatric Medicine about (I think) 4-5 years ago on the use of LA in insertional plantar fasciitis with some pretty good results.

__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia
http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________
God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University
This is where I am, where are you?

I have the study by Pavier & Liggins (2001) BJP on the use of 0.5% bupivicaine ...in the tx of PF., if thats what your referring too, but thanks for that Craig.
regards
Dyn

Hello Dyn,
Although it doesn't concern serial injections, you may find the following article useful:

Crawford F, Atkins D, Young P, Edwards J. Steroid injection for heel pain: evidence of short-term effectiveness. A randomized controlled trial. Rheumatology (Oxford). 1999 Oct;38(10):974-7.
Or go to : http://rheumatology.oupjournals.org/...full/38/10/974


And I found an article on serial injections of marcaine for the shoulder:

Dahan TH, Fortin L, Pelletier M, Petit M, Vadeboncoeur R, Suissa S.
Double blind randomized clinical trial examining the efficacy of bupivacaine suprascapular nerve blocks in frozen shoulder. J Rheumatol. 2000 Jun;27(6):1464-9

If you put either of these titles into pubmed and select 'related articles', you'll probably find a few more relevant ones. Best of luck with it,
Lee

many thanks Lee,
the Marcaine study is the type of studies I'm looking for, but obviously missed when I searched pubmed, the other study by Fay Crawford I already had; have loads of steroid studies, but currently only looking for serial injections of analgesics (marcaine, xylocaine etc) & not just to lower limbs.
thanks again
Dyn

Hi,
Just wondering how you are getting on with injection therapy. The post was a couple of years ago now. Serial injections seem to be quite common in the UK with reasonable anecdotal evidence to support them. Marcaine is usually the LA of choice.

Brendan

Hello

I'm continuing with the study but it is longitudinal in nature and I really don't expect to have statistically meaningful figures for a year or two yet.
All the best

Bill Liggins

Neural therapy is a European technique involving injections of local anaesthetics - fascinating results - used it for years. See www.neuraltherapy.com Can be used for pain since surgery or accident and also effective in complex regional pain syndrome. Also see my website www.drmtaylor.com.au for details of prolotherapy where the local anaesthetic is combined with glucose for a strengthening effect - great for strained ligaments in the foot and ankle. Can tighten ligaments like the ones on the outside of bunions, hammer toes etc, can fix recurrent sprains of calcaneo-fibular ligaments and sagging arches. I'm running a workshop in Sydney for podiatrists in August 2006 and I'm coming to UK in October 2006 - anyone want a workshop there? Evidence base etc of course.

Hi your web site wont appear? Can you post further details of Sydney Aug 2006' thanks hj

Prolotherapy workshop in Sydney is at 27 Monro Ave Kirrawee on Sunday 27.8.06 from 8.30am-5.30pm for $300 plus GST - contact me at taylorme@internode.on.net for program and registration and try again on the website for links to references http://www.drmtaylor.com.au/ - it worked for me just now.

Is this legal for UK use with just an LA cert' ?

Cheers,

Martin

__________________
Darn it Jim, I'm just an old country Chiropodist - not a miracle worker

Dunno I'm just an Aussie Doctor, what would I know?? But firstly, in my workshop I would be teaching neural therapy which IS just local anaesthetics. And secondly, in prolotherapy the healing response is triggered partially by the osmotic effect of slightly hypertonic glucose and partially by the needle trauma. It's like the acupuncture technique, pecking the bone. They both release inflammatory cytokines in tiny amounts which initiate the inflammatory response ie attract polymorphs, then macrophages, then fibroblasts which lay down new collagen (Go back to your old textbooks - its all there) in and around the old strained ligament, especially where it attaches to the bone. Then as collagen matures it shrinks - awful for burns, but just what you want in sagging arches, bunions, hammer toes, sprained ankles etc. So, even if you couldn't inject glucose (whyever not, its not even a drug) you could still use the technique and get probably much the same effect. Some of my patients think I am a miracle worker, cos this technique works. eg 2 young soccer players with badly sprained ankles which weren't improving after 2 months of rest and were still unable to play. After 1 treatment were back playing, tho they both still needed a bit more to become completely well. Also a woman unable to sit down for more than half an hour for 26 years due to strain of the sacrococcygeal joint causing extreme pain in the area of the sacrum, now has no pain at all after about 3-4 treatments.

Thanks for the info. Very interesting idea and the theory stacks up. Disappointed to learn that Aussie Doc's don't know absolutely everything - its shattered my boyish illusions.

Regards,


Martin

__________________
Darn it Jim, I'm just an old country Chiropodist - not a miracle worker

Anybody doing foot prolotherapy in the NHS in the UK??

Someone else could answer this better than I. I hope there will be more after I come to UK in October. - keep in touch, there may be a workshop.
Margaret Taylor

A few questions (and answers) about prolotherapy that may be of interest to others:

RE Plantar fasciitis: Are you aiming to infiltrate the fascia itself, if necessary?
When ligaments tear they usually tear at the weakest point which is the attachment to the bone where ligament spreads out and becomes periosteum. So you always (almost) treat by touching bone (here the calcaneal spur) with the needle and injecting there.

Where can I get the 15% glucose? Is it standard pharmacy supply? There is no listing in the BNF.
You make up the 15% by dilution of 25% or 50% glucose, whichever is cheapest, with the lignocaine and some additional saline.

Is there an advantage to ultrasound guidance needle placement?
No advantage to using ultrasound guidance, the finger finding the tenderness is very accurate.

With prolo, would you consider a wider treatment area if the pain is diffuse?
Diffuse pain is trigger point referral or fibromyalgia or many different tender ligamentous strain points.

Recently I have also introduced cryosurgery for treating heel pain.
Cryotherapy is another way of triggering the inflammatory (healing) response as is prolotherapy, possibly not as accurate as a needle?
Margaret Taylor www.drmtaylor.com.au

Thanks for the technique tips.

The British National Formulary lists IV glucose (I assume this can be used?) as a POM. For UK Podiatrist it may be difficult to get hold of injectable glucose? I have a hunch it would not be acceptable to dissolve a sugar cube ......

A way around this might be a PGD (Patient Group Directive) but I would need to reference this to a reliable source. An ideas on quotable research papers confirming efficacy and safety?

Thanks !

In Australia we can just go into a surgical supplies shop and buy an IV bag with 25% sterile glucose for IV infusion for about $7 - ie very cheap compared to multi-dose vials, which are $27 a bottle. No need for a prescription. Just try ringing and asking.