Aftercare


Pain Management Aftercare, Portsmouth, NH
Congratulations on having an injection at American Pain Institute! There are a number of possible consequences to having a procedure. As always, if you have any questions or concerns, please let us know.

  • If your procedure is a diagnostic procedure it is to test whether numbing a certain region is effective for your pain. If numbing the region reduces your pain, it signifies that the region numbed has been generating your pain. So if your pain is replaced by numbness, that is appropriate and a desired response. Unfortunately the local anesthetic used is temporary and may only last an hour or so. Once it wears off, the pain signals from the area will return, like Cinderella’s carriage which returned to a pumpkin at midnight. Your brain processes pain information. When pain increases gradually over time, the brain perceives the pain as minor. When pain increases suddenly, the brain perceives the pain as severe. An example of this is when you take a hot shower. If you step into the shower when the water is hot, you may feel pain and duck away from the stream of hot water. You then probably reduce the temperature of the water and go back in when it’s comfortably warm. As you stand under the stream of water, you will gradually increase the temperature every minute or so as your body gets used to the temperature. Eventually you can get to a very high temperature which feels great. But had you gone under the water stream with that same temperature to start, you would have ducked away thinking it was too hot and painful. If you have chronic pain, your pain probably increased gradually over months to years. That gave you time to get used to it, just like turning up the temperature in the shower over time. When the numbing medication wears off, it wears off quickly. As a result, your pain shoots right back up to where it used to be. However, instead of reaching that point over months to years, it reaches it in minutes. This is why your brain will perceive that pain as stronger than before the injection for the next couple of days. This is normal. Please remember that since your brain is causing this perception of your pain, taking more pain medication will not help. The best advice we can give you is to use distraction techniques and keep busy to reduce this false perception of increased pain. Please consult with your Physician at American Pain Institute before making any changes in your pain medication, particularly opioid analgesics.
  • If your injection was a therapeutic procedure, it probably involved the injection of a steroid. Steroids relieve pain by reducing inflammation and also by calming down nerves which are actively sending pain signals to your brain. Steroids take at least 24 hours to start reducing inflammation and pain. Do not be surprised if you don’t feel any relief for the first few days. That is normal. Another expectation of steroid injections is that the first injection is unlikely to relieve your pain very much. The steroid injections work best when stacked on top of each other. It is analogous to taking an antibiotic. It usually takes several doses of an antibiotic before the infection is treated. Therefore please do not expect a miracle with the first steroid injection. Its purpose is lay a foundation to reduce inflammation. The second injection is expected to work much better than the first. The third injection in the series usually results in prolonging the pain relief. The steroids persist for several weeks before breaking down in your body. There is a limit to how frequently they can be performed due to side effects affecting glucose levels, bone density, and other hormonal effects. If you have Thyroid Disease, you can experience side effects of facial flushing, generalized swelling, and increased appetite. If you have Diabetes, please monitor your blood sugar diligently as you will likely have to increase your Diabetes medications as steroids cause increased blood sugar levels. Consult with the Physician prescribing your Diabetes medications prior to making any changes. Some patients develop easy bruising on their arms and legs from steroid injections. Although unsightly, these will resolve over weeks after the last steroid injection. Please let your Physician at American Pain Institute know if you have any side effects.
  • You should be able to walk off the table after your procedure and return to your regular life or work immediately thereafter.
  • It is common to have soreness at the injection site once the local anesthetic has worn off. This can be addressed with ice or cold in the first 24 hours. After that you can use heat or an anti-inflammatory such as Ibuprofen or a pain medication such as Acetaminophen. The soreness can last several days. Please consult with your Physician before making any changes in your pain medication, particularly opioid analgesics.
  • It is less common, but not unexpected to have bruising or a bump under the surface of the skin at the injection site. There are blood vessels everywhere and if the needle hit a blood vessel, it can result in a bruise (a collection of blood) which will feel tender and swollen. Over the next several days to weeks, the body will reabsorb the collection of blood. An appropriate treatment for this is ice or cold in the first 24 hours to reduce the blood flow in the area. After that, you can use heat or an anti-inflammatory such as Ibuprofen or a pain medication such as Acetaminophen. The soreness will last until your body reabsorbs the collection of blood. Please consult with your Physician before making any changes in your pain medication, particularly opioid analgesics.
  • If you experience the following, please alert your Physician at American Pain Institute immediately: redness and pus from the region with or without fever, numbness or weakness persisting beyond 24 hours, severe headache persisting beyond 24 hours, or increased pain persisting beyond 24 hours. If you have any further concerns, please call.
Congratulations on undergoing Radiofrequency Neurolysis at American Pain Institute! There are a number of possible consequences to having this procedure. As always, if you have any questions or concerns, please let us know.

  • Radiofrequency Neurolysis has been around for 50 years and is tried and true technology for pain relief. The Radiofrequency Needle emits energy to increase the temperature of the surrounding tissue to destroy or cripple nerves. If the nerves are transmitting pain, Radiofrequency Neurolysis can reduce the transmission of pain from these nerves. The nerves will regenerate over time. The longer it takes them to regenerate the longer the duration of pain relief. The duration is usually from 6-12 months. The older you are, the longer it takes the nerves to regenerate. This is a nice benefit to getting older. The idea of using electricity to destroy or cripple nerves sounds painful, but it isn’t. The reason for this is that your Physician will inject numbing medication through the Radiofrequency needle before turning on the machine to “zap” the nerves. The most people feel is a dull aching sensation. If you feel pain, simply inform your Physician who will stop the machine and inject more numbing medication through the Radiofrequency needle. An important feature of Radiofrequency Neurolysis is safety. Before activating the strong amount of energy required to destroy or cripple a nerve, your Physician will first use a weak stimulating energy to verify that the Radiofrequency needle is not near any other nerves in the area, such as nerves that go to the muscles. This way you can feel confident that after the procedure is over, you should not experience any weakness in the region. With respect to pain relief, any nerve which is not destroyed on the spot enters a degenerating or “suicide” mode which reaches its conclusion in about two weeks. You need to wait two weeks after the procedure before seeing how much pain relief it gave you. As far as what to routinely expect after the procedure, it is the same as an injection procedure since Radiofrequency Neurolysis is performed through a needle.
  • You should be able to walk off the table after your procedure and return to your regular life or work immediately thereafter.
  • It is common to have soreness at the procedure sites once the local anesthetic has worn off. This can be addressed with ice or cold in the first 24 hours. After that you can use heat or an anti-inflammatory such as Ibuprofen or a pain medication such as Acetaminophen. The soreness can last several days. Please consult with your Physician before making any changes in your pain medication, particularly opioid analgesics.
  • It is less common, but not unexpected to have bruising or a bump under the surface of the skin at the procedure sites. There are blood vessels everywhere and if the needle hit a blood vessel, it can result in a bruise (a collection of blood) which will feel tender and swollen. Over the next several days to weeks, the body will reabsorb the collection of blood. An appropriate treatment for this is ice or cold in the first 24 hours to reduce the blood flow in the area. After that you can use heat or an anti-inflammatory such as Ibuprofen or a pain medication such as Acetaminophen. The soreness will last until your body reabsorbs the collection of blood. Please consult with your Physician before making any changes in your pain medication, particularly opioid analgesics.
  • If you experience the following, please alert your Physician at American Pain Institute immediately: redness and pus from the procedure sites with or without fever, numbness or weakness persisting beyond 24 hours, or increased pain persisting beyond 24 hours. If you have any further concerns, please call.
Congratulations on undergoing Kyphoplasty at American Pain Institute! There are a number of possible consequences to having this procedure. As always, if you have any questions or concerns, please let us know.

  • Kyphoplasty is used to treat spinal vertebral fractures. Unlike arms or legs which can be casted, there is no way to cast a vertebral fracture. Kyphoplasty involves the safe injection of a resin or cement inside the fractured vertebral body. The goal is to stabilize the fracture so it does not progress. Fractured vertebrae can be very painful since the fracture zone can behave like a geological fault line. Think about the San Andreas Fault. Whenever there is movement between the two plates of the fault, it creates earthquakes. When this happens in the fracture zone of a vertebrae, it creates pain. By stabilizing the fracture zone of a vertebrae, there is no longer any movement in the zone and pain is relieved.
  • Do not forget to take your antibiotic prior to the procedure.
  • You will need to have a driver.
  • You will need to hold absolutely still during the procedure for your safety.
  • Kyphoplasty is performed through a needle. It is a large needle and it requires a tiny incision in the skin to place the needle. As the needle needs to travel through bone, a mallet is used to tap the needle into place. Your Physician will inject numbing medication along the needle’s path while advancing it, minimizing any pain. You will hear the sound of the mallet tapping the needle which can be unsettling, like hearing the sound of the drill at the Dentist. Some people like to listen to music to drown out the sound, which is perfectly fine. Feel free to bring a music player and headphones.
  • The needle creates a tunnel into the center of the vertebral body. The next step is to place a smaller tube with an inflatable balloon at the end at the end of that tunnel. The balloon is inflated to create a cave. The inflation can be painful but just for a minute.
  • The needle is deflated which relieves any pain inflating it caused.
  • Next another needle is placed into the cave in the center of the vertebral body. Through the needle, a resin or cement is injected. The resin or cement contains contrast which makes it visible under X-Ray. Your Physician will inject the resin or cement very slowly and watch it in real time under fluoroscopy to make sure it goes into the correct location. Once your Physician is satisfied that the resin or cement is blanketing the fracture zone, they will stop injecting and remove the needle.
  • Since a small incision was made in your skin, your Physician will apply a dab of surgical glue to seal the incision as it’s too small to require a stitch.
  • After the procedure, you will get off the table and walk to the recovery room. When you feel ready, you will change back into your clothes. It is common to have soreness at the injection site once the local anesthetic has worn off. This can be addressed with ice or cold in the first 24 hours. After that you can use heat or an anti-inflammatory such as Ibuprofen or a pain medication such as Acetaminophen. The soreness can last several days. Please consult with your Physician before making any changes in your pain medication, particularly opioid analgesics.
  • It is less common, but not unexpected to have bruising or a bump under the surface of the skin at the injection site. There are blood vessels everywhere and if the needle hit a blood vessel, it can result in a bruise (a collection of blood) which will feel tender and swollen. Over the next several days to weeks, the body will reabsorb the collection of blood. An appropriate treatment for this is ice or cold in the first 24 hours to reduce the blood flow in the area. After that you can use heat or an anti-inflammatory such as Ibuprofen or a pain medication such as Acetaminophen. The soreness will last until your body reabsorbs the collection of blood. Please consult with your Physician before making any changes in your pain medication, particularly opioid analgesics.
  • The surgical glue will last for a number of days and will flake off your skin by itself. Please treat it like a scab and do not remove it yourself.
  • If you experience the following, please alert your Physician at American Pain Institute immediately: redness and pus from the region with or without fever, numbness or weakness persisting beyond 24 hours, severe headache persisting beyond 24 hours, or increased pain persisting beyond 24 hours. If you have any further concerns, please call.
Congratulations on undergoing Hydrodiscectomy at American Pain Institute! There are a number of possible consequences to having this procedure. As always, if you have any questions or concerns, please let us know.

  • Hydrodiscectomy is a procedure that occurs within a herniated or bulging disc. It is minimally invasive and is performed through a needle, rather than making an open incision. It can be performed under local anesthesia and you can return to your usual routine or work the very next day. We recommend having a driver just to be safe.
  • Do not forget to take your antibiotic prior to the procedure.
  • You will need to have a driver.
  • You will need to hold absolutely still during the procedure for your safety.
  • Hydrodiscectomy is performed through a needle. It is a large needle and it requires a tiny incision in the skin to place the needle. Your Physician will inject numbing medication along the needle’s path while advancing it, minimizing any pain. Once the needle is placed into the disc, your Physician will place the Hydrodiscectomy wand into the disc. You will hear the sound of the water circulating within the Hydrodiscectomy wand which can be unsettling, like hearing the sound of the drill at the Dentist. Some people like to listen to music to drown out the sound, which is perfectly fine. Feel free to bring a music player and headphones.
  • Since a small incision was made in your skin, your Physician will apply a dab of surgical glue to seal the incision as it’s too small to require a stitch.
  • After the procedure, you will get off the table and walk to the recovery room. When you feel ready, you will change back into your clothes. It is common to have soreness at the injection site once the local anesthetic has worn off. This can be addressed with ice or cold in the first 24 hours. After that you can use heat or an anti-inflammatory such as Ibuprofen or a pain medication such as Acetaminophen. The soreness can last several days. Please consult with your Physician before making any changes in your pain medication, particularly opioid analgesics.
  • It is less common, but not unexpected to have bruising or a bump under the surface of the skin at the injection site. There are blood vessels everywhere and if the needle hit a blood vessel, it can result in a bruise (a collection of blood) which will feel tender and swollen. Over the next several days to weeks, the body will reabsorb the collection of blood. An appropriate treatment for this is ice or cold in the first 24 hours to reduce the blood flow in the area. After that you can use heat or an anti-inflammatory such as Ibuprofen or a pain medication such as Acetaminophen. The soreness will last until your body reabsorbs the collection of blood. Please consult with your Physician before making any changes in your pain medication, particularly opioid analgesics.
  • The surgical glue will last for a number of days and will flake off your skin by itself. Please treat it like a scab and do not remove it yourself.
  • If you experience the following, please alert your Physician at American Pain Institute immediately: redness and pus from the region with or without fever, numbness or weakness persisting beyond 24 hours, severe headache persisting beyond 24 hours, or increased pain persisting beyond 24 hours. If you have any further concerns, please call.
Congratulations on undergoing your trial of Spinal Cord Stimulation at American Pain Institute! There are a number of possible consequences to having this procedure. As always, if you have any questions or concerns, please let us know.

  • The trial of Spinal Cord Stimulation is a procedure involving the placement of electrodes within the Epidural Space. It is no more invasive than an Epidural Steroid injection and is performed under local anesthesia. The electrodes are placed temporarily and are removed after 5 days. No incision is required as the needles used to place the electrodes are small.
  • Do not forget to take your antibiotic prior to the procedure.
  • You will need to have a driver.
  • You will need to hold absolutely still during the procedure for your safety.
  • You will need to wear a shirt which buttons down the front. Do not wear anything that you have to pull over your head to take off as that can catch on the electrodes and pull them out by accident. If the electrodes are pulled out by even a centimeter, the trial will fail and you will have to repeat it.
  • Your Physician will numb your skin and the path taken for the procedure. A needle will be placed along that path into the epidural space. Your physician can always inject more numbing medication if you feel any pain, just ask. Once the needle is in the epidural space your Physician will feed an electrode through the needle and into the epidural space. Then your Physician will advance the electrode to the proper location. While the electrode is being advanced it will not touch any nerves. However the vibration of its passage can cause an electrical “twinge”. Do not be scared as this is harmless and do not move. If there is any scar tissue or adhesions in the area, you may also experience an electrical “twinge”. Again do not be scared as this is harmless and do not move.
  • Once both electrodes are in place, the device will be activated. There are two different modes of the device. The traditional mode involves a low frequency of stimulation that you can feel as a pleasant deep tingling massage. The newer mode is a high frequency mode which you cannot feel. Either way, you need to hold still and simply answer our questions verbally. Please do not point or reach back as we need you to hold still for your safety. Our goal is to see if the electrodes are in the correct location. Each electrode has a number of contacts through which energy can flow. Because of the number of contacts, there are many combinations that can be tried to find the “sweet spot” of stimulation. Based upon your answers, we will hone in on the “sweet spot.” Sometimes we have to reposition the electrodes to find the “sweet spot.” Since everyone is different, this is common and do not concern yourself if this happens.
  • Once your Physician is confident that the electrodes are in the “sweet spot”, the needles will be removed, leaving only the electrodes under your skin. Your physician will numb your skin and stitch the electrodes where they emerge from your skin to secure them from moving. Next your Physician will apply a dab of surgical glue to where the electrodes emerge from your skin to further secure them and to prevent anything else from entering your skin. The entry sites of the needles are too small to require a stitch. Finally a bandage will be applied to your skin.
  • After the procedure, you will get off the table and walk to the recovery room. There you will be further educated on the use of the trial device. When you feel ready, you will change back into your clothes.
  • Please understand that the nerves we are trying to target are called “Interneurons”. Interneurons are in between the peripheral pain nerves and the pain nerves that travel up the spinal cord to the brain. Interneurons cannot be stimulated with electricity in the sense that you can feel them being stimulated. The sensation of stimulation caused by Spinal Cord Stimulation comes from electrically stimulating the nerves at the traditional low frequency. If the high frequency mode is used, you will feel nothing and can ignore the rest of this paragraph. A useful analogy is that the nerves which involve the sensation of vibration are located in the same “zip code” as the Interneurons. They are not in the same location. Therefore if you do not feel the sensation of stimulation covering every millimeter of where you feel pain, do not worry and do not obsess over this. When the settings are correct, the sensation of Spinal Cord Stimulation is a pleasant tingling sensation which massages the region. The strength of stimulation needed is very weak. It should feel like a “feather touch.” More is not better. Therefore if you are experiencing increased pain, do not increase the strength of stimulation as that will result in the wrong nerves being stimulated which will cause increased pain, muscle spasm, and twitching.
  • Please understand that the minority of people feel immediate relief at the beginning of the Trial of Spinal Cord Stimulation. For most, it takes several days before they perceive a difference. If you don’t feel immediate relief, do not worry as this is common. Furthermore, once the numbing medication wears off you will feel tenderness and pain at the insertion site of the electrodes which can prevent you from seeing how much pain relief the device is giving you. As the song says in the Broadway show “Hamilton,” “wait for it.”
  • Please understand that the trial version of Spinal Cord Stimulation is “primitive” and not as accurate at tracking your movement compared with the implanted version. It is meant to be a crude approximation to see if this technology is effective for your pain, nothing more. You fill find that every time you change position such as lying down, sitting up, twisting, or bending that the area of stimulation shifts around and changes in intensity. This is expected when using low frequency stimulation. What we are looking for is to see that when you feel the sensation of stimulation overlapping your pain it is relieving your pain by 50% or more. The implanted version is better at tracking your movements and is less “positional” in nature than the trial version. Again, if we are using the high frequency mode, you will not experience any sensation of stimulation, no matter what position your body is in.
  • Your activity level during the Trial of Spinal Cord Stimulation should be constrained to walking, driving, and sitting. Do not perform strenuous work like shoveling, raising your hands over your shoulders, severe bending, running, or exercising at the gym. Even though the electrodes are stitched and glued, do not shower as they must not get wet. Furthermore, if the electrodes move even a few millimeters from the “sweet spot” you may lose the pain relief and your Physician cannot simply push the electrodes back into place. You will have voided the Trial of Spinal Cord Stimulation and will have to repeat it if you want to move forward with the implantable version.
  • Another thing to look for during the Trial of Spinal Cord Stimulation is “bounce back.” Normally chronic pain patients have to rest after overexerting themselves from tasks like doing the dishes or going shopping. After going through this a number of times, they can anticipate how much time it will take for them to “bounce back.” You will be given a pain journal during the Trial of Spinal Cord Stimulation to record your observations. Please take note if you “bounce back” faster with the use of Spinal Cord Stimulation.
  • Another thing to look for is how people around you perceive you. For example, a relative or friend may look at you and tell you that your face seems more relaxed, that your mood is better, that you seem more energetic, or that your voice sounds less strained on the phone. This is important feedback to how you are doing so during your trial, be social and see the people who know you well and let them see how you are doing. They may see things you don’t about yourself.
  • It is common to have soreness at the injection site once the local anesthetic has worn off. This can be addressed with ice or cold in the first 24 hours. After that you can use heat or an anti-inflammatory such as Ibuprofen or a pain medication such as Acetaminophen. The soreness can last several days. Please consult with your Physician before making any changes in your pain medication, particularly opioid analgesics.
  • It is less common, but not unexpected to have bruising or a bump under the surface of the skin at the injection site. There are blood vessels everywhere and if the needle hit a blood vessel, it can result in a bruise (a collection of blood) which will feel tender and swollen. Over the next several days to weeks, the body will reabsorb the collection of blood. An appropriate treatment for this is ice or cold in the first 24 hours to reduce the blood flow in the area. After that you can use heat or an anti-inflammatory such as Ibuprofen or a pain medication such as Acetaminophen. The soreness will last until your body reabsorbs the collection of blood. Please consult with your Physician before making any changes in your pain medication, particularly opioid analgesics.
  • The Trial of Spinal Cord Stimulation is started on Monday. You will return on Wednesday to meet with your Physician and the Representative from the Stimulator company to check your dressing, your progress, make sure you are using the device appropriately, and to reprogram the device if necessary. Do not miss this appointment.
  • The Trial of Spinal Cord Stimulation is usually ended on Friday. Prior to coming to American Pain Institute, you must see the Physical Therapist to perform a new functional capacity evaluation to objectively measure your progress from using Spinal Cord Stimulation for 5 days. After the Physical Therapist is done, please come straight to American Pain Institute where your Physician will remove the electrodes. If there is any doubt regarding the effectiveness of Spinal Cord Stimulation, your Physician may allow you to continue the Trial through the weekend to give you more time to decide how effective it is.
  • The removal of the electrodes is quick and usually with minimal pain. The dressing is removed, the surgical glue is picked off, the stitches removed, and then the electrodes are removed. The removal of the electrodes feels creepy but is not painful. Your Physician will show you the electrodes and you will likely be surprised at how far under the skin they were! If you want to take the electrodes home, that is fine.
  • Some people are certain about how the Trial of Spinal Cord Stimulation went for them. If not, do not worry as some people need to see what happens after the Trial of Spinal Cord Stimulation is over so they can see how well they did in retrospect. If you feel confident in proceeding with the implantation, that will be arranged and will occur in about a month.
  • If you experience the following, please alert your Physician at American Pain Institute immediately: redness and pus from the region with or without fever, numbness or weakness persisting beyond 24 hours, severe headache persisting beyond 24 hours, or increased pain persisting beyond 24 hours. If you have any further concerns, please call.
Congratulations on undergoing a Platelet Rich Plasma Injection at American Pain Institute! There are a number of possible consequences to having this procedure. As always, if you have any further questions or concerns, please let us know.

  • Platelet Rich Plasma is a form of Regenerative Medicine. Whenever we are injured, our bodies possess the ability to heal and regenerate. The ability to heal and regenerate comes from our blood. Within our blood are different types of cells. There are Red Cells for carrying Oxygen. There are White Cells for fighting Infection. And there are Platelets for helping our blood to clot. But the Platelets also contain proteins which cause growth of various types of tissue: nerves, blood, cartilage. When the platelets are delivered to an area of injury, they help heal and regenerate the injured tissue. Unfortunately we are limited in our ability to heal and regenerate. If you take someone’s blood, you can put it into a centrifuge and concentrate the platelets which contain the regenerative proteins. When you inject the concentrated platelets, you deliver many times more regenerative proteins to an injured area. This dramatically augments the ability to heal and regenerate an area, using your own blood. Since your own blood is being used, there is no chance of rejection, unlike a blood transfusion from another donor. The centrifuge used at American Pain Institute is capable of turning 60cc of your blood into 3cc of Platelet Rich Plasma, an increase in concentration of 20 times normal. Other centrifuges out there increase the concentration by 4 times normal which pales in comparison. When injected into a arthritic joint, damaged nerve, torn tendon or muscle, there is an 80% chance of success. And since it is your own tissue that is being regenerated, the results should be permanent.
  • Prior to the Platelet Rich Plasma injection, you should avoid any medications or supplements which injure or destroy the platelets. Examples of such medications are NSAID’s (Ibuprofen, Ketoprofen, Ketorolac etc.). If you have any questions, consult your Physician.
  • The Platelet Rich Plasma Injection has two steps. The first step is to draw your blood. Please make sure you are well hydrated prior to coming in. Please come in at least 30 minutes prior to the time of your actual procedure. This gives us adequate time to draw your blood and to centrifuge it. The blood draw is performed with you lying down so you should not faint. Numbing medication is used for the blood draw to minimize any pain. After your blood is drawn, you will be asked to sit and wait for your turn to have your injection.
  • As we usually end up with 3cc of Platelet Rich Plasma, we can only inject up to two sites at a time. Therefore if you want both knees injected, we can accommodate that. If you want your knees and shoulders injected, we cannot do that as that would require diluting the Platelet Rich Plasma. Diluting the Platelet Rich Plasma goes against the idea of injecting the most concentrated form for optimal relief.
  • The fee per session is a flat rate. Whether you have one location or two injected, the fee is the same.
  • The injection of Platelet Rich Plasma is likewise performed under local anesthesia so the actual needle placement should be minimally painful. However when the Platelet Rich Plasma is injected, it will be painful. The reason for this is that the regenerative proteins trigger inflammation as part of the healing and regenerative process. There is no way to alter this as you have to avoid any anti inflammatory medication for a month before and after the procedure to get the best results. Yes, you have to avoid any anti inflammatory medication for a month after the injection to get the best results. If you deviate from this, you will destroy the platelets which you are relying upon to heal you.
  • You can expect to feel increased pain for several days to a week after the injection.
  • You can use Acetaminophen for pain relief as it does not affect the platelets.
  • It takes about a month to see results from the Platelet Rich Plasma injection.
  • After the first month, the Platelet Rich Plasma will continue to heal and regenerate so you may notice continued gains and improvement monthly.
  • At six months after the injection, you will know how much the Platelet Rich Plasma injection helped you as the effects end at this point.
  • Regarding duration, the Platelet Rich Plasma Injection should last until you break down or traumatize the area again. Therefore unless there has been a re injury, you should not need another injection.
  • If the first Platelet Rich Plasma injection fails, we do not recommend performing another one. If there is another part of your body which merits an injection, you can decide whether to have the Platelet Rich Plasma injection performed there.
  • It is not appropriate to perform a Platelet Rich Plasma injection on a herniated disc or bulging disc. The reason is that the herniated disc material is a solid object and the only way to get rid of it is to actually remove it via a minimally invasive procedure like Hydrodiscectomy or an open surgical procedure like Microdiscectomy. If this is something of interest to you, please inform your Physician.
  • It is common to have soreness at the injection site once the local anesthetic has worn off. This can be addressed with ice or cold in the first 24 hours. After that you can use heat or a pain medication such as Acetaminophen, but no NSAID’s. The soreness can last several days. Please consult with your Physician before making any changes in your pain medication, particularly opioid analgesics.
  • It is less common, but not unexpected to have bruising or a bump under the surface of the skin at the injection site. There are blood vessels everywhere and if the needle hit a blood vessel, it can result in a bruise (a collection of blood) which will feel tender and swollen. Over the next several days to weeks, the body will reabsorb the collection of blood. An appropriate treatment for this is ice or cold in the first 24 hours to reduce the blood flow in the area. After that you can use heat or a pain medication such as Acetaminophen. The soreness will last until your body reabsorbs the collection of blood. Please consult with your Physician before making any changes in your pain medication, particularly opioid analgesics.
  • If you experience the following, please alert your Physician at American Pain Institute immediately: redness and pus from the region with or without fever, numbness or weakness persisting beyond 24 hours. If you have any further concerns, please call.