Pain Awareness Month: Moving Beyond Opioids and Steroids


If you are one of the more than 50 million Americans suffering from chronic pain, you know just how debilitating it can be. More than just physical, chronic pain can profoundly impact your mental and social well-being. In fact, it’s estimated that nearly 85% of those suffering from chronic pain also suffer from depression. Unfortunately, for many patients, current interventions involve throwing steroids and opioids at the problem. These “solutions” fail to address the root of the problem, simply masking the pain without really discovering the cause. Additionally, they come with real risks. Opioids carry a high risk of addiction when used long-term, something the opioid epidemic has laid bare over the past few years. While steroids may not be addictive, emerging research demonstrates that steroids inhibit wound healing - actually slowing your body’s natural repair process. Add to that the possibility of immunosuppression with long-term steroid use- and it becomes abundantly clear that patients need different options for pain management.


More and more, patients ask me questions like, “How can I get relief without steroids?” or “What alternatives are there to opioids?” As the Director of Interventional and Integrative Pain Management at Case Integrative Health, I have one of the most extensive tool sets in the country for dealing with pain. Sometimes steroids are the answer; sometimes they are not. We provide better care by having a physician who has access to every tool available. Ultimately, the goal is to identify, isolate, and treat the causative problem. In this way, we hope you’ll achieve immediate and long-term relief- breaking the endless cycle of steroid injections and opioid prescriptions.


Here are three of the more interesting alternatives, in my judgment.


Prolozone Injections


This is one of my favorite treatments for chronic pain is prolozone therapy. Prolozone therapy is a non-surgical, non-steroid (option to include or exclude a steroid) injection. When delivered to a joint, prolozone improves oxygenation to the area. This increased oxygen helps trigger a cascading set of reactions that accelerate wound healing. In addition, prolozone injections include anti-inflammatories, vitamins, and minerals that will help ease the pain. In this way, prolozone can positively promote pain relief and joint regeneration. I use it to help patients relieve persistent and chronic body pain, arthritis, as well as tears, strains, and sprains. But, it can also be used to treat rotator cuff injuries, shoulder and elbow pain, carpal tunnel syndrome, and even degenerated spinal discs.


Ketamine Infusions


Another useful option is IV ketamine. For many years, ketamine was used to induce anesthesia in surgery, but it has a wide range of applications today- from pain management to treating depression. We’ve since moved away from ketamine as a primary surgical anesthetic, but it is still a part of the Anesthesiologist toolkit for certain surgical applications. What excites me most, however, is its non-surgical applications for pain management. Extensive studies have shown that, in lower doses titrated over a couple of hours, IV ketamine infusions are a highly effective way to relieve chronic pain, particularly for those seeking to avoid or decrease their use of opioids. Essentially, ketamine lessens pain by interacting with a chemical reactor in the nervous system called NMDA. By blocking the NMDA receptor, ketamine blocks the transmission of pain signals. Administered under the close supervision of a physician, preferably an anesthesiologist (but I’m biased), ketamine infusions typically take anywhere from 45 minutes to a few hours. While patients often report immediate relief, many also favor ketamine for its ability to produce long-lasting results. Additionally, ketamine is shown to be non-habit forming, so there is less risk than opioids. Though we don’t use ketamine to treat addictions here at CIH, several addiction centers around the country use ketamine as a way to step down from more serious narcotics without triggering dangerous withdrawal symptoms.


Platelet Rich Plasma Injections (PRP)


Finally, I want to highlight an emerging therapy called Platelet Rich Plasma, or PRP. This technique is an offshoot of research into stem cell therapy. Stem cells are the “generic” cell in the body that transforms into whatever they need to (nerves, bone, muscle, organ, etc.) The belief is that by injecting stem cells into a troubled area, we can stimulate the regrowth of a damaged area.


PRP works based on this idea. Research is proving that you may not need stem cells to trigger regeneration; the material your body needs to trigger a response is already carried in your own blood! PRP is a process by which we extract a small amount of blood and separate and concentrate the plasma which carries the material we’re looking for. Then, this platelet-rich plasma is injected back into your body at the site of injury or pain. From there, the platelets get to work, reducing inflammation and restoring you to normal function. Additionally, because PRP utilizes the patient’s own plasma, it can be coupled with other therapies within the same session. At Case Integrative Health, we are experimenting with combining PRP and prolozone to amplify the regenerative results in a joint.


Research into PRP has shown that this type of therapy can be as effective as surgery at decreasing pain and increasing joint mobility. If you’re moving down a path toward joint replacement, I encourage you to get educated on this as a potential alternative.


Chronic pain can disrupt your day-to-day routine, with far-reaching effects on every aspect of your life. However, it doesn’t have to be. By working with an integrative MD, particularly one specializing in pain management, you can return to living the life you love. Instead of resorting to steroids and opioids, invest in your long-term health. By utilizing integrative interventional pain therapies, we can decipher the source of your pain and harness your body’s own power to restore and regenerate. I look forward to going on this journey together.



In Health,


Dr. Agarwal


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