What are the treatment options for chronic pain? An explanation of the sequence from regenerative injections to catheter intervention

A common scenario encountered in the outpatient clinic is this: joint or tendon pain has lasted for more than six months, and PRP has been administered at other clinics. It felt effective the first few times, but later the effect became shorter and shorter. The physician suggested considering surgery, but the patient does not want to undergo surgery yet.

At times like this, it is worth understanding one thing first: even if the effect of PRP is limited, it does not mean that surgery is the only path left. There are still several steps in between that can be evaluated, provided that the source of the pain is clarified first.

Why should the treatment of chronic pain be observed in several stages?

Because there is more than one stage in the source of pain, and different treatments address different aspects.
The goal of injection therapies like PRP and high-concentration dextrose is to stimulate the repair of damaged tissues, such as tendons, ligaments, and soft tissues around joints. If the pain mainly stems from damage to these tissues, injections have their purpose.

However, in areas of long-term chronic pain, in addition to tissue damage, abnormally proliferating microvessels may also appear, accompanied by new nerve endings that continuously send out pain signals. This aspect is not the target of repair-type injections, which is one of the reasons why some patients find that "injections are effective, but the effect becomes shorter and shorter."
To understand the individual factors affecting injection efficacy (blood quality, injection location, dosage, and precision of image guidance), please refer to the article on this site regarding Differences in PRP Efficacy.

Therefore, which stage to proceed to depends not on switching to a stronger injection, but on first confirming which stage the source of pain is located in.

I've tried rehabilitation, PRP, and hyaluronic acid but still feel pain. What other minimally invasive treatments are available?

Yes, and there is more than one type. However, one thing must be confirmed first in terms of order: re-confirm which stage the source of pain is in.
Pain in the same area can originate from tissue damage, nerve irritation, or abnormally proliferating microvessels. The corresponding minimally invasive treatments for these three sources are different. Only after confirming the source can the options be laid out.

Currently, non-surgical interventional treatments are roughly divided into three categories. Nerve intervention: image-guided nerve blocks, nerve hydrodissection injections, and cooled radiofrequency neurotomy address pain caused by nerve irritation or adhesion. For the application of this category in low back and leg pain, please refer to 〈Why Does Sciatica Recur?〉.
Regenerative repair injections: PRP, amniotic membrane matrix, BMAC, and PLT freeze-dried crystals address the repair of the tissue itself.
Vascular intervention: TAME (Transcatheter Arterial Microembolization) addresses abnormally proliferating microvessels in chronically inflamed tissues. This layer is evaluated only after conservative treatment and injections have been tried, and pain still persists for more than six months.

All three categories are performed under local anesthesia and do not require hospitalization. The nerve interventions and catheter-based C-TAME at Shi Clinic are both performed by Director Lu Bing-sheng. Surgery is reserved for situations with clear structural problems: obvious nerve compression, large-scale tears, or severe joint deformities.

What are the treatment choices? How is the order arranged?

Pain treatment can be roughly divided into three levels. The actual order is determined by the physician based on the examination and evaluation results, and not everyone will go through all the treatments.

The first stage is repair-type injection therapy, which involves injecting prolotherapy agents into the joint or near the damaged tissue, with the goal of assisting tissue repair. Common options include high-concentration dextrose, PRP (platelet-rich plasma), amniotic membrane matrix, BMAC (bone marrow aspirate concentrate), and PLT freeze-dried crystals. This treatment method is quite common in orthopedic and rehabilitation clinics. Which type to use and how many injections to administer are determined by the physician based on the medical condition, site, and past injection responses.

The second stage is TAME (Transcatheter Arterial Microembolization). It addresses abnormally proliferating microvessels with the goal of reducing the source of pain signals and alleviating local, persistent inflammatory states. When pain recurs and the effect of repair-type injections is limited, and imaging and examinations indicate that the pain may be related to abnormal blood vessels, TAME will be included in the evaluation list.

The third stage is surgery. When imaging shows obvious structural problems or when symptoms of impaired neurological function appear, surgery remains a necessary option. This article does not mean that surgery is bad, but rather that there is still room for evaluation and treatment before reaching the point of surgery.

What needs to be specially explained here is that these three stages are not levels to clear in a game. Some people obtain sufficient improvement in the first stage; for some, after evaluation, the source of pain is not suitable for embolization treatment, and at this time, the physician will recommend other treatment directions; there are also some who should directly consider surgery from the very beginning. The arrangement of treatment is decided by the physician based on the medical condition, imaging, and treatment feedback.

How to choose among PRP, Amniotic Membrane Matrix, and C-TAME?

First, let's make it clear that the three are not the same type of treatment method.

PRP, amniotic membrane matrix, BMAC, and PLT freeze-dried crystals all belong to repair-type injections, which are injected into the joint or near the damaged tissue, and the purpose of treatment is to repair the tissue itself.
The differences lie in the source and components: PRP is obtained from the patient's own blood; BMAC is obtained from the patient's own bone marrow, extracted and processed into a preparation by a cell company before being injected back into the joint; amniotic membrane matrix and PLT freeze-dried crystals are pre-prepared products. Which one is suitable depends on the site, the condition of the tissue, what has been injected in the past, and the feedback status after treatment.

C-TAME is another type of minimally invasive treatment method.
This minimally invasive treatment is not an injection. It is not injected into the joint. Instead, a microcatheter is guided through an artery to deliver embolization particles to the abnormally proliferating microvessels. It addresses the source of pain signals, not tissue repair. Therefore, it has a different treatment logic from the aforementioned prolotherapy; rather, they are different stages of treatment.

So, how do we arrange this in practice? For most symptoms, we start with repair-type injections because they are less invasive and do not require catheters or angiography equipment.
If you have had several injections with limited effect, and the pain has persisted for more than six months, and imaging and examinations indicate that the pain may be related to abnormal blood vessel proliferation, then TAME will enter the evaluation stage. It must be specially explained here that not everyone needs to proceed to this stage, and some people are found unsuitable after evaluation.

In addition, there is a practical difference worth understanding: repair-type injections are quite common in orthopedic and rehabilitation clinics, whereas C-TAME requires angiography equipment and catheterization techniques.
Shi Clinic utilizes the GE OEC 3D mobile C-arm with cone-beam CT (3D tomography) function, and the procedure is performed by Director Lu Bing-sheng.
As to whether the symptoms require ultrasound-guided s-TAME or catheter-based C-TAME, this is evaluated and determined by the physician based on the depth of the pain site and imaging. For the differences between the two, please see 〈What is the difference between C-TAME and s-TAME?〉.

Having received PRP or hyaluronic acid injections in the past does not affect the evaluation for TAME; the physician will judge based on current symptoms and imaging. If the pain site is the knee, please refer to 〈Still in pain after knee injections of PRP or Hyaluronic Acid? Reasons for ineffective treatment and a complete decision guide for the next step〉. People with allergies to contrast agents or poor kidney function fall into the category that needs to be evaluated by a physician first, as different approaches have different considerations.

Under what circumstances should surgery still be considered?

If imaging examinations show obvious structural compression or damage, symptoms continue to worsen after conservative and interventional treatments, or signs of impaired neurological function appear (such as muscle atrophy or obvious weakness in the lower limbs), these conditions should undergo surgical evaluation. If urinary/fecal incontinence or numbness in the perineal area occurs, these are emergency red flags; please seek medical attention immediately.

What should be prepared if I want an evaluation?

Bringing all imaging and previous medical records can save you a clinic visit.
Please bring past imaging data (X-rays, MRI, ultrasound) and treatment records to your appointment, including the types and frequencies of injections received at other clinics and your responses at that time. This information will affect the physician's judgment regarding the source of pain and the next steps.

Pre-evaluation can be conducted via LINE first, followed by scheduling a pain clinic appointment.
Shi Clinic is located at 2F-1, No. 40, Sec. 2, Heping E. Rd., Da'an Dist., Taipei City, and operates strictly by appointment. Phone: (02) 2366-0186.

Author: Dr. Lu Bing-sheng

Last updated: September 2, 2026

Disclaimer: This article is for health education information purposes and cannot replace a physician's diagnosis and treatment advice. The suitability of any treatment must be decided by a physician after evaluation.

References for Dr. Yuji Okuno's Transcatheter Arterial Microembolization (TAME) Papers:
Okuno Y, Korchi AM, Shinjo T, et al. Midterm clinical outcomes and MR imaging changes after transcatheter arterial embolization as a treatment for mild to moderate radiographic knee osteoarthritis resistant to conservative treatment. J Vasc Interv Radiol. 2017;28(7):995-1002. doi:10.1016/j.jvir.2017.02.033

Okuno Y, Iwamoto W, Matsumura N, et al. Clinical outcomes of transcatheter arterial embolization for adhesive capsulitis resistant to conservative treatment. J Vasc Interv Radiol. 2017;28(2):161-167.e1. doi:10.1016/j.jvir.2016.09.028

Iwamoto W, Okuno Y, Matsumura N, et al. Transcatheter arterial embolization of abnormal vessels as a treatment for lateral epicondylitis refractory to conservative treatment: a pilot study with a 2-year follow-up. J Shoulder Elbow Surg. 2017;26(8):1335-1341. doi:10.1016/j.jse.2017.03.026