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

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

At this point, it is worth understanding one thing: 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 viewed in multiple layers?

Because the source of pain is more than one layer, and different treatments address different hooks.
The goal of injection therapies such as 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 comes from the damage to these tissues, injections have their use.

However, in areas of long-term chronic pain, in addition to tissue damage, there may also be abnormal proliferation of microvessels, accompanied by newly formed nerve endings that continuously send pain signals. This aspect is not the target of repair-type injections, which is also one of the reasons why some patients feel "it works, 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.

So, for which layer to go, the key is not to switch to a stronger injection, but to first confirm which layer the source of pain is located in.

What are the treatment options? How are they ordered?

Pain treatment can be roughly divided into three levels. The actual sequence depends on the doctor's assessment through examination results, and not everyone will go through all the treatments.

The first level is repair-type injection therapy. In addition to PRP and high-concentration dextrose, there are other autologous or tissue-sourced preparations available for evaluation clinically, such as amniotic fluid and BMAC (bone marrow aspirate concentrate). The common direction is to assist in the repair of damaged tissues. Whether it is suitable and which one to use is determined by the physician based on the condition.

The second level is TAME (Transcatheter Arterial Micro-Embolization). It addresses abnormally proliferating microvessels, aiming to reduce the source of pain signals and alleviate local continuous inflammation. When pain recurs and the effect of repair-type injections is limited, and images and examinations show that the pain may be related to abnormal blood vessels, TAME will enter the evaluation list.

The third level is surgery. When images show significant structural problems, or symptoms of neurological impairment appear, surgery is still a necessary option. This article is not to say that surgery is bad, but rather that before reaching surgery, there is still room for evaluation and treatment in between.

It should be specially explained here that these three levels are not upgrade stages. Some people get enough improvement at the first level; for some, after evaluation, the source of pain is not suitable for embolization, at which point the doctor will recommend other treatment directions; some people should directly consider surgery from the very beginning. The arrangement of treatment is decided by the doctor based on the condition, images, and treatment feedback.

What is TAME? How is it different from injection therapy?

The difference lies in the target of treatment.
TAME (Transcatheter Arterial Micro-Embolization) selectively addresses pain-related abnormal microvessels using embolic materials, causing these vessels to shrink; repair-type injection therapy targets damaged soft tissues. The two do not replace each other but address different aspects of chronic pain.

Having received PRP or hyaluronic acid injections in the past does not affect the evaluation for TAME. The doctor will make a judgment based on current symptoms and imaging.

How to choose between C-TAME and s-TAME?

The choice depends on the depth of the pain site and whether it can be localized with ultrasound.

C-TAME (catheter-based) is performed under the guidance of angiography equipment with cone-beam CT (3D tomography) function. A microcatheter is used to deliver embolic agents to the target blood vessels for selective embolization, and a contrast agent needs to be injected during the procedure.
The equipment used at Sih-Yi is the GE OEC 3D mobile C-arm, and the treatment is completed in the in-hospital angiography operating room. It is suitable for deeper areas with more complex vascular pathways, such as the knee, hip, and shoulder.

s-TAME (simple type) is completed via fine needle injection under ultrasound guidance, without catheter insertion or contrast agent, and is suitable for superficial areas that can be clearly localized by ultrasound, such as fingers, wrists, and soles of the feet. For those allergic to contrast agents or with poor renal function, s-TAME is one of the treatment methods that can be discussed with the doctor.

Both are performed under local anesthesia in the outpatient clinic and do not require hospitalization. For a complete comparison, please see "What is the difference between C-TAME and s-TAME?".

Under what circumstances should surgery still be considered?

Imaging examinations showing significant structural compression or damage, symptoms continuing to worsen after conservative and interventional treatments, or manifestations of neurological impairment (such as muscle atrophy, obvious weakness in lower limbs) should undergo surgical evaluation. If urinary/fecal incontinence or perineal numbness occurs, it is an emergency warning sign; please seek medical attention immediately.

If I want to undergo evaluation, what should I prepare?

Bringing all images and previous medical information can save the time of one clinic visit.
Please bring past imaging data (X-ray, MRI, ultrasound) and treatment records when visiting the clinic, including the types of injections received at other clinics, the number of times, and the response at that time. This information will affect the doctor's judgment on the source of pain and the next steps.

You can first conduct a pre-evaluation through LINE, and then arrange a specialized pain clinic appointment.
Sih-Yi Clinic is located at 2F-1, No. 40, Sec. 2, Heping E. Rd., Da'an Dist., Taipei City. It operates entirely on an appointment basis, Tel: (02) 2366-0186.